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Total 291 results found since Jan 2013.

Polycystic kidney disease among 4,436 intracranial aneurysm patients from a defined population
Conclusions: Subarachnoid hemorrhage occurs at younger age and from smaller IAs in patients with ADPKD and risk for de novo IAs is higher than in the general Eastern Finnish population. ADPKD should be considered as an indicator for long-term angiographic follow-up in patients with diagnosed IAs.
Source: Neurology - October 30, 2017 Category: Neurology Authors: Nurmonen, H. J., Huttunen, T., Huttunen, J., Kurki, M. I., Helin, K., Koivisto, T., von und zu Fraunberg, M., Jääskeläinen, J. E., Lindgren, A. E. Tags: Stroke in young adults, Cohort studies, Subarachnoid hemorrhage, All Genetics ARTICLE Source Type: research

Teaching NeuroImages: Artery of Percheron thrombosis causing selective downgaze palsy
A 47-year-old man with migraines presented with sudden onset of vertical diplopia, dysarthria, right facial weakness, and downgaze palsy (figure 1). Brain MRI revealed ischemic strokes in the midbrain periaqueductal gray, bilateral thalamic–midbrain junction, and thalamus (figure 2, A–C). Gradient echo and T1 MRI showed hypointensity in the interpeduncular fossa (figure 2, D and E). No flow could be visualized in this structure on CT angiogram or catheter angiogram, demonstrating a thrombosed artery of Percheron (figure 2, F–H). Downgaze palsy, which improved 18 months later, may result from bilateral les...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Sechler, M., Singh, J., El Husseini, N. Tags: MRI, DWI, All Cerebrovascular disease/Stroke, Infarction RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: Giant cell arteritis presenting with acute ischemic strokes due to diffuse intracranial stenoses
A 72-year-old woman with unremarkable medical history was admitted with acute ischemic strokes (AIS) in multiple arterial distributions in anterior and posterior circulation (figure 1A and supplemental data at Neurology.org). Elevated erythrocyte sedimentation rate (98 mm/h) prompted the evaluation of superficial temporal arteries (STA) with duplex sonography (halo sign; figure 1B) and contrast angiography (right STA [figure 2A] and multiple intracranial arterial stenoses [figure 2, A–D]). STA biopsy confirmed the diagnosis of giant cell arteritis (GCA; figure 1, C and D).
Source: Neurology - October 9, 2017 Category: Neurology Authors: Kargiotis, O., Safouris, A., Petrou, V. N., Magoufis, G., Stamboulis, E., Tsivgoulis, G. Tags: MRI, Ultrasound, Vasculitis, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: RCVS causing simultaneous convexity subarachnoid hemorrhage and hemimedullary infarction
A 34-year-old previously healthy man presented with thunderclap headache, dysphagia, dysarthria, and oscillopsia. Neurologic examination revealed right-beating nystagmus, dysphagia, hypophonia, right hemianesthesia, and left hemiparesis. Brain imaging showed convexity subarachnoid hemorrhage (figure 1A) and left hemimedullary infarct (figure 1B). Catheter angiography showed tapering of left vertebral artery and diffuse segmental vasoconstriction (figure 2). Routine serum and CSF results were unremarkable. Thorough infectious, immunologic, and coagulopathy workup was negative. Reversible cerebral vasoconstriction syndrome (...
Source: Neurology - September 18, 2017 Category: Neurology Authors: Selvan, P., Levine, S. R. Tags: Stroke in young adults, Other cerebrovascular disease/ Stroke, All Cerebrovascular disease/Stroke, Infarction, Subarachnoid hemorrhage RESIDENT AND FELLOW SECTION Source Type: research

Intra-arterial milrinone may differentiate fulminant RCVS from vasculitis
A 39-year-old woman taking a monoamine oxidase inhibitor presented with a 1-week history of severe non-thunderclap headache and visual field deficits. Brain CT showed infarcts in both parietal lobes, with narrowing of intracranial vessels on CT angiogram (figure 1), suggesting either vasculitis or reversible cerebral vasoconstriction syndrome (RCVS). Despite treatment with both methylprednisolone and nimodipine, she experienced progressive aphasia and right leg weakness. She underwent an urgent cerebral angiogram (figure 2), during which intra-arterial milrinone reversed both the vasoconstriction and its symptoms, thereby ...
Source: Neurology - September 4, 2017 Category: Neurology Authors: Laneuville, M., Ding, J., Shamy, M., Lum, C., Dowlatshahi, D. Tags: All Headache, Other cerebrovascular disease/ Stroke NEUROIMAGES Source Type: research

Teaching NeuroImages: Artery of Percheron aneurysm masquerading as ICH spot sign
A 50-year-old Japanese woman presented with left thalamic intracerebral hemorrhage (ICH). CT angiography demonstrated an ICH spot sign and intracranial vasculopathy consistent with Moyamoya disease (figure 1). Conventional angiography demonstrated that the spot sign was actually a pseudoaneurysm arising from the artery of Percheron (figure 2). Intracranial aneurysms may complicate Moyamoya disease and occur at the circle of Willis, distal peripheral arteries, or Moyamoya vessels at a ratio of 3:1:1.1 Aneurysms in thalamo-perforating arteries are rare2 and an artery of Percheron aneurysm in Moyamoya disease has not been rep...
Source: Neurology - August 7, 2017 Category: Neurology Authors: Moughamian, A. J., Morshed, R. A., Colorado, R. A., Liner, Z., Cooke, D., Hemphill, J. C. Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage RESIDENT AND FELLOW SECTION Source Type: research

Determining the optimal target blood pressure after thrombectomy: High or low?
The management of patients with acute ischemic stroke has changed dramatically with modern mechanical thrombectomy (MT) techniques and improved patient selection using CT angiography.1 Although the benefit of early recanalization in large vessel occlusion (LVO) seems clear, the optimal periprocedural management remains uncertain. Unresolved issues include the method of analgesia and sedation, reversal and application of adjunctive periprocedural anticoagulation, glycemic control, ventilatory management, and perhaps most important, blood pressure (BP) control.
Source: Neurology - August 7, 2017 Category: Neurology Authors: Wartenberg, K. E., Mayer, S. A. Tags: EDITORIALS Source Type: research

Teaching NeuroImages: Abnormal cervical and cerebral vasculature in 22q11 deletion syndrome
A 12-day-old girl with a postnatal microarray diagnosis of 22q11.2 deletion syndrome was transferred for surgical repair of truncus arteriosus. Neurologic examination at the time of transfer was unremarkable. Brain MRI on day of life 9 demonstrated an absent left internal carotid flow void. Magnetic resonance angiography of the head (figure, A) and neck (figure, B) was subsequently obtained prior to cardiac repair. Patients with 22q11 deletion syndromes may have abnormal cervical vessel development.1 Children with congenital heart disease have an elevated stroke risk, particularly for periprocedural stroke.2 Understanding ...
Source: Neurology - July 3, 2017 Category: Neurology Authors: Mithal, D. S., Kurz, J. E. Tags: All Cerebrovascular disease/Stroke, Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke, All Genetics RESIDENT AND FELLOW SECTION Source Type: research

Tenecteplase in ischemic stroke offers improved recanalization: Analysis of 2 trials
Conclusions: Tenecteplase may offer greater recanalization efficacy compared to alteplase, possibly exaggerated in patients with complete vessel occlusions on baseline CTA.
Source: Neurology - July 3, 2017 Category: Neurology Authors: Bivard, A., Huang, X., Levi, C. R., Spratt, N., Campbell, B. C. V., Cheripelli, B. K., Kalladka, D., Moreton, F. C., Ford, I., Bladin, C. F., Davis, S. M., Donnan, G. A., Muir, K. W., Parsons, M. W. Tags: CT, MRI, All Cerebrovascular disease/Stroke, Infarction ARTICLE Source Type: research

Proatlantal intersegmental artery with internal carotid artery stenosis
A 56-year-old man presented with vertigo of 4 days duration. Neurologic examination was unremarkable. CT angiograms revealed a right internal carotid artery (ICA) stenosis and an ipsilateral proatlantal intersegmental artery (PIA, type 1). The PIA arose from the ICA, ran upward, then took a dorsal course, and continued as the vertebral artery, serving as the major contributor of the posterior circulation (figure, A–C). Catheter-based angiogram showed ICA stenosis of 60% (figure, D). He chose drug therapy and remained asymptomatic on follow-up. Such combination can lead to TIA of the vertebrobasilar system; treatment ...
Source: Neurology - July 3, 2017 Category: Neurology Authors: Yu, W., Feng, Z., Zhao, C., Fu, C. Tags: CT, All Clinical Neurology, All Cerebrovascular disease/Stroke NEUROIMAGES Source Type: research

Teaching NeuroImages: Takayasu arteritis: Neuroimaging progression after immunosuppressant treatment
A 29-year-old woman presented with a 2-year history of heel pain, constitutional symptoms, and increased acute phase reactants. CT and magnetic resonance (MR) angiography revealed a thickening of aortic walls and a thread-like appearance of bilateral subclavian and common carotid arteries. The findings were consistent with Takayasu arteritis (TA)1 and the patient was prescribed methylprednisolone, followed by azathioprine. Follow-up MR angiography, 6 years later, showed an important improvement with only a mild luminal narrowing of both common carotid arteries (figures 1 and 2, A and B). TA is a large-artery inflammatory d...
Source: Neurology - May 15, 2017 Category: Neurology Authors: Martinez Rodriguez, L., Caminal Montero, L., Pena Suarez, J., Garcia-Cabo Fernandez, C., Calleja Puerta, S. Tags: MRI, Vasculitis, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research

Predicting growth of brain aneurysms
In their article "The ELAPSS score for prediction of risk of growth of unruptured intracranial aneurysms," Backes et al.1 developed a risk score for aneurysm growth. They followed 1,507 people who had 1,909 unruptured intracranial aneurysms (some people had more than 1 aneurysm). The patients were from several medical centers around the world: Canada, the Netherlands, Finland, China, and Japan. They were all over 18 years old. Their aneurysms were followed by several types of imaging: some centers used MRI, while others used CT angiography, or calibrated digital subtraction angiography. The local doctor decided how of...
Source: Neurology - April 24, 2017 Category: Neurology Authors: Karceski, S. Tags: Stroke prevention, Other cerebrovascular disease/ Stroke, All Cerebrovascular disease/Stroke PATIENT PAGES Source Type: research

A rare cause of stroke in young: PHACE syndrome (P1.253)
Conclusions:Neurocutaneous syndromes are typically diagnosed in childhood and can be a rare cause of stroke in young. Our patient suffered an ischemic stroke secondary to sequelae of undiagnosed PHACE syndrome. Early identification of neurocutaneous syndromes allows for proper surveillance, evaluation, and preventative education for development of complications.Disclosure: Dr. Fitzgerald has nothing to disclose. Dr. Chandra has nothing to disclose. Dr. Dannenbaum has nothing to disclose. Dr. Sharrief has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Fitzgerald, K., Chandra, S., Dannenbaum, M., Sharrief, A. Tags: Genetic Stroke Syndromes, Biomarkers, and Translational/Basic Research Source Type: research

Evaluation and Validation of Prehospital Acute Stroke Scale to Predict Large Vessel Occlusion in Patients with Proven Large Vessel Occlusion- Single Center study in US (P1.274)
Conclusions:The PASS tool is simple, quick, and easy to perform and has high sensitivity in AIS patients with LVO. To assess its value and efficacy in real time it should be implemented into EMS systems and be performed in the pre-hospital setting.Disclosure: Dr. E-Ghanmh has nothing to disclose. Dr. Niazi has nothing to disclose. Dr. Reichwein has nothing to disclose. Dr. Ermak has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: El-Ghanem, M., Niazi, M., Reichwein, R., Ermak, D. Tags: Pre-Hospital Stroke, Tele-Stroke, and mHealth Source Type: research

Hyperacute Carotid Stenting for Acute Ischemic Stroke After Systemic Thrombolysis with IV rt-PA (P1.282)
Conclusions:These 2 cases demonstrate a successful use of hyperacute carotid stenting and antiplatelet load in patients who received systemic thrombolysis with IV rt-PA. Both had excellent outcomes and no complications. This management may be considered in patients with similar clinical and imaging characteristics.Disclosure: Dr. Marulanda-Londoño has nothing to disclose. Dr. DeLeon-Bendetti has nothing to disclose. Dr. Ortiz has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Marulanda-Londono, E., DeLeon-Bendetti, A., Ortiz, G. Tags: Cerebrovascular Disease Case Reports I Source Type: research