Endovascular stroke treatment is a neurointerventional emergency where the main goal is the early recanalization of the occlusion within the critical time window, as safely as possible. Although the time window and rate of complications for endovascular stroke treatment differ with anterior and posterior circulation strokes, awareness of potential periprocedural complications is important, as they affect patient morbidity and mortality. Periprocedural complications are classified as haemorrhagic complications, procedure-/device-related, puncture site complications, and late-onset events including vascular stenosis. We present the digital subtraction angiography and CT imaging findings related to these complications in a study of 56 stroke patients, as they relate to previous findings in the literature.
Recent studies have pointed out dysfunction and histopathological changes of the choroid plexuses (CPs) with aging. This paper reviews apparent diffusion coefficient (ADC) values of the CPs for age-related changes. All the brain MR images of the patients between January 2013 and June 2014 in our Radiology Department were retrospectively investigated. Patients with major cranial abnormalities (brain tumors, hyperacute or acute ischemia, developmental anomalies, hemorrhage, hydrocephaly) were excluded. Diffusion-weighted images were obtained at the parameter values of b = 1000 s/mm in the axial plane. The transverse diameters of the lateral ventricles (LVs) and ADC values of both CPs were measured. Brain MRIs of 202 individuals, 97 men (48%), 105 women (52%), were studied. There were statistically significant positive correlations between the ADC values of CP and patient ages. (Right CP: r = 0.623; p < 0.05. Left CP: r = 0.654; p < 0.05). There were positive correlations between LV diameters and age ( r = 0.624, p < 0.05 for the right LV; r = 0.621, p < 0.05 for the left LV). The ADC values of age groups significantly differed ( p < 0.05); the ≥61-year-old group was significantly higher compared to younger individuals. There is a progressive increase of water diffusivity in the CPs during aging. ADC values should be considered as a neuroimaging quantitative biomarker in normal aging-dementia syndromes.
Spontaneous Solitaire™ stent retriever detachment is a rarely defined entity seen during stroke treatment, which can result in a disastrous clinical outcome if it cannot be solved within a critical stroke treatment time window. Two solutions to this problem are presented in the literature. The first is to leave the stent in place and apply angioplasty to the detached stent, while the second involves surgically removing the stent from the location at which it detached. Here, we present a case of inadvertent stent detachment during stroke treatment for a middle cerebral artery M1 occlusion resulting in progressive thrombosis. The detached stent was removed endovascularly by another Solitaire stent, resulting in the recanalization of the occluded middle cerebral artery.
In cases of acute stroke, differentiation between an occluded and a patent internal carotid artery (ICA) is crucial for diagnosis and management. Although CT angiography (CTA) can be highly accurate in defining high-grade stenosis and ICA occlusions, misleading ICA occlusion patterns are not rare in patients with acute stroke. We investigated the underlying causes of ICA pseudo-occlusions with CTA with respect to digital subtraction angiography. 11 out of 72 patients had pseudo-occlusion on CTA. Of these, there were three cases of tandem occlusions accompanying highgrade ICA stenosis, five cases of Distal ICA bifurcation occlusion as a result of atrial fibrillation, two cases of cervical ICA dissection and one acute thrombosis of the stent. Consideration of the aforementioned aetiologies by interventionists is warranted, as it may change the planning of endovascular intervention and treatment of acute stroke.
Non-ischemic, high-flow priapism is defined as the state of painless and permanent erection of the penis which generally develops by perineal trauma. Selective transarterial embolisation is one of the treatment options. We present an 18-year-old men who had complaints of painless and permanent erection after a blunt perineal trauma. Colour Doppler ultrasound revealed a pseudoaneurysm and fistula at the left cavernosal artery. Hence autologous blood clot injection was performed to embolise the pseudoaneurysm. Due to the recanalization on the postprocedural seventh day, second embolisation was performed. One month after the second procedure, colour Doppler ultrasound revealed a 50% shrink but mild refilling in the pseudoaneurysm, whereas complete thrombus formation was observed on follow-up imaging. His priapism had fully recovered and erectile functions were totally normal at the six months and one year follow up. Autologous blood clot embolisation seems as a safe and successful treatment.
Objective: Mastalgia is the most frequent symptom seen in patients who undergo breast imaging. There are various medical treatment methods in the literature. However, malignancy should be excluded before starting treatment. This is a prospective study, evaluating the necessity of imaging in patients who have applied for cyclic or non-cyclic breast pain, with normal physical examination, and without a family history. Material and Methods:Two hundred women, younger than 30 years of age, who applied to Iğdır State Hospital general surgery department with complaint of cyclic or non-cyclic breast pain, were prospectively studied. Patients with nipple discharge, complaint of lump in their breast, who were pregnant or lactating, who had breast cancer history in their family and those who were found to have lumps on examination were excluded from the study. All patients underwent ultrasound imaging and the same radiologist evaluated them. Results:The breast examination was normal in all patients. Ultrasound imaging results were completely normal in 98 (48%) patients. 47 (23.5%) patients were found to have fibroadenoma, with a mean diameter of 9.6 mm (5 mm-14 mm). 45 (22.5%) patients had simple cysts with a mean diameter of 7.8 mm (3 mm-11 mm). 6 (3%) patients were found to have intraductal papillomas and 4 (2%) to have lipomas. All patients were classified as either BI-RADS 1 or BI-RADS 2. Conclusion:It is recommended that malignancy should be eliminated before starting treatment in patients with breast pain. In this study, the necessity of imaging in patients younger than 30 years and who applied to the general surgery department for only breast pain, was investigated. None of the patients with a normal breast examination were found to have any lesions considered suspicious for malignancy. We believe that if breast examination is normal, the patient is equal to or younger than 30 years of age and there is no family history, imaging is not necessary and that medical therapy can be started directly after the patient is informed.
Dissection of the internal carotid artery (ICA) is a rare condition that accounts for a significant proportion of ischemic strokes in young adults. Iatrogenic dissection as a complication of neurointerventional procedures is a traumatic dissection which has been reported relatively rare in the literature. In this report, a case of dissection of the ICA is reported that was caused by repetitive movement of the balloon guiding catheter during stent-assisted thrombectomy (SAT), resulting in occlusion of the ICA.
Background Ifosfamide (IFO) is an alkylating agent used to treat broad range of malignancies. One of the life-threatening toxic effects is reversible neurotoxicity. In this report; we presented a case report of ifosfamide induced encephalopathy (IIE) in a child with osteosarcoma in order to emphize that it is important to continue ifosfamide treatment as well as the importance of this potentially fatal complication. Case report Following the 20th week of ifosfamide treatment, the patient's follow-up with the diagnosis of osteosarcoma developed neurological findings. Laboratory analyzes before and after ifosfamide infusion were normal. No pathological findings were seen on MR imaging. Hypoglycemia, electrolyte disturbances, encephalitis, meningitis, metastasis and posterior reversible encephalopathy syndrome (PRES) were not considered. Electroencephalography was found compatible with neuronal hyperexcitability originating from the left hemisphere. With the diagnosis of ifosfamide induced encephalopathy, prophylaxis with methylene blue was received before the next infusion of ifosfamide. Neurological findings were not observed in the patient's follow-up. Conclusion Patients who develop IIE can continue their treatment protocol with methylene blue prophylaxis and supportive therapy.
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