Background Aneurysm formation of internal carotid arteries (ICA) in patients with mucormycosis is a scarce phenomenon. However, the prevalence of rhino-cerebral mucormycosis has been reported to increase after the coronavirus disease 2019 (COVID-19) pandemic. Methods Three patients with stroke and subarachnoid hemorrhage due to ICA aneurysm after the involvement of adjacent paranasal sinuses with mucormycosis were presented. All patients were recruited from Namazi and Khalili hospitals affiliated with Shiraz University of Medical Sciences in Iran from April 2021 to May 2021. Results They had a history of diabetes and corticosteroid use. Also, one of them was treated with imatinib. Two out of three patients were infected with SARS-CoV-2 infection before developing mucormycosis. Two patients had diagnostic angiography before endovascular intervention. One patient did not undergo any therapeutic intervention due to total artery occlusion, whereas the other patient experienced a successful parent artery occlusion by coiling, and only this patient survived. Although all patients received antifungal treatment and surgical debridement, two of them died. Conclusions In the patients with rhino-cerebral mucormycosis evolving of aneurysm should be promptly and meticulously investigated by magnetic resonance angiography (MRA) and computed tomography angiography (CTA). As this type of aneurysms was very fast-growing, as soon as the involvement of sphenoid sinus was detected, the possibility of ICA aneurysm formation should always be kept in mind. If the patient developed an aneurysm, prompt intensive antifungal therapy and therapeutic endovascular interventions such as stenting, coiling, or sacrificing should be considered as soon as possible to optimize outcomes.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the respiratory system but can also lead to neurological complications. Among COVID-19 patients, the endothelium is considered the Achilles heel. A variety of endothelial dysfunctions may result from SARS-CoV-2 infection and subsequent endotheliitis, such as altered vascular tone, oxidative stress, and cytokine storms. The cerebral hemodynamic impairment that is caused is associated with a higher probability of severe disease and poor outcomes in patients with COVID-19. This review summarizes the most relevant literature on the role of vasomotor reactivity (VMR) in COVID-19 patients. An overview of the research articles is presented. Most of the studies have supported the hypothesis that endothelial dysfunction and cerebral VMR impairment occur in COVID-19 patients. Researchers believe these alterations may be due to direct viral invasion of the brain or indirect effects, such as inflammation and cytokines. Recently, researchers have concluded that viruses such as the Human Herpes Virus 8 and the Hantavirus predominantly affect endothelial cells and, therefore, affect cerebral hemodynamics. Especially in COVID-19 patients, impaired VMR is associated with a higher risk of severe disease and poor outcomes. Using VMR, one can gain valuable insight into a patient’s disease progression and make more informed decisions regarding appropriate treatment options. A new pandemic may develop with the COVID-19 virus or other viruses, making it essential that healthcare providers and researchers remain focused on developing new strategies for improving survival in such patients, particularly those with cerebrovascular risk factors.
Delayed cerebral ischemia (DCI) or vasospasm following transsphenoidal surgery (TSS) is a life-threatening and life-altering event that could potentially cause devastating complications, neurological morbidity, and high mortality. Herein, we report the case of a 16-year-old woman without a marked medical history and unusual complications after TSS for pituitary adenoma resection who developed cerebral vasospasm and infarction after TSS. To the best of our knowledge, this is the first case involving a patient under 18 years old and requiring thrombectomy after TSS. Additionally, we present our review of published case reports to underline the most often presentation characteristics, the interval between TSS and vasospasm, and therapeutic management. With respect to our case, we analyzed 27 cases of TSS complicated by symptomatic vasospasm. We include only pituitary adenoma resection and exclude other causes. The mean age was 47.33 ± 15.22 years at the time of surgery, and the male-to-female ratio was roughly equal among cases (female: 51.9%). Following surgery, 85.2% of patients experienced subarachnoid hemorrhage (SAH), and 22.3% experienced cerebrospinal fluid (CSF) leakage. The mean clinical presentation time of vasospasm ranged from 3 to 13 (mean: 7.5 ± 2.6) days after TSS. At discharge, 51.8% of cases at least had one neurologic complication, including six dead patients (18.5%). A high index of suspicion for vasospasm has been recommended because of the diverse symptoms of this rare condition and the high mortality rate.
Background: Dietary patterns play an essential role in vascular diseases; however, the association of specific dietary patterns and the risk of stroke is unknown. We designed the current study to evaluate several dietary patterns and their association with ischemic stroke. Materials and Methods: This case-control study was performed on 300 subjects, including 150 cases with ischemic stroke admitted to a tertiary referral center in Shiraz, Southern Iran, and 150 age- and sex-matched stroke-free individuals as controls. Using a 62-item Simple Stroke Food Frequency Questionnaire (SS-FFQ), we collected data regarding the dietary habits of all the participants. We extracted the major dietary patterns via principal component analysis using the varimax rotation technique with Kaiser Normalization. Finally, adherence to dietary patterns among the participants was divided into quartiles. We investigated the association between dietary patterns and ischemic stroke using multiple logistic regression analyses. Results: One-hundred and fifty ischemic stroke patients (91 males and 59 females, mean age of 63.9±16.04 years) and 150 age- and sex-matched controls (91 males and 59 females, mean age of 61.99±16.04 years) were included. After adjusting five major dietary patterns for vascular risk factors, we found that diets rich in fibers and plant-based proteins (P<0.001) and micronutrients (P<0.001) had a lower odds of ischemic stroke as compared to high-fat proteins (P=0.003) and empty calories (P<0.001) diets, but consuming healthy animal proteins (P=0.115) had no effects on the occurrence of ischemic stroke. Conclusion: Based on our study, we suggest that fibers and plant-based proteins, and micronutrient diets could reduce the odds of stroke, so public awareness about the effects of different dietary patterns should be raised.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.