“…With MMD progression, the Suzuki grade will become high, which gives more time to aneurysm growth. In Sun et al’s 14 report of MMD-associated aneurysms, Suzuki grades of III–V accounted for more than 70%. In our study, Suzuki grades of III–V accounted for 94.3%.…”
Section: Discussionmentioning
confidence: 98%
“…13 Therefore, the close follow-up was necessary. 14 However, in the real world, most aneurysms in MMD cannot be found until they rupture. In the current study, 82.9% of aneurysms were ruptured because regular physical examination was not common in China, and these aneurysms were not found until they had ruptured.…”
Section: Discussionmentioning
confidence: 99%
“…By searching PubMed, the report contained more cases than other previous reports. 3,[9][10][11][12][13][14]…”
Background Main trunk aneurysms in the residual anterior circulation in moyamoya disease (MMD) are uncommon, and in such cases, endovascular treatment (EVT) is a good choice. Materials and methods A retrospective study was performed on 35 consecutive patients admitted to our hospital who were diagnosed with MMD and main trunk aneurysms in the residual anterior circulation and were treated with EVT. Result The 35 patients were aged 38–77 years (mean, 56.1 ± 8.8 years) and included 17 females (48.6%, 17/35). There were 29 cases (82.9%, 29/35) of hemorrhagic onset. In 35 patients, there were 38 main trunk aneurysms in the residual anterior circulation. Thirty-eight aneurysms underwent coiling; among them, coiling with stent assistance was used in the treatment of 6 (15.8%, 6/38) aneurysms. The immediate modified Raymond-Roy classification (MRRC) was grade I for all aneurysms. Among 35 patients, intraoperative bleeding occurred in 2 (5.7%, 2/35) patients. After EVT, immediate hemiplegia occurred in 4 (11.4%, 4/35) patients, and immediate coma occurred in 1 (2.9%, 1/35) patient. At discharge, in 35 patients, the Glasgow Outcome Scale (GOS) was five in 88.6% of them. Of 35 patients, 68.6% had follow-up data, GOS was five in 87.5% patients, and the MRRC was grade I for all aneurysms in the follow-up angiography. Conclusion For main trunk aneurysms in the residual anterior circulation in MMD, although EVT was accompanied by potential ischemic and hemorrhagic complications, which should be considered, EVT can still offer an acceptable prognosis in more than 85% of patients.
“…With MMD progression, the Suzuki grade will become high, which gives more time to aneurysm growth. In Sun et al’s 14 report of MMD-associated aneurysms, Suzuki grades of III–V accounted for more than 70%. In our study, Suzuki grades of III–V accounted for 94.3%.…”
Section: Discussionmentioning
confidence: 98%
“…13 Therefore, the close follow-up was necessary. 14 However, in the real world, most aneurysms in MMD cannot be found until they rupture. In the current study, 82.9% of aneurysms were ruptured because regular physical examination was not common in China, and these aneurysms were not found until they had ruptured.…”
Section: Discussionmentioning
confidence: 99%
“…By searching PubMed, the report contained more cases than other previous reports. 3,[9][10][11][12][13][14]…”
Background Main trunk aneurysms in the residual anterior circulation in moyamoya disease (MMD) are uncommon, and in such cases, endovascular treatment (EVT) is a good choice. Materials and methods A retrospective study was performed on 35 consecutive patients admitted to our hospital who were diagnosed with MMD and main trunk aneurysms in the residual anterior circulation and were treated with EVT. Result The 35 patients were aged 38–77 years (mean, 56.1 ± 8.8 years) and included 17 females (48.6%, 17/35). There were 29 cases (82.9%, 29/35) of hemorrhagic onset. In 35 patients, there were 38 main trunk aneurysms in the residual anterior circulation. Thirty-eight aneurysms underwent coiling; among them, coiling with stent assistance was used in the treatment of 6 (15.8%, 6/38) aneurysms. The immediate modified Raymond-Roy classification (MRRC) was grade I for all aneurysms. Among 35 patients, intraoperative bleeding occurred in 2 (5.7%, 2/35) patients. After EVT, immediate hemiplegia occurred in 4 (11.4%, 4/35) patients, and immediate coma occurred in 1 (2.9%, 1/35) patient. At discharge, in 35 patients, the Glasgow Outcome Scale (GOS) was five in 88.6% of them. Of 35 patients, 68.6% had follow-up data, GOS was five in 87.5% patients, and the MRRC was grade I for all aneurysms in the follow-up angiography. Conclusion For main trunk aneurysms in the residual anterior circulation in MMD, although EVT was accompanied by potential ischemic and hemorrhagic complications, which should be considered, EVT can still offer an acceptable prognosis in more than 85% of patients.
“…In clinical practice, the flow rate in cerebral arteries is commonly altered with cerebral blood flow (CBF), defined as the blood volume that flows per unit volume per unit time in brain tissue. In a cohort of 310 Moyamoya patients, regional CBF measured with perfusion-CT was lower in patients with IAs [ 44 ]. Knowing that the flow rate of parent arteries is majorly determined by the CoW configuration, the above-mentioned findings suggested a promising association between parent artery hemodynamics and IA.…”
Background: The role of regional hemodynamics in the intracranial aneurysmal formation, growth, and rupture has been widely discussed based on numerical models over the past decades. Variation of the circle of Willis (CoW), which results in hemodynamic changes, is associated with the aneurysmal formation and rupture. However, such correlation has not been further clarified yet. The aim of this systematic review is to investigate whether simulated hemodynamic indices of the CoW are relevant to the formation, growth, or rupture of intracranial aneurysm. Methods: We conducted a review of MEDLINE, Web of Science, and EMBASE for studies on the correlation between hemodynamics indices of the CoW derived from numerical models and intracranial aneurysm up to December 2020 in compliance with PRISMA guidelines. Results: Three case reports out of 1046 publications met our inclusion and exclusion criteria, reporting 13 aneurysms in six patients. Eleven aneurysms were unruptured, and the state of the other two aneurysms was unknown. Wall shear stress, oscillatory shear index, von-Mises tension, flow velocity, and flow rate were reported as hemodynamic indices. Due to limited cases and significant heterogeneity between study settings, meta-analysis could not be performed. Conclusion: Numerical models can provide comprehensive information on the cerebral blood flow as well as local flow characteristics in the intracranial aneurysm. Based on only three case reports, no firm conclusion can be drawn regarding the correlation between hemodynamic parameters in the CoW derived from numerical models and aneurysmal formation or rupture. Due to the inherent nature of numerical models, more sensitive analysis and rigorous validations are required to determine its measurement error and thus extend their application into clinical practice for personalized management. Prospero registration number: CRD42021125169.
“…In patients with unilateral findings, arteriopathy often progresses to bilaterality in 15–30% of patients [ 38 ]. Cerebral aneurysms may occur in up to 14% of patients [ 39 ], with a high rate of rupture [ 40 ]. Fig.…”
Purpose of Review
Uncommon causes of stroke merit specific attention; when clinicians have less common etiologies of stoke in mind, the diagnosis may come more easily. This is key, as optimal management will in many cases differs significantly from “standard” care.
Recent Findings
Randomized controlled trials (RCT) on the best medical therapy in the treatment of cervical artery dissection (CeAD) have demonstrated low rates of ischemia with both antiplatelet and vitamin K antagonism. RCT evidence supports the use of anticoagulation with vitamin K antagonism in “high-risk” patients with antiphospholipid antibody syndrome (APLAS), and there is new evidence supporting the utilization of direct oral anticoagulation in malignancy-associated thrombosis. Migraine with aura has been more conclusively linked not only with increased risk of ischemic and hemorrhagic stroke, but also with cardiovascular mortality. Recent literature has surprisingly not provided support the utilization of
l
-arginine in the treatment of patients with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS); however, there is evidence at this time that support use of enzyme replacement in patients with Fabry disease. Additional triggers for reversible cerebral vasoconstriction syndrome (RCVS) have been identified, such as capsaicin. Imaging of cerebral blood vessel walls utilizing contrast-enhanced MRA is an emerging modality that may ultimately prove to be very useful in the evaluation of patients with uncommon causes of stroke. A plethora of associations between cerebrovascular disease and COVID-19 have been described. Where pertinent, authors provide additional tips and guidance.
Summary
Less commonly encountered conditions with updates in diagnosis, and management along with clinical tips are reviewed.
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