Recurrent neurovascular hypertension: MR findings before and after surgical treatments.
(65/642)
A case of recurrent brain stem edema after surgical vascular decompression in a patient with neurogenic hypertension is presented. The surgical treatment resulted in occlusion of the left vertebral artery, stable blood pressure values, and no recurrence of the brain stem edema. MR imaging and MR angiography are excellent methods with which to assess patients suspected of having neurovascular hypertension, both before and after surgical treatment. (+info)
Cervical myelopathy due to compression by bilateral vertebral arteries--case report.
(66/642)
A 69-year-old man presented with progressive cervical myelopathy due to vascular compression of the upper cervical spinal cord. Vertebral angiography and magnetic resonance imaging revealed that the elongated bilateral vertebral arteries (VAs) had compressed the spinal cord at the C-2 level. The spinal cord was surgically decompressed laterally by retracting the VAs with Gore-Tex tape and anchoring them to the dura. The patient's symptoms improved postoperatively. Decompression and anchoring of the causative vessels is recommended due to the large size of the VAs. (+info)
Global ischemia induces expression of acid-sensing ion channel 2a in rat brain.
(67/642)
Acid-sensing ion channels (ASICs) are ligand-gated cation channels that respond to acidic stimuli. They are expressed throughout the mammalian nervous system. In the peripheral nervous system, ASICs act as nociceptors, responding to the tissue acidosis that accompanies ischemic and inflammatory conditions. The function of ASICs in the central nervous system is not known. In this article, the authors present evidence that transient global ischemia induces ASIC 2a protein expression in neurons that survive ischemia. Western blot analysis with an anti-ASIC 2a antibody revealed up-regulation of an 80 kD protein in ischemic rat brain. Immunohistochemical analysis showed that ASIC 2a protein expression increased in neurons of the hippocampus and cortex. Klenow fragment-mediated labeling of DNA strand breaks determined that ASIC 2a induction did not occur in cells with detectable DNA damage. The current results suggest a possible role for ASICs in mediating a cellular response to ischemia. (+info)
Analysis of intellectual and cognitive performance in patients with multi-infarct dementia, vertebrobasilar insufficiency with dementia, and Alzheimer's disease.
(68/642)
A prominent feature in dementia is intellectual deterioration. Review of the clinical literature indicates a lack of suitably quantitated studies of specific intellectual defects in dementia. The present study investigated the performance of patients with multi-infarct dementia (MID), dementia due to Alzheimer's disease (AD), and vertebrobasilar insufficiency (VBI) with dementia using the Wechsler Adult Intelligence Scale (WAIS). Forty-two patients ranging in age from 45 to 85 years (x 66) were included. Significant differences in cognitive and intellectual performance were found between patients with dementia due to VBI and MID versus neuronal atrophy of the Alzheimer's type. The group with AD performed significantly and consistently lower on all measures. There were no significant differences between the two cerebrovascular disease groups, even though the MID group performed consistently more poorly than the VBI group. A discriminant function analysis classified 74% of the patients correctly based on the individual WAIS scores. The diagnosis was more easily made when tasks measuring visual motor coordination and abstract reasoning were included in the analysis. (+info)
Role of cerebral angiography in vertebrobasilar occlusive disease.
(69/642)
The authors attempt to separate clinical subgroups of patients within the larger category of vertebrobasilar artery disease, and to indicate the present role of angiography in their recognition and management. Angiography is of use in separating posterior fossa occlusive vascular lesions from space occupying lesions. In addition, by defining the locus and nature of the occlusive process, it may result in more rational treatment and prognostication. Subgroups of vertebrobasilar ischaemia which have a favourable prognosis may be separable clinically or, in unclear cases, angiographically. (+info)
Posterolateral tunnels and ponticuli in human atlas vertebrae.
(70/642)
The posterolateral tunnel on the superior surface of the first cervical (atlas) vertebra is of normal occurrence in monkeys and other lower animals, but its presence in the form of a tunnel-like canal, for the passage of the third part of the vertebral artery over the posterior arch of the human atlas vertebra is not reported. The aim of the present study was to detect the presence of such a canal, in addition to other types of ponticuli (little bridges) reported by earlier investigators, in macerated atlas vertebrae and routine cadaveric dissections. The posterolateral tunnel was detected in 1.14%, and the posterior and lateral ponticuli in 6.57 and 2% of vertebrae. Probably the bony roof of the posterolateral tunnel serves the purpose of additional lateral extension for the attachment of the posterior atlanto-occipital membrane in quadrupeds, where the load of the head is supported by the extensor muscles of the neck, ligaments and posterior atlanto-occipital membrane. In man, where the weight of the head is borne by the vertical loading of the superior articular process of the atlas, the roof of the tunnel has disappeared. (+info)
Contrast-enhanced magnetic resonance angiography of the cervical vessels: experience with 422 patients.
(71/642)
BACKGROUND AND PURPOSE: Contrast-enhanced magnetic resonance angiography (CEMRA) permits acquisition of high-spatial-resolution, venous-suppressed, 3D MR angiograms of the cervical carotid and vertebral arteries. In this study, an elliptic centric-view ordering with either MR fluoroscopic triggering or test bolus timing was used. The use of CEMRA of the cervical vessels has changed our clinical practice and is replacing conventional angiography for the evaluation of most carotid and vertebral artery diseases. METHODS: We retrospectively reviewed our experience with the use of CEMRA performed in 422 patients from January through December 1999. RESULTS: CEMRA was performed to evaluate transient ischemic attack and ischemic stroke in 239 patients, asymptomatic carotid bruit in 88 patients, and other neurological symptoms in 95 patients. Carotid endarterectomies were performed in 97 patients (103 procedures), and conventional angiography was performed in 12 of these patients. CEMRA was used to evaluate for the presence of an arterial dissection in 85 of the 239 patients with transient ischemic attack and ischemic stroke. Of this group, 32 patients had cervical arterial dissection, and pseudoaneurysm was detected in 11 of these patients. Compared with ultrasonography of the cervical vessels, CEMRA provided additional information in 43 of 422 patients and led to changes in the decision as to whether to perform carotid endarterectomy in 5 patients. CONCLUSIONS: Use of CEMRA permits noninvasive evaluation of patients suspected of having carotid or vertebral disease and avoids the potential complications of conventional angiography. (+info)
Aneurysmal rupture during embolization with Guglielmi detachable coils: causes, management, and outcome.
(72/642)
BACKGROUND AND PURPOSE: Aneurysmal rupture during endovascular treatment is one of the most feared complications of endovascular aneurysm therapy. The purpose of this study was to determine the frequency, causes, management, and outcome of aneurysmal rupture that occurred during treatment with Guglielmi detachable coils (GDCs) in an unselected series of patients with ruptured cerebral aneurysms. METHODS: Between July 1997 and December 2000, we treated 164 acutely ruptured cerebral aneurysms with GDCs. All charts were reviewed, and patients with aneurysmal rupture occurring during embolization were identified. RESULTS: Five patients had an intraprocedural aneurysmal rupture. In one patient, rupture was due to guidewire perforation of the wall. In two patients, the microcatheter itself perforated the aneurysm. In another two patients, rupture occurred during placement of the first coil. Endovascular packing was continued in all patients. One patient died as a result of the aneurysmal rupture. No negative long-term effects were observed in the remaining four patients. In summary, we observed intraprocedural aneurysmal rupture in 3% of our patients, with a mortality rate of 20% and no long-term morbidity. CONCLUSION: Aneurysmal rupture during endovascular treatment with GDCs is a rare event; clinical severity may be variable. Embolization of the aneurysm can be continued in most cases, and most patients with treatment-related subarachnoid hemorrhage survive without serious sequelae. (+info)