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1.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2019 Nov 28;44(11):1222-1229. doi: 10.11817/j.issn.1672-7347.2019.190459.

[Effect of Naoshuming decoction on expression of NF-κB, TNF-α, and IL-1β in focal cerebral ischemia rats].

[Article in Chinese; Abstract available in Chinese from the publisher]

Author information

1
Key Laboratory of Internal Medicine of Chinese Medicine, First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha 410208, China.
2
Shenzhen Beikelian Pharmaceutical Technology Limited Liability Company, Shenzhen 518000, China.

Abstract

To explore the effect of Naoshuming decoction on cerebral ischemic rats.
 Methods: The model of cerebral ischemia in rats was established via middle cerebral artery occlusion (MCAO). The MCAO model rats were randomly divided into a model group (n=36), a Naoshuming decoction at high dose group (n=36), a Naoshuming decoction at middle dose group (n=36) and a Naoshuming decoction at low dose group (n=36). In addition, a normal group (n=12) and a sham operation group (n=12) were included. Rats in each group were killed on the 3rd, 7th, and 14th day to detect relevant indicators. The Ayelet Levy 14 method was used to score the neurological function. Immunohistochemical method was used to detect the protein expression of nuclear factor kappa-B (NF-κB)/p50, NF-κB/p65, tumor necrosis factor-α (TNF-α), and IL-1β. The quantitative real-time PCR were used to detect the mRNA expression of NF-κB, TNF-α and IL-1β. 
 Results: Compared with the sham group, at each time point, the inflammation indexes in the model group and different dose of Naoshuming decoction groups were significantly enhanced, and all of them showed neurological dysfunction. But the inflammatory indexes and neurological function scores would were gradually improved with the pass of time. Compared with the model group, the neurological dysfunction, the protein levels of NF-κB/p50, NF-κB/p65, TNF-α and IL-1β, and the mRNA of NF-κB, TNF-α and IL-1β in the high, middle and low dose of Naoshuming decoction groups were reduced at 3, 7 and 14 d, with statistical difference (all P<0.05 or P<0.01). 
 Conclusion: Naoshuming decoction can alleviate the cerebral ischemic injury in rats.

[Indexed for MEDLINE]
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2.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2019 Jul 25;48(5):552-559.

[Autophagy regulates the function of vascular smooth muscle cells in the formation and rupture of intracranial aneurysms].

[Article in Chinese]

Author information

1
Institute of Neuroscience, Zhejiang University School of Medicine, Hangzhou 310058, China.

Abstract

Vascular smooth muscle cells (VSMC) are the main cellular component of vessel wall. The changes of VSMC functions including phenotypic transformation and apoptosis play a critical role in the pathogenesis of intracranial aneurysm (IA). Autophagy can participate in the regulation of vascular function by regulating cell function. In the initial stage of IA, the activation of autophagy can accelerate the phenotypic transformation of VSMC and inhibit VSMC apoptosis. With the progress of IA, the relationship between autophagy and apoptosis changes from antagonism to synergy or promotion, and a large number of apoptotic VSMC lead to the rupture of IA. In this review, we describe the role of autophagy regulating the function of VSMC in the occurrence, development and rupture of IA, for further understanding the pathogenesis of IA and finding molecular targets to prevent the formation and rupture of IA.

PMID:
31901031
[Indexed for MEDLINE]
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3.
Neurol Neurochir Pol. 2019;53(6):398-399. doi: 10.5603/PJNNS.a2019.0065.

With a subarachnoid haemorrhage, the outcome is never enough.

Author information

1
Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland. wambrosius@ump.edu.pl.

Abstract

INTRODUCTION:

In the current edition, Nastasovic et al. present the results of a prospective study on patients with aneurysm subarachnoid haemorrhage (SAH) regarding the association of selected variables and outcomes three months after the incident.

CLINICAL REFLECTIONS:

The independent predicting factors of an unfavourable aneurysm SAH outcome are aneurysm re-rupture, high systolic blood pressure (SBP), and increased heart rate.

CLINICAL IMPLICATIONS:

The article findings confirm easily monitored parameters that could be potentially useful in clinical approaches to this critical illness.

PMID:
31891409
DOI:
10.5603/PJNNS.a2019.0065
[Indexed for MEDLINE]
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5.
6.
World Neurosurg. 2020 Jan;133:441-442. doi: 10.1016/j.wneu.2019.09.169.

Reply to Letter to the Editor Regarding "One and Done: Multimodal Treatment of Pediatric Arteriovenous Malformations in a Single Anesthesia Event".

Author information

1
Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
2
Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. Electronic address: Shahid.Nimjee@osumc.edu.
PMID:
31881566
DOI:
10.1016/j.wneu.2019.09.169
[Indexed for MEDLINE]
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8.
World Neurosurg. 2020 Jan;133:433-435. doi: 10.1016/j.wneu.2019.08.144.

Letter to the Editor Regarding "PulseRider-Assisted Coil Embolization for Treatment of Intracranial Bifurcation Aneurysms: A Single-Center Case Series with 24-Month Follow-up".

Author information

1
GCP Center/Institute of Drug Clinical Trials, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
2
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
3
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China. Electronic address: zhangchangweiHX@163.com.
PMID:
31881562
DOI:
10.1016/j.wneu.2019.08.144
[Indexed for MEDLINE]
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9.
Medicine (Baltimore). 2019 Dec;98(52):e18420. doi: 10.1097/MD.0000000000018420.

Delayed spontaneous rupture of cavernous segment of the internal carotid artery following dual ophthalmic segment aneurysms treatment with pipeline embolization device: A case report.

Author information

1
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
2
Department of Medicine, Princefield University, Ghana West Africa.

Abstract

RATIONALE:

The incidence of double aneurysms on the ophthalmic segment of the internal carotid artery (ICA) is very rare. Nevertheless, delayed rupture of a parent artery instead of the aneurysmal sac following pipeline embolization device (PLED) is unusual.

PATIENT CONCERNS:

We present a 72-year-old female who was admitted at our facility with gradual onset of nonspecific visual changes.

DIAGNOSIS:

Conventional angiography revealed 2 aneurysms located at the ophthalmic segment of the left ICA.

INTERVENTIONS:

Both aneurysms were successfully treated with PLED.

OUTCOMES:

Two months after discharge, the patient was rushed into the emergency with bilateral conjunctival congestion. Computed tomography revealed intracranial hemorrhage at left temporal lobe while digital subtraction angiography established a left direct carotid cavernous fistula. We utilized stent (Solitaire 6*30) assisted coils to occlude the fistula. The patient is well and go about her normal duties.

LESSIONS:

Manipulation of the tortuous parent artery resulted in a focal traumatic weakness in the artery and subsequently a delay tear. We are of the view that, endovascular surgeons should be on the lookout for this complication following flow deviation treatment modalities.

PMID:
31876716
DOI:
10.1097/MD.0000000000018420
[Indexed for MEDLINE]
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10.
Medicine (Baltimore). 2019 Dec;98(52):e18418. doi: 10.1097/MD.0000000000018418.

Regression of a symptomatic varix after transarterial embolization of a brain arteriovenous malformation: A case report and literature review.

Author information

1
Department of Neurology.
2
Department of Neurosurgery.
3
Department of Operation Room, The First Hospital of Jilin University, Changchun, China.

Abstract

RATIONALE:

Brain arteriovenous malformation (BAVM)-associated varix is always asymptomatic, and no special treatment is needed. However, there is no consensus regarding how to address a varix that has led to clinical manifestation.

PATIENT CONCERNS:

An 11-year-old girl was admitted complaining of left hemiparesis for 4 days. She was previously healthy and denied any history of similar ictus. She was alert, and a physical examination performed upon admission was unremarkable except for the left hemiparesis.

DIAGNOSES:

Head magnetic resonance imaging (MRI) showed a linear and round flow void and perilesional edema in the region of the right basal ganglia, indicating a BAVM. Gadolinium-enhanced MRI showed peripheral enhancement of the round lesion. Computed tomography angiography (CTA) showed that the BAVM was fed by the ipsilateral posterior cerebral artery and anterior choroidal artery and drained into the vein of Galen. A large varix was also noted at the top of the BAVM and was consistent with the round flow void observed at the right basal ganglia on MRI. The Spetzler-Martin grading scale was grade IV INTERVENTIONS:: The patient experienced a TAE of the BAVM nidus with liquid embolic agent.

OUTCOMES:

A follow-up investigation showed regression of the varix, although there was still some residual BAVM. The patient experienced a favorable recovery.

LESSONS:

In the case of a BAVM-associated symptomatic varix, if surgical resection cannot readily be performed, initial TAE of the BAVM nidus can be attempted.

PMID:
31876715
DOI:
10.1097/MD.0000000000018418
[Indexed for MEDLINE]
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11.
No Shinkei Geka. 2019 Dec;47(12):1281-1287. doi: 10.11477/mf.1436204116.

[A Case of Ruptured Cerebral Arteriovenous Malformation Associated with Hereditary Hemorrhagic Telangiectasia].

[Article in Japanese]

Author information

1
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.

Abstract

BACKGROUND:

Patients with hereditary hemorrhagic telangiectasia(HHT)are known to have high rates of cerebral arteriovenous malformations(AVMs). Compared to patients with sporadic AVMs, patients with HHT are less likely to present with ruptured AVMs.

CASE REPORT:

A 14-year-old male patient presented with headache that had lasted for 2 days. CT revealed an intracerebral hemorrhage in the right parietal lobe, and enhanced CT revealed an AVM in the upper part of the hematoma. The size of the nidus was 20 mm, and its feeders were the right superior internal parietal artery and a branch of the anterior cerebral artery. In addition, the AVM had no deep drainer. We also found another AVM in the right temporal lobe and identified telangiectasia of the nose using digital subtraction angiography. We suspected HHT and performed whole body CT, which revealed an arteriovenous fistula in the right lung and a hematoma-like lesion in the spleen. Thus, we diagnosed the patient with HHT. His ruptured AVM was removed electively.

CONCLUSION:

We report a case of HHT that presented as an intracerebral hemorrhage in a patient. Based on our case study findings, it is necessary to perform long-term follow-up not only for brain AVMs but also for visceral vascular malformations in such patients, as well as perform HHT screening for families. Although such cases are rare, some features of HHT must be considered to accurately diagnose suspected HHT.

PMID:
31874950
DOI:
10.11477/mf.1436204116
[Indexed for MEDLINE]
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12.
No Shinkei Geka. 2019 Dec;47(12):1261-1267. doi: 10.11477/mf.1436204113.

[A Case of Pediatric C1 Dysplasia with Ruptured Aneurysm in Collateral Plexiform Arterial Network].

[Article in Japanese]

Author information

1
Department of Neurosurgery, Kainan Hospital.

Abstract

A 3-year-old girl was admitted to our hospital with symptoms including headache, nausea, and vomiting. Head CT scan showed subarachnoid hemorrhage in the right carotid cistern. Digital subtraction angiography revealed right internal caortid artery(ICA)malformation at the C1 segment with collateral plexiform arterial network. The right ICA branched into posterior communicating artery and anterior choroidal artery(AChoA)and the ICA was decreased in caliber. The distal portion of the C1 segment of the ICA continued to the collateral plexiform arterial network, forming a saccular aneurysm. The plexiform arterial network connected to the right AChoA and the anterior communicating artery and continued to the distal portion of the right M1 segment. Right cervical carotid artery was normal. There was no transdural collateral flow from the right external carotid artery. Genetic analysis of a variant of RING finger protein 213 was negative. We diagnosed this patient with C1 dysplasia. We performed coil embolization for the aneurysm. The patient was discharged without any neurological deficit. Four months after the surgery, recurrence of the aneurysm was observed. We suspected that the aneurysm was formed due to hemodynamic mechanism and vulnerability of the collateral plexiform arterial network.

PMID:
31874947
DOI:
10.11477/mf.1436204113
[Indexed for MEDLINE]
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13.
Nihon Hoshasen Gijutsu Gakkai Zasshi. 2019;75(12):1446-1451. doi: 10.6009/jjrt.2019_JSRT_75.12.1446.

[Setting Method of the Optimal Slab of Brain MRA for Detective Unruptured Cerebral Aneurysm].

[Article in Japanese]

Author information

1
Section of Radiology, Ishii Hospital, Ishii Association.
2
Gunma Prefectural College of Health Sciences.
3
Division of Radiological Technology, Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences.
4
Clinical Radiology Service, Yokohama Health Service Bureau Hospital.

Abstract

Generally, the imaging range of the brain magnetic resonance angiography (MRA) is determined in the subjectivity by the operator used by the plan image that a blood vessel is not depicted. However, a necessary blood vessel may not be often depicted by an error of the setting of the imaging area. Therefore, optimal slab angle, thickness, distance, and image contrast for depiction of the unruptured cerebral aneurysm were examined. The brain MRA of 14 subjects was imaged in a wide area parallel to an orbitomeatal line (OM) line. The line which linked the arteria vertebral (the first cervical vertebrae curved section) to anterior cerebral artery (A3) was determined with an optimal slab base line, and the angle with the OM line was evaluated. Moreover, slavic range including the unruptured aneurysm was calculated. In addition, the distance from the inferior margin of pons to the slavic bottom end was measured. Furthermore, the cerebrovascular contrast by the slave angle was compared. As a result, the slave setting of the range was recommended in brain-MRA as an angle was 34.3 degrees, and the thickness was 56.4 mm, and, as the distance from the inferior margin of pons was 27.6 mm. The cerebrovascular contrast of the optimal slab base line angle did not have a significant difference for an OM line.

KEYWORDS:

cerebral aneurysm; magnetic resonance angiography; thinnest slab; time-of-flight

[Indexed for MEDLINE]
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14.
Nihon Hoshasen Gijutsu Gakkai Zasshi. 2019;75(12):1437-1445. doi: 10.6009/jjrt.2019_JSRT_75.12.1437.

[Imaging Parameter Optimization of Non-contrast Three-dimensional Time-of-flight Magnetic Resonance Angiography for Patients with Intracranial Stents Using a 1.5 T Magnetic Resonance Imaging System].

[Article in Japanese]

Author information

1
Department of Radiological Technology, Tsukuba Medical Center Hospital.
2
Department of Radiological Sciences, Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences.
3
Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences.

Abstract

The imaging parameters of non-contrast three-dimensional time-of-flight magnetic resonance angiography (3D TOF-MRA) were optimized to improve the image quality for patients treated using stent-assisted coiling. A simulated blood flow phantom with three types of stents (Enterprise 2, Neuroform Atlas, and LVIS) was imaged by changing echo time (TE), band width (BW), flip angle (FA), and matrix (phase, frequency). The difference between the signal intensity in the simulated vessel and the background was measured at each imaging condition. The ratio of this difference with and without the stent was evaluated as the relative in-stent signal (RIS). In addition, the error ratio of the stent lumen diameter was assessed by comparing the full width at half maximum (FWHM) to that measured by 3D X-ray angiography. The RIS was higher in order of LVIS, Neuroform Atlas, and Enterprise 2 in all conditions. The RIS was higher in imaging conditions with short TE, narrow BW, high FA, and large phase matrix. The highest RIS was seen with a frequency matrix of 320 in the Enterprise 2 and 256 in the others. FWHM error ratio was smaller in the same order as the RIS. FWHM error ratio was smaller in imaging conditions with short TE, large frequency matrix (>384), large phase matrix (>224), and high FA (>20°). Imaging conditions of 3D TOF-MRA that were effective to improve the image quality for stent lumen evaluation were short TE and high spatial resolution.

KEYWORDS:

intracranial; magnetic resonance angiography (MRA); non-contrast; stent; time of flight (TOF)

[Indexed for MEDLINE]
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15.
Medicine (Baltimore). 2019 Dec;98(51):e18296. doi: 10.1097/MD.0000000000018296.

Multiple cerebral microbleeds and atypical β-amyloid deposits: A case report.

Author information

1
Department of Neurology.
2
Department of Radiology.
3
Department of Nuclear Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, South Korea.

Abstract

RATIONALE:

Cerebral microbleeds are increasingly recognized in various neurological disorders such as cerebral amyloid angiopathy (CAA), Alzheimer disease, and stroke. The presence and number of cerebral microbleeds are known to be independent predictors of cognitive impairment.

PATIENT CONCERNS:

A 73-year-old woman visited our memory disorder clinic complaining of progressive memory impairment, which started 2 years ago.

DIAGNOSES:

The patient had innumerable cortical/subcortical cerebral microbleeds in the entire brain. We diagnosed the patient with amnestic mild cognitive impairment due to CAA. Interestingly, only focal β-amyloid deposits at the bilateral parietal cortices were seen on amyloid positron emission tomography (PET) scan.

INTERVENTIONS:

We have observed changes in her cognitive function without any medication.

OUTCOMES:

The cognitive function of the patient was unchanged during the follow-up period.

LESSONS:

Our case was interesting in a few aspects, including the number of cerebral microbleeds and the atypical β-amyloid deposition pattern on amyloid PET scan. Further studies on more cases are needed to evaluate β-amyloid burden and distribution patterns in CAA.

PMID:
31860978
DOI:
10.1097/MD.0000000000018296
[Indexed for MEDLINE]
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16.
Angiol Sosud Khir. 2019;25(4):131-138. doi: 10.33529/ANGIO2019412.

[Surgical treatment of a patient with saccular arterial aneurysm of the cavernous-ophthalmic segment].

[Article in Russian; Abstract available in Russian from the publisher]

Author information

1
Kemerovo Regional Clinical Cardiological Dispensary named after Academician L.S. Barbarash, Kemerovo, Russia; Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russia.
2
Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russia.
3
Kemerovo Regional Clinical Cardiological Dispensary named after Academician L.S. Barbarash, Kemerovo, Russia.
4
Kemerovo State Medical University of the RF Ministry of Public Health, Kemerovo, Russia.

Abstract

Presented in the article are the results of surgical management of a patient with an extremely rare pathology - a saccular arterial aneurysm of the cavernous-ophthalmic segment of the left internal carotid artery. We performed multistage open surgical intervention in the following scope: osteoplastic pterional craniotomy on the left, creation of a wide-lumen anastomosis between the left external carotid artery and M2 segment of the left middle cerebral artery with the use of the radial artery, ligation of the cervical portion of the left internal carotid artery and clipping of its supraclinoid portion. The chosen surgical policy made it possible to create sufficient volumetric blood flow through the shunt, comparable to the blood flow through the internal carotid artery, which helped avoid ischaemic stroke after exclusion of the aneurysm from circulation. A conclusion was drawn on efficacy of this method of treatment.

KEYWORDS:

giant aneurysm; microsurgical treatment; saccular arterial aneurysm of the cavernous-ophthalmic segment; wide-lumen anastomosis

PMID:
31855210
DOI:
10.33529/ANGIO2019412
[Indexed for MEDLINE]
17.
Medicine (Baltimore). 2019 Dec;98(50):e18326. doi: 10.1097/MD.0000000000018326.

Efficacy and safety of Shenmayizhi decoction as an adjuvant treatment for vascular dementia: Study protocol for a randomized controlled trial.

Author information

1
Graduate School, Beijing University of Chinese Medicine, Chaoyang District.
2
Department of Geriatrics, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Haidian District, Beijing, China.

Abstract

BACKGROUND:

Vascular dementia (VaD) is the second most common cause of dementia. The treatment of VaD still remains a challenge so far. Traditional Chinese Herbal medicine is a promising therapy due to their multiple components and targets. Shenmayizhi decoction (SMYZD), a Chinese Herbal prescription, has been reported its effective in alleviating cognitive dysfunction in clinical practice. However, strong clinical research of SMYZD in the treatment of VaD was lack. Therefore, we design this study to evaluate the adjuvant role of SMYZD in the treatment of VaD.

METHODS:

This is a multicenter, randomized, blind, controlled trial. A total of 196 eligible patients will be assigned to receive Ginkgo biloba extracts (GBEs) plus SMYZD granule or GBEs plus SMYZD mimetic granule in a 1:1 ratio. The duration of the trial will be 12 weeks, and a follow-up will be performed at the 24th week. The primary outcomes are the National Institute of Health stroke scale (NIHSS) and the Alzheimer Disease Assessment Scale-cognitive subscale (ADAS-cog). The secondary outcomes include the Mini-Mental State Examination (MMSE), the traditional Chinese Medicine (TCM) syndrome scale, Activities of Daily Living (ADL), concentrations of hypersensitive C-reactive protein (Hs-CRP), neuron-specific enolase (NSE) and homocysteine (HCY) in serum. Researchers will record any adverse events throughout the trial.

DISCUSSION:

This study will provide evidences to evaluate the efficacy and safety of SMYZD in combination with GBEs in treatment of VaD, as well as the adjuvant role of SMYZD in combination.

TRIAL IS REGISTERED AT CHINESE CLINICAL TRIAL REGISTRY:

ChiCTR1800017359.

PMID:
31852125
DOI:
10.1097/MD.0000000000018326
[Indexed for MEDLINE]
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18.
Zh Vopr Neirokhir Im N N Burdenko. 2019;83(5):67-77. doi: 10.17116/neiro20198305167.

[Successful combination treatment of giant bicameral fusiform partially thrombosed vertebral artery aneurysm at 12-year-old patient (practical case and literature review)].

[Article in Russian; Abstract available in Russian from the publisher]

Author information

1
Burdenko Neurosurgical Center, Moscow, Russia.

Abstract

Giant cerebral aneurysms are diagnosed more often in children than in adults. Treatment of giant aneurysms is carried out both by endovascular and microsurgical methods. Literature information on combination of microsurgical and endovascular operations of cerebral aneurysms at children is little. A clinical case of the combined treatment of a giant bicameral fusiform partially thrombosed aneurysm of the right vertebral artery at a 12-year-old patient and a literature review on this topic are presented. The patient underwent several complex neurosurgical interventions during two operations: 1) microsurgery including revascularization of the right posterior lower cerebellar artery, thrombectomy and trapping of the larger chamber of fusiform aneurysm of the right vertebral artery, and 2) endovascular, which consists in the installation of redirecting stent from the left vertebral artery to main artery. The uniqueness of the case which we presented lies in the fact that the tactics of stage combined treatment for a complex aneurysm at child was originally planned and successfully implemented. The treatment allowed to ensure a complete shutdown of aneurysm and to exclude postoperative cerebral complications.

KEYWORDS:

EC-IC bypass; anastomosis; aneurysm at children; clipping; combined treatment; fisiform aneurysm; giant aneurysm; stenting; thrombectomy

PMID:
31825377
DOI:
10.17116/neiro20198305167
[Indexed for MEDLINE]
19.
Zh Vopr Neirokhir Im N N Burdenko. 2019;83(5):5-13. doi: 10.17116/neiro2019830515.

[Surgical treatment of patients with cerebral aneurysms in the acute stage of rupture: dynamics of results during 2006-2018].

[Article in Russian; Abstract available in Russian from the publisher]

Author information

1
Burdenko Neurosurgical Center, Moscow, Russia.

Abstract

Treatment of cerebral aneurysms in the acute stage of subarachnoid hemorrhage (SRH) especially on the background of cerebral vasospasm continues to be a difficult task.

OBJECTIVE:

Assessment of dynamics of the surgical treatment results of patients with cerebral aneurysms in acute period of SRH.

MATERIAL AND METHODS:

A comparative analysis of the results of patients' surgical treatment in NMRCN Burdenko about aneurysm in 1-21 days after hemorrhage was made. The following periods were selected: 2006-2014 (343 patients) and 2015-2018 (356 patients). Most patients had microsurgical operations in both periods. The tactics of choosing the surgery time was the main difference between the periods: particularly in 2015-2018 period the surgery was not postponed at patients with severe.

RESULTS:

Analysing the post surgical mortality, it was found that since 2006 there is a consistent trend towards a decrease in the number of patients who died after surgery. When calculating the average post surgical mortality for the studied periods this trend is confirmed - number of lethal cases in 2015-2018 reliably decreased when comparing with 2006-2014 - from 6.8 till 3.2%; p=0.03. At the same time, the number of patients with outcome of vegetative status (from 0.3 till 5%).

CONCLUSION:

The tactics of surgical treatment of patients with cerebral aneurysms in the acute period of SRH regardless of severity of patient's condition and time of hemorrhage did not lead to worse treatment. In contrast, post surgical mortality rates show a consistent decline. We associate this fact with a number of changes that have occurred in the management and treatment of patients. In particular, we have high hopes for developing new approaches to the treatment of vasospasm, which remains the leading cause of lethal cases. More definite conclusions will be made at the end of the treatment analysis of the respective patient groups.

KEYWORDS:

acute period of SRH; cerebral aneurysms; cerebral vasospasm; mortality at SRH

PMID:
31825370
DOI:
10.17116/neiro2019830515
[Indexed for MEDLINE]
20.
Zh Nevrol Psikhiatr Im S S Korsakova. 2019;119(8. Vyp. 2):28-34. doi: 10.17116/jnevro201911908228.

[Intracerebral hemorrhage in the late period of internal carotid artery dissection].

[Article in Russian; Abstract available in Russian from the publisher]

Author information

1
Research Center of Nevrology, Moscow, Russia.

Abstract

Cervical artery dissection is the common cause of ischemic stroke in young and middle-age patients. According to our previous studies, dissection is related to arterial wall dysplastic changes, which in their turn are due to mitochondrial cytopathy. The authors describe three male patients who at the age of 53, 25 and 35 years underwent internal artery (ICA) dissection with occlusion of its lumen and subsequent recanalization in one of them. In 3.5 months, 13.5 years and 3 years respectively, patients developed intracerebral hemorrhage (IСH), which was not related to arterial hypertension, cerebral arterial aneurysms and anticoagulants. IСH were located on the side of ICA occluded after dissection (2 patients) or bilaterally in the territory of patent ICA (1 patient). Multivoxel 1H-MR spectroscopy performed in one patient on 40 and 48 days after ICH revealed a high lactate peak in the externally unchanged hemispheric white matter. It is assumed that mitochondrial cytopathy in patients with dissection may involve large as well as small intracerebral arteries (mitochondrial microangiopathy), which could be the cause of ICH.

KEYWORDS:

internal carotid artery dissection; intracerebral hemorrhage; late period of dissection

PMID:
31825359
DOI:
10.17116/jnevro201911908228
[Indexed for MEDLINE]

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