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posterior circulation stroke

Hiroyuki Kawano, Takashi Johno, Masataka Torii, Hiroshi Kamiyama, Tatsuo Amano, Yuko Honda, Haruko Okano, Yoshiko Unno, Shin Yamada, Yasutomo Okajima, Yoshiaki Shiokawa, Teruyuki Hirano
BACKGROUND: The functional independence measure (FIM) is a standard tool to provide a detailed evaluation of ADL of patients with disabilities. This study aimed to show the differences in FIM scores as an outcome predictor between patients with anterior circulation (AC) and posterior circulation (PC) strokes. METHODS: Consecutive patients with acute ischemic stroke hospitalized within 7 days after onset were investigated. Baseline NIHSS scores, 1st-FIM (< 72 h after -admission to stroke unit), 2nd-FIM (< 72 h before discharge), and modified Rankin Scale (mRS) scores were collected...
March 21, 2019: European Neurology
Wei Fa Chu, Han Jui Lee, Chung Jung Lin, Feng Chi Chang, Wan Yuo Guo, Liang Wei Chen, Yi Yang Lin, Chao Bao Luo
BACKGROUND: Quantitative digital subtraction angiography (DSA) facilitates in-room assessment of flow changes in various cerebrovascular diseases, and improves patient safety. The purpose of this study was to compare the diagnostic accuracy of quantitative fluoroscopic angiography (FA) and DSA. METHODS: Twenty-two patients with more than 70% carotid stenosis according to NASCET criteria were prospectively included. All patients received DSA and FA (ArtisZee, Siemens Healthcare, Forchheim, Germany) before and after carotid stenting in the same angiosuite...
March 11, 2019: Journal of the Chinese Medical Association: JCMA
Matthew W Lukies, Wesley Wh Teoh, Warren Clements
INTRODUCTION: Computed tomography-guided cervical nerve root corticosteroid injections are a commonly performed procedure for cervical radiculopathy. There have been major complications such as spinal cord infarction and posterior circulation stroke reported mostly with X-ray fluoroscopic-guided methods, however, there is relatively little data on the safety of newer CT-guided methods. The purpose of this study was to identify any major complications and evaluate the rate of minor complications from CT-guided cervical nerve root corticosteroid injections performed in a tertiary public hospital...
March 12, 2019: Journal of Medical Imaging and Radiation Oncology
Ho Jun Yi, Jae Hoon Sung, Min Hyung Lee, Dong Hoon Lee
BACKGROUND: We report the experience of the FlowGate2 (FG2) as a new balloon guide catheter (BGC) in endovascular stroke intervention. METHODS: We evaluated the various outcomes and complications of patients with intracranial large artery occlusion undergoing endovascular stroke intervention with FG2 at our center. Baseline characteristics (failure rate of device application, sex, age, risk factors, arterial occlusion sites, and time intervals) were reviewed. Outcomes were evaluated according to National Institutes of Health Stroke Scale (NIHSS) score, Modified Rankin Scale (mRS) score, number of stent passages required, and Thrombolysis in Cerebral Infarction (TICI) score...
March 6, 2019: World Neurosurgery
Zhen Yu Jia, Yun Sun Song, Jae Jon Sheen, Joong Goo Kim, Deok Hee Lee
OBJECTIVE: Symptomatic non-acute intracranial arterial occlusion (NAICO) is not uncommon. We report a single-center experience of the feasibility and safety of endovascular treatment of anterior circulation NAICO and summarize the outcomes of patient groups with successful or failed recanalization. METHODS: Patients who underwent endovascular therapy for intracranial arterial stenosis between January 2010 and May 2017 were retrospectively reviewed. Thirty-eight patients with symptomatic NAICO (symptom onset > 24 hours) in the anterior circulation were identified...
February 27, 2019: Interventional Neuroradiology
Joong-Goo Kim, Dongwhane Lee, Jay Chol Choi, Yunsun Song, Deok Hee Lee, Dae Chul Suh
BACKGROUND AND PURPOSE: The prognosis of patients with acute basilar arterial occlusion after endovascular reperfusion therapy with diffusion-weighted imaging - posterior circulation-Alberta Stroke Program Early Computed Tomography Score (DWI-pc-ASPECTS) of 6 or less remains unclear. We aimed to assess the characteristics and prognosis of endovascular reperfusion therapy in patients with acute basilar arterial occlusion and DWI-pc-ASPECTS of 6 or less. METHODS: We analysed data collected from 1 January 2012 to 31 January 2018 in a prospective neuro-interventional registry of consecutive patients treated with endovascular reperfusion therapy...
February 25, 2019: Interventional Neuroradiology
Leonard Ll Yeo, Tommy Andersson, Åke Holmberg, Anastasios Mpotsaris, Michael Söderman, Staffan Holmin, Pervinder Bhogal, Yang Cunli, Anil Gopinathan, Benjamin Yq Tan, Vamsi Gontu, Jens Kolloch, Åsa KuntzeSöderqvist, Patrick A Brouwer, Sandra Cornelissen
BACKGROUND: Collateral blood flow is known to be an important factor that sustains the penumbra during acute stroke. We looked at both the leptomeningeal collateral circulation and the presence of anterior and posterior communicating arteries to determine the factors associated with good outcomes and mortality. METHODS: We included all patients with acute ischaemic stroke in the anterior circulation, who underwent thrombectomy with the same thrombectomy device from 2013 to 2016...
February 25, 2019: Interventional Neuroradiology
O Bill, N M Inácio, D Lambrou, M Wintermark, G Ntaios, V Dunet, P Michel
BACKGROUND AND PURPOSE: Perfusion CT may improve the diagnostic performance of noncontrast CT in acute ischemic stroke. We assessed predictors of focal hypoperfusion in acute ischemic stroke and perfusion CT performance in predicting infarction on follow-up imaging. MATERIALS AND METHODS: Patients from the Acute STroke Registry and Analysis of Lausanne data base with acute ischemic stroke and perfusion CT were included. Clinical and radiologic data were collected...
February 21, 2019: AJNR. American Journal of Neuroradiology
M Caroline Nally, Catherine Kling, Kyle M Hocking, Heather Lillemoe, Julia M Boll, John A Curci, C Louis Garrard, Thomas C Naslund, R James Valentine
OBJECTIVE: Routine computed tomography (CT) imaging in trauma patients has led to increased recognition of blunt vertebral artery injuries (BVIs). We sought to determine the prevalence of strokes, injury progression, and need for intervention in patients with BVI. METHODS: Consecutive patients presenting with BVI during 2 years were identified from the institutional trauma registry. Inpatient records, imaging studies, and follow-up data were reviewed in detail from the electronic medical record...
February 18, 2019: Journal of Vascular Surgery
Mona Laible, Ekkehart Jenetzky, Markus A Möhlenbruch, Ulf Neuberger, Martin Bendszus, Peter A Ringleb, Timolaos Rizos
BACKGROUND AND PURPOSE: Renal dysfunction (RD) is overall associated with unfavorable functional outcome and higher risk of mortality after acute ischemic stroke. Associations between RD and outcome in patients with acute vertebrobasilar stroke treated with thrombectomy have not been evaluated so far. MATERIALS AND METHODS: Consecutive patients with vertebrobasilar stroke treated with mechanical thrombectomy between October 2010 and July 2017 at our center were analyzed...
February 15, 2019: Cerebrovascular Diseases
Mukesh Dube, Raunak Dani, Ayush Dubey, Dinesh Chouksey
BACKGROUND: In the list of named numerical neuro-ophthalmological syndromes, such as one-and-a-half syndrome and others, we report for the first time twenty-and-a-half syndrome, which is characterized by one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy (1.5 + 7 + 7 + 5 = 20.5) in a patient with ischemic stroke. CASE PRESENTATION: A 45-year-old Asian Hindu woman presented with vomiting and imbalance of 1 day's duration. She had left-sided ataxic hemiparesis with one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy...
February 15, 2019: Journal of Medical Case Reports
Kiersten L Gurley, Jonathan A Edlow
Dizziness is a common chief complaint with an extensive differential diagnosis that includes both benign and serious conditions. Physicians must distinguish the majority of patients who suffer from self-limiting conditions from those with serious illnesses that require acute treatment. The preferred approach to the diagnosis of an acutely dizzy patient emphasizes different aspects of the history to guide a focused physical examination, with the goal of differentiating benign peripheral vestibular conditions from dangerous posterior circulation strokes...
February 2019: Seminars in Neurology
Paul R Freund, Laila Alshafai, Edward A Margolin
A 34-year-old man with chronic neck pain was treated with regular cervical paravertebral ozone injections. After his last injection, he experienced a syncopal episode and, upon awakening, was found to have ataxia, aphasia, hemiparesis, and left sixth nerve palsy. Computed tomographic angiography demonstrated intra-arterial gas in the right vertebral artery; multiple posterior circulation infarcts were seen on brain MRI. This case illustrates the potential dangers of paravertebral injections of ozone.
February 6, 2019: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Manuri Gunawardena, Jeffrey M Rogers, Marcus A Stoodley, Michael K Morgan
OBJECTIVEPrevious trials rejected a role of extracranial-to-intracranial bypass surgery for managing symptomatic atheromatous disease. However, hemodynamic insufficiency may still be a rationale for surgery, provided the bypass can be performed with low morbidity and patency is robust.METHODSConsecutive patients undergoing bypass surgery for symptomatic non-moyamoya intracranial arterial stenosis or occlusion were retrospectively identified. The clinical course and surgical outcomes of the cohort were evaluated at 6 weeks, 6 months, and annually thereafter...
February 8, 2019: Journal of Neurosurgery
Rui Felgueiras, Rui Magalhães, Mário R Silva, Maria C Silva, Manuel Correia
OBJECTIVE: A decline in TIA incidence would be expected mirroring stroke trends, but patient's awareness of symptoms/signs, improved diagnostic procedures and changes in severity of vascular disease may raise TIA incidence. We aimed to estimate changes in TIA incidence and 30-day stroke risk in Portugal. METHODS: Data from two prospective community-based registers of first-ever TIA in 104,700 (1998-2000) and 118,232 (2009-2011) persons were collected using comprehensive case ascertainment methods...
February 8, 2019: International Journal of Stroke: Official Journal of the International Stroke Society
Mohamed Al-Khaled
Dysphagia is a common neurological, often underdiagnosed symptom of an acute stroke, particularly, in patients suffering from a stroke in the posterior circulation, particularly brainstem infarction or a malign anterior circulation stroke, with altered consciousness. Up to 80% of acute stroke patients showed a dysfunction in swallowing, whereas the determined rate of dysphasia is depending on the stroke's severity, the type and timing of the dysphasia screening techniques. A quarter of the dysphasia patients developed a chronic swallowing dysfunction which severely affects the quality of life in addition to the malnutrition and dehydration risk ...
February 3, 2019: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Yang Hua, Lingyun Jia, Yingqi Xing, Pinjing Hui, Xuan Meng, Delin Yu, Xiaofang Pan, Yalan Fang, Binbin Song, Chunxia Wu, Chunmei Zhang, Xiufang Sui, Youhe Jin, Jingfen Zhang, Jianwei Li, Ling Wang, Yuming Mu, Jingxin Zhong, Yuhong Zhu, Heng Zhang, Xiaoyu Cai
The aim of this multicenter study was to demonstrate the distribution pattern of atherosclerotic stenosis and its trend with aging between extracranial and intracranial arteries and its distribution between the anterior and posterior circulations in Chinese patients hospitalized with ischemic stroke. In addition, the risk factors for the distribution pattern were illustrated. From June 2015 to May 2016, 9,346 patients with ischemic stroke from 20 hospitals were enrolled. Carotid artery ultrasonography and transcranial color-coded sonography/transcranial Doppler were used to evaluate the extracranial and intracranial arteries...
February 2019: Aging and Disease
Matthew John Harris, Mark Daniel Cossburn, George Pengas
A 52-year-old man experienced a relapse of neurosarcoidosis, characterised by obstructive hydrocephalus and multiple posterior circulation infarcts. He was taking methotrexate, but his prednisolone was being weaned because of adverse effects. Stroke is rare in neurosarcoidosis and typically relates to granulomatous inflammation with a predilection for the perforator arteries. Sarcoidosis generally responds well to corticosteroids; however, patients with leptomeningeal involvement usually require additional immunosuppression as relapses can occur on weaning of corticosteroids...
January 30, 2019: Practical Neurology
Liping Wang, Panting Zhou, Zhihao Mu, Xiaojie Lin, Lu Jiang, Zhuo Cheng, Longlong Luo, Zhiming Xu, Jieli Geng, Yongting Wang, Zhijun Zhang, Guo-Yuan Yang
A rodent model of embolic middle cerebral artery occlusion is used to mimic cerebral embolism in clinical patients. Thrombolytic therapy is the effective treatment for this ischemic injury. However, it is difficult to detect thrombolysis dynamically in living animals. Synchrotron radiation angiography may provide a novel approach to directly monitor the thrombolytic process and assess collateral circulation after embolic stroke. Thirty-six adult Sprague-Dawley rats underwent the embolic stroke model procedure and were then treated with tissue plasminogen activator...
January 24, 2019: Translational Stroke Research
Felipe Araujo Andrade Oliveira, Pedro Augusto Sampaio Rocha-Filho
INTRODUCTION: Although headaches attributed to ischemic strokes and transient ischemic attack occur frequently, they are often overlooked and underdiagnosed as manifestations of cerebrovascular disease. METHOD: This is a narrative review. RESULTS: The prevalence of headache attributed to ischemic stroke varies between 7.4% and 34% of cases and of headache attributed to transient ischemic attack, from 26% to 36%. Headache attributed to ischemic stroke is more frequent in younger patients, in migraineurs, in those who have suffered a larger stroke, a posterior circulation infarction, or a cortical infarction, and is less frequent in lacunar infarctions...
January 22, 2019: Headache
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