Makoto Sainouchi, Michikazu Nakamura, Yuichi Masuda, Ryo Ohtani
We report an 86-year-old woman who suffered sudden onset of diplopia while cooking. The patient presented with binocular diplopia, bilateral adduction weakness, convergence disorder and bilateral abduction nystagmus. Although brain MRI on admission detected no abnormality, a repeat MRI examination on the following day demonstrated a focal hyperintense lesion in the tegmentum of the midbrain on diffusion-weighted images. At 36 hours after admission, lower abdominal distension became apparent, and about 1 liter of urine was drained via a urethral catheter...
December 15, 2020: Rinshō Shinkeigaku, Clinical Neurology
Jing Zhang, Qian You, Junlong Shu, Qiang Gang, Haiqiang Jin, Meng Yu, Wei Sun, Wei Zhang, Yining Huang
Vascular endothelial cell (EC) and blood-brain barrier (BBB) dysfunction is the core pathogenesis of cerebral small vessel disease (CSVD). Moreover, animal experiments have shown the importance of connexin (Cx)-43 in EC and BBB function. In this study, we recruited 200 patients diagnosed with sporadic CSVD. Initially, we examined imaging scores of white matter hyperintensities (WMH), lacunar infarction (LI), and cerebral microbleeds (CMB). Additionally, we performed next-generation sequencing of the GJA1 gene (Cx43 coding gene) to examine correlation between these single-nucleotide polymorphisms and the burden and distribution of CSVD...
2020: Frontiers in Neurology
Mohamed Okasha, Georgia Ineson, Jonathan Pesic-Smith, Surash Surash
BACKGROUND:  Retraction of white matter overlying a brain lesion can be difficult without causing significant trauma especially when using traditional methods of bladed retractors. These conventional retractors can produce regions of focal pressure resulting in contusions and areas of infarct. METHODS:  In this article, we present a retrospective case series of six patients with deep-seated intraventricular and intra-axial tumors that were approached using a ViewSite Brain Access System (tubular retractor)...
December 15, 2020: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Jing Sun, Baofeng Xu, Xuejiao Zhang, Zhidong He, Ziwei Liu, Rui Liu, Guangxian Nan
The continually increasing number of patients with type 2 diabetes is a worldwide health problem, and the incidence of microvascular complications is closely related to type 2 diabetes. Structural brain abnormalities are considered an important pathway through which type 2 diabetes causes brain diseases. In fact, there is considerable evidence that type 2 diabetes is associated with an increased risk of structural brain abnormalities such as lacunar infarcts (LIs), white matter hyperintensities (WMHs), and brain atrophy...
2020: Frontiers in Public Health
RuoNan Tang, ZanHua Liu
AIM: To reveal the correlation between total cerebrovascular disease load and primary lacunar infarction. BACKGROUND: Cerebral small vessel disease (CSVD) is the lack of specific clinical manifestations, whose clinical diagnoses are highly dependent on neuroimaging results. Total CSVD load scores may be more suitable for the assessment of overall brain function damage caused by CSVD. Little is known about whether the association between imaging markers of CSVD and CSVD total load scores at the time of first-ever lacunar infarction (LI)...
November 12, 2020: Clinical Neurology and Neurosurgery
Morten Fenger-Grøn, Ida Paulsen Møller, Henrik Schou Pedersen, Lars Frost, Annelli Sandbæk, Dimitry S Davydow, Søren P Johnsen, Nicklas Vinter
Background Stress has been reported to trigger stroke, and the death of a loved one is a potentially extremely stressful experience. Yet, previous studies have yielded conflicting findings of whether bereavement is associated with stroke risk, possibly because of insufficient distinction between ischemic stroke (IS) and intracerebral hemorrhage (ICH). We therefore examined the associations between bereavement and IS and ICH separately in contemporary care settings using nationwide high-quality register resources...
November 17, 2020: Journal of the American Heart Association
Michal Krawczyk, Lillian J Barra, Luciano A Sposato, Jennifer L Mandzia
BACKGROUND: Primary Central Nervous System Vasculitis (PCNSV) remains a diagnostic challenge due to its variable and non-specific clinical manifestations. In part, the clinical heterogeneity of PCNSV may be a consequence of the modalities used for diagnosis; accordingly, there may be different subtypes of PCNSV based on whether the diagnosis was attained by biopsy or cerebral angiography. OBJECTIVE: To examine the frequency of symptoms, laboratory, and radiological features associated with PCNSV, and to identify distinct clinical features between biopsy and angiography defined PCNSV...
January 2021: Autoimmunity Reviews
George Markousis-Mavrogenis, Petros P Sfikakis, Sophie I Mavrogeni, Maria G Tektonidou
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by arterial, venous, and/or small vessel thrombosis, pregnancy morbidity, and persistently elevated levels of antiphospholipid antibodies (aPL). Cardiovascular disease (CVD) in APS can present as heart valvular disease (HVD), macro-micro-coronary artery disease (CAD), myocardial dysfunction, cardiac thrombi, or pulmonary hypertension. Brain disease presents as stroke or transient ischemic attack (TIA) and less frequently as cerebral venous thrombosis, seizures, cognitive dysfunction, multiple sclerosis (MS)-like syndrome, or chorea...
November 16, 2020: Clinical Rheumatology
Susan A Farr, Salvatore Cuzzocrea, Emanuela Esposito, Michela Campolo, Michael L Niehoff, Timothy M Doyle, Daniela Salvemini
BACKGROUND: Traumatic brain injury (TBI) is a common pathological condition that presently lacks a specific pharmacological treatment. Adenosine levels rise following TBI, which is thought to be neuroprotective against secondary brain injury. Evidence from stroke and inflammatory disease models suggests that adenosine signaling through the G protein-coupled A3 adenosine receptor (A3 AR) can provide antiinflammatory and neuroprotective effects. However, the role of A3 AR in TBI has not been investigated...
November 12, 2020: Journal of Neuroinflammation
Bradley Ashley Ong, Romergryko Geocadin, Chun Woo Choi, Glenn Whitman, Sung-Min Cho
Despite the common occurrence of neurologic complications in patients with extracorporeal membrane oxygenation (ECMO), data on magnetic resonance imaging (MRI) findings in adult ECMO are limited. We aimed to describe the MRI findings of patients after ECMO cannulation. Records of patients who underwent ECMO from September 2017 to June 2019 were reviewed. MRI studies were performed using multiplanar sequences consisting of T1-, T2-weighted, fluid attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), and susceptibility weighted images (SWI)...
November 12, 2020: Perfusion
Hertzel C Gerstein, Eric E Smith, Chinthanie Ramasundarahettige, Dipika Desai, Philip Awadalla, Philippe Broet, Sandra Black, Trevor J B Dummer, Jason Hicks, Alan Moody, Jean-Claude Tardif, Koon K Teo, Jennifer Vena, Salim Yusuf, Douglas S Lee, Matthias G Friedrich, Sonia S Anand
BACKGROUND: Diabetes is a risk factor for cerebrovascular disease and cognitive impairment. The anatomical basis for this is uncertain. METHODS: The Canadian Alliance for Healthy Hearts and Minds (CAHHM) collected brain and carotid magnetic resonance imaging (MRI) and two cognitive tests (DSST and MoCA) in a cross-sectional sample of men and women. Brain MRIs identified brain infarcts (BI), lacunar BI, high white matter hyperintensity (WMH), vascular brain injury (VBI - BI or high WMH) and small vessel VBI (lacunar BI or high WMH)...
November 9, 2020: Journal of Clinical Endocrinology and Metabolism
Dao Ming Tong, Guo-Hong Liu, Yuan-Wei Wang, Han-Pei Gu, Ying Wang, Jun-Jie Bao, Xian Zhang, Jiu-Ling Liu
We were to investigate the time course of lesions for awakening in acute Percheron artery ischemic coma (PAIC), which was previously unknown. Patients who had newly identified acute PAIC events in 2012-2015 and had not received thrombolytic therapy were enrolled retrospectively. The time course of lesions in PAIC was investigated by diffusion-weighted imaging (DWI). Ninety-three patients met the inclusion criteria, of whom 63 and 30 had transient PAIC and persistent PAIC, respectively. The time course of awakening events in persistent PAIC decreased over time, with large lesions in the bilateral paramedian thalamus/ rostral midbrain on DWI almost in all patients who was either plus or minus a "top of basilar artery" strokes...
December 2020: Brain Research Bulletin
Remco J Hack, Julie W Rutten, Thomas N Person, Jiang Li, Ayesha Khan, Christoph J Griessenauer, Vida Abedi, Saskia A J Lesnik Oberstein, Ramin Zand
BACKGROUND AND PURPOSE: Cysteine altering NOTCH3 variants, which have previously been exclusively associated with the rare hereditary small vessel disease cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, have a population frequency of 1:300 worldwide. Using a large population database, and taking genotype as a starting point, we aimed to determine whether individuals harboring a NOTCH3 cysteine altering variant have a higher load of small vessel disease markers on brain magnetic resonance imaging than controls, as well as a higher risk of stroke and cognitive impairment...
December 2020: Stroke; a Journal of Cerebral Circulation
Jiali Zhao, Fudi Chen, Lin Lu, Chunxia Li, Yifeng Du
INTRODUCTION: Japanese encephalitis (JE) is one of the most serious viral infectious diseases of the central nervous system in Asia. The clinical manifestations of it might be non-specific. We herein report a case of JE mimicking acute ischemic stroke. PATIENT CONCERNS: A 52-year-old man presented with acute onset of left-sided limb weakness for 2 hours and a 5-year history of hypertension but with no fever or cold before the onset. Immediate cranial computed tomography scan showed small ischemic foci...
November 6, 2020: Medicine (Baltimore)
Anna Kopczak, Andreas Schindler, Anna Bayer-Karpinska, Mia L Koch, Dominik Sepp, Julia Zeller, Christoph Strecker, Johann-Martin Hempel, Chun Yuan, Rainer Malik, Frank A Wollenweber, Tobias Boeckh-Behrens, Clemens C Cyran, Andreas Helck, Andreas Harloff, Ulf Ziemann, Sven Poli, Holger Poppert, Martin Dichgans, Tobias Saam
BACKGROUND: The underlying etiology of ischemic stroke remains unknown in up to 30% of patients. OBJECTIVES: This study explored the causal role of complicated (American Heart Association-lesion type VI) nonstenosing carotid artery plaques (CAPs) in cryptogenic stroke (CS). METHODS: CAPIAS (Carotid Plaque Imaging in Acute Stroke) is an observational multicenter study that prospectively recruited patients aged older than 49 years with acute ischemic stroke that was restricted to the territory of a single carotid artery on brain magnetic resonance imaging (MRI) and unilateral or bilateral CAP (≥2 mm, NASCET [North American Symptomatic Carotid Endarterectomy Trial] <70%)...
November 10, 2020: Journal of the American College of Cardiology
Mohammad Moniruzzaman, Aya Kadota, Hiroyoshi Segawa, Keiko Kondo, Sayuki Torii, Naoko Miyagawa, Akira Fujiyoshi, Takashi Hisamatsu, Yoshiyuki Watanabe, Akihiko Shiino, Kazuhiko Nozaki, Hirotsugu Ueshima, Katsuyuki Miura
BACKGROUND AND PURPOSE: Cerebral small vessel disease (CSVD) is a common subclinical feature of the aging brain. Steps per day may contribute to its prevention. We herein investigated the association between step counts and CSVD in a healthy Japanese male population. METHODS: We analyzed data from 680 men who were free of stroke and participated in this observational study. Seven-day step counts were assessed at baseline (2006-2008) using a pedometer. CSVD was assessed at follow-ups (2012-2015) based on deep and subcortical white matter hyperintensities (WMHs), periventricular hyperintensities, lacunar infarcts, and cerebral microbleeds on magnetic resonance imaging...
November 5, 2020: Stroke; a Journal of Cerebral Circulation
Sanjeev Pattankar, Basant Kumar Misra
Objectives: Decompressive craniectomy (DC) is an emergency life-saving procedure used to treat refractory intracranial hypertension (RICH). The authors aim to analyze their experience with protocol-based early DC (<24 h) in RICH cases diagnosed based on clinical and radiological evidence, without preoperative intracranial pressure monitoring done over 10 years. Materials and Methods: This is a retrospective, observational study which includes 58 consecutive patients who underwent protocol-based early DC by the senior author at a single institution between 2007 and 2017...
July 2020: Asian Journal of Neurosurgery
Salvatore Rudilosso, Marta Olivera, Diana Esteller, Carlos Laredo, Sergio Amaro, Laura Llull, Arturo Renú, Víctor Obach, Víctor Vera, Alejandro Rodríguez, Jordi Blasco, Antonio López-Rueda, Xabier Urra, Ángel Chamorro
OBJECTIVES: Recent small subcortical infarcts (RSSI) are considered an acute manifestation of cerebral small vessel disease. Paramagnetic signals in perforating arteries supplying RSSI may be detected on T2*-relaxation derived sequences on MRI and is defined as susceptibility vessel sign (SVS). We aimed to study the prevalence of SVS in patients with RSSI, and explore whether its identification is related to cerebral small vessel disease markers. MATERIALS AND METHODS: We selected patients with RSSI identified on MRI during admission from a single-center stroke registry...
October 30, 2020: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
M Novoa Ferro, E Santos Armentia, N Silva Priegue, C Jurado Basildo, C A Sepúlveda Villegas, S Del Campo Estepar
OBJECTIVES: To evaluate the most common reasons for requesting brain CT studies from the emergency department and to calculate the prevalence of urgent acute pathology on this population group. MATERIAL AND METHODS: We reviewed brain CT studies requested from the emergency department during October and November 2018. We recorded the following variables: age, sex, reason for requesting the study, CT findings, use of contrast agents and reasons for using them, and, in patients who had undergone previous head CT studies, whether the findings had changed...
October 29, 2020: Radiología
Yangyi Fan, Chang Hou, Li Peng, Xuguang Gao, Yan Xu
Background: Lacunar infarcts, white matter lesions, cerebral microbleed, enlarged perivascular space and brain atrophy are regarded as magnetic resonance imaging (MRI) manifestations of cerebral small vessel disease (cSVD). 24-hour blood pressure variability (BPV) has been reported to relate with cerebral small vessel disease, but the impact of 24-h BPV on the total MRI cSVD burden and its progression in inpatients with cerebrovascular disease has not been investigated yet. Methods: We enrolled inpatients with cerebrovascular disease, who underwent the 24-h ambulatory blood pressure monitoring (ABPM) and the brain MRI scan at baseline and had the follow-up brain MRI images stored in the clinical information system of our hospital...
2020: Frontiers in Neurology
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