11/952. Twinkling artifact on intracerebral color Doppler sonography. Transcranial Doppler sonography shows potential as a noninvasive technique for long-term follow-up of treated intracranial saccular aneurysms. This technical note describes a color Doppler artifact related to microcoil architecture that might represent a potential pitfall in transcranial Doppler sonographic evaluation of aneurysmal cavity thrombosis, since it may be wrongly interpreted as residual flow or aneurysmal cavity recanalization. ( info) |
12/952. Cerebellar infarct caused by spontaneous thrombosis of a developmental venous anomaly of the posterior fossa. Spontaneous thrombosis of a posterior fossa developmental venous anomaly (DVA) caused a nonhemorrhagic cerebellar infarct in a 31-year-old man who also harbored a midbrain cavernous angioma. DVA thrombosis was well depicted on CT and MR studies and was proved at angiography by the demonstration of an endoluminal clot. ( info) |
13/952. Acute embolic carotid occlusion after cardiac catheterization: effect of local intra-arterial urokinase thrombolysis. A 64-year-old woman developed a severe embolic cerebral attack with total left hemiplegia approximately 30 hours after cardiac catheterization for mitral stenosis. She underwent intra-arterial thrombolysis of the right internal carotid artery four and one-half hours after the onset of neurologic deficit with subsequent recanalization of the occluded vessel and near complete neurologic recovery. ( info) |
| During antibiotic therapy, a 56-year-old man with a streptococcus bovis endocarditis developed an infarction of the right middle cerebral artery (MCA). Thirty hours after stroke onset, cranial computed tomography controls demonstrated a secondary subarachnoid hemorrhage, marked in the cistern of the right MCA. The latent period, cerebrospinal fluid analysis, angiographic and pathologic findings favor the assumption of a pyogenic arterial wall necrosis of the MCA due to a septic embolus. This pathomechanism of intracranial hemorrhage in infective endocarditis should be distinguished from a rupture of a mycotic aneurysm. ( info) |
15/952. Cerebral and renal embolization after lymphography in a patient with non-Hodgkin lymphoma: case report. An unusual case of lipid embolization to brain and kidney after lymphography in a patient with non-Hodgkin lymphoma of the upper anterior mediastinum is reported. Contrast material-enhanced echocardiography demonstrated a right-to-left shunt to the left atrium without evidence of a patent foramen ovale. Echo contrast particles were transiently present within the tumor surrounding the great vessels. ( info) |
| BACKGROUND: diffusion-weighted (DWI) and perfusion-weighted (PI) MRI are highly sensitive techniques for early diagnosis of arterial infarction, but little data on venous cerebral ischemia are available. We describe a case in which DWI, PI, and fast T2-weighted sequences were performed in the acute phase of deep cerebral venous thrombosis (CVT). CASE DESCRIPTION: An 11-year-old girl with Crohn's disease developed deep CVT in which extensive edema was shown in the deep gray matter on T2-weighted sequence images. Isotropic echo-planar DWI demonstrated a local augmentation of the apparent diffusion coefficient (1.1 to 1.6x10(-3) mm2/s), consistent with vasogenic edema. In dynamic contrast-enhanced PI, the regional cerebral blood volume was increased and the passage time of the contrast bolus was markedly prolonged. Clinically, the patient recovered totally after intravenous full-dose heparinization. T2 abnormalities, apparent diffusion coefficient values (0.8 to 0.92x10(-3) mm2/s), and brain perfusion alterations resolved without damage to brain tissue. CONCLUSIONS: Unlike arterial infarction, DWI demonstrated vasogenic edema in a patient with deep CVT, which proved to be reversible in follow-up magnetic resonance imaging. PI showed areas with extensive venous congestion, but perfusion deficits were missing. Therefore, we believe that DWI and PI may play a role in detecting venous congestion in CVT and in prospective differentiation of vasogenic edema and venous infarction. ( info) |
17/952. Treatment and results of partially thrombosed giant aneurysms. Partially thrombosed giant aneurysms are one of the most difficult diseases in the neurosurgical field. We have had 18 of these cases namely, three in vertebral artery, four in basilar artery, four in internal carotid artery, five in middle cerebral artery, and two in anterior communicating artery. Nine aneurysms were clipped, two aneurysms were removed with anastomosis, two cases were treated interventionally, and five cases were treated conservatively because of serpentine and fusiform types of aneurysms in internal carotid artery bifurcation. These conservatively treated patients died due to infarction. When surgery is selected in the thrombosed giant aneurysms, the approach is the most important to secure the neck. Three-dimensional computed tomography angiography was useful to plan the strategy for surgery. If the neck is big enough for placement of a clip, arterial reconstruction is the choice. The reconstruction must be done including an adequate size of the artery because of the thick wall. If the aneurysm neck is too small to reconstruct, aneurysmectomy with anastomosis is one of the choices. ( info) |
18/952. 99mTc-bicisate and 99mTc-HMPAO SPECT imaging in early spontaneous reperfusion of cerebral embolism. Two patients with a cerebral embolism were evaluated by using both 99mTc-ethyl cysteinate dimer (ECD, or Bicisate) and 99mTc-hexamethylpropyleneamine oxime (HMPAO) single-photon emission computed tomography (SPECT). In one patient, 99mTc-ECD SPECT images revealed hypoactivity in a reflow hyperemic area where an infarct was seen later on CT scans. In another patient, a reperfused area showed hyperactivity on 99mTc-ECD SPECT without any abnormality on follow-up CT. 99mTc-ECD represents a potential agent with which to evaluate cerebral tissue viability in early reperfusion after ischemia. ( info) |
19/952. Cerebral embolism associated with left ventricular assist device support and successful therapy with intraarterial urokinase. A patient with a bioprosthetic aortic valve sustained a cerebral embolism during support with an implantable left ventricular assist device. This was lysed with intraarterial urokinase with complete resolution of the neurological deficit. Subsequently the patient underwent heart transplantation and remains neurologically intact. This case report is the first successful use of thrombolysis for cerebral embolism associated with a mechanical assist device. ( info) |
20/952. Acute deterioration from thrombosis and rerupture of a giant intracranial aneurysm. The authors describe a patient with an unusual clinicopathologic picture of giant aneurysmal hemorrhage followed by sudden deterioration due to acute intra-aneurysmal thrombosis and fatal rebleeding. This patient underscores the poor natural history associated with this devastating disease and serves to highlight the dangers inherent in the delayed treatment of these life-threatening lesions. ( info) |