The Role of Angioplasty Alone in Intracranial Atherosclerosis: 2-Dimensional Operative Video

2021 ◽  
Vol 20 (5) ◽  
pp. E350-E351
Author(s):  
Salomon Cohen-Cohen ◽  
Giuseppe Lanzino ◽  
Waleed Brinjikji ◽  
Adam Arthur ◽  
Mark Bain ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Ct Perfusion ◽  
Video Production ◽  
Intracranial Atherosclerosis ◽  
Cerebral Angiogram ◽  
Neurological Exam ◽  
Conventional Angioplasty ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Angioplasty And Stenting

Abstract Intracranial atherosclerosis disease (IAD) is the cause of stroke in up to 10% of cases. Symptomatic IAD results mainly from hypoperfusion, embolic phenomenon, and occlusion. Treatment consists of conservative management with aggressive medical treatment, surgery, and endovascular therapy.1,2 This video is about a 62-yr-old male who presented with left-sided hemiparesis and right gaze preference secondary to an acute ischemic stroke in the right middle cerebral artery (MCA) territory treated initially with  tissue plasminogen activator (tPA). Head computed tomography (CT) angiography (CTA) revealed occlusion of the extracranial and cavernous segments of the internal carotid artery (ICA). CT perfusion (CTP) showed hypoperfusion in the MCA territory and magnetic resonance imaging (MRI) revealed multifocal, wedge-shaped areas of restricted diffusion in the right hemisphere. During his hospitalization, he experienced worsening of his symptoms in the setting of hypoperfusion (hypotension). The patient underwent a cerebral angiogram with thrombectomy and submaximal angioplasty (SA). Successful revascularization of the right ICA was obtained. No procedure-related complications occurred, and the patient's neurological exam improved. SA can be as efficient and a safer option than conventional angioplasty or angioplasty and stenting for symptomatic IAD. The patient consented for the procedure and for the video production.

scholarly journals Shifting of global aphasia to Wernicke’s aphasia in a patient with intact motor function: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ya-Chi Chuang ◽  
Chuan-Ching Liu ◽  
I-Ching Yu ◽  
Yu-Lin Tsai ◽  
Shin-Tsu Chang
Keyword(s):  
Computed Tomography ◽  
Right Hemisphere ◽  
Single Photon ◽  
Ct Perfusion ◽  
Single Case ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Speech Fluency ◽  
Language Functions ◽  
The Right

Abstract Background Global aphasia without hemiparesis (GAWH) is a rare stroke syndrome characterized by the dissociation of motor and language functions. Here, we present a case of GAWH with the patient later regaining speech fluency. Case presentation A 73-year-old man was admitted to our emergency department immediately after an episode of syncope. On arrival, we noted his global aphasia but without any focal neurologic signs. Computed tomography (CT) perfusion scans showed a large hypodense region over his left perisylvian area. Under the impression of acute ischaemic stroke, he received recombinant tissue plasminogen activator (rtPA) injection and was treated as an inpatient. The patient was later discharged with GAWH status and received regular speech rehabilitation. After 14 months of rehabilitation, the patient gradually recovered his language expression ability. The degree of aphasia was evaluated with the Concise Chinese Aphasia Test (CCAT), and we obtained brain single photon emission computed tomography (SPECT) scans to assess cerebral blood flow. Conclusion A patient with severe impairments of Broca’s and Wernicke’s areas was able to talk fluently despite being unintelligible. SPECT revealed relative high level of radioactivity uptake in the right frontal lobe, suggesting the deficits in speech fluency could have been compensated by the right hemisphere. Although this is a single case demonstration, the results may strengthen the role of the right hemisphere in GAWH patients and suggests additional study that examines the possible benefits of stimulating activity at right homologous regions for recovering language function after global aphasia.

Emotions Are Rising: The Growing Field of Affect Neuropsychology

2017 ◽  
Vol 23 (9-10) ◽  
pp. 719-731 ◽  
Author(s):  
Skye McDonald
Keyword(s):  
Cognitive Processing ◽  
Mirror Neurons ◽  
Right Hemisphere ◽  
Task Demands ◽  
Careful Examination ◽  
Somatic Marker ◽  
Cortical Responses ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

AbstractThirty years ago, the neuropsychology of emotion started to emerge as a mainstream topic. Careful examination of individual patients showed that emotion, like memory, language, and so on, could be differentially affected by brain disorders, especially in the right hemisphere. Since then, there has been accelerating interest in uncovering the neural architecture of emotion, and the major steps in this process of discovery over the past 3 decades are detailed in this review. In the 1990s, magnetic resonance imaging (MRI) scans provided precise delineation of lesions in the amygdala, medial prefrontal cortex, insula and somatosensory cortex as underpinning emotion disorders. At the same time, functional MRI revealed activation that was bilateral and also lateralized according to task demands. In the 2000s, converging evidence suggested at least two routes to emotional responses: subcortical, automatic and autonomic responses and slower, cortical responses mediating cognitive processing. The discovery of mirror neurons in the 1990s reinvigorated older views that simulation was the means to recognize emotions and empathize with others. More recently, psychophysiological research, revisiting older Russian paradigms, has contributed new insights into how autonomic and other physiological indices contribute to decision making (the somatic marker theory), emotional simulation, and social cognition. Finally, this review considers the extent to which these seismic changes in understanding emotional processes in clinical disorders have been reflected in neuropsychological practice. (JINS, 2017, 23, 719–731)

scholarly journals Current knowledge of large vascular occlusion due to intracranial atherosclerosis: focusing on early diagnosis

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
He Li ◽  
Peng Liu ◽  
Pei Liu ◽  
Weilong Hua ◽  
Wenjin Yang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Current Knowledge ◽  
Vascular Occlusion ◽  
Diagnostic Methods ◽  
Intracranial Atherosclerosis ◽  
Endovascular Recanalization ◽  
The Status ◽  
Medical Histories ◽  
Magnetic Resonance Imaging Mri ◽  
Angioplasty And Stenting

Abstract Intracranial atherosclerosis (ICAS)-related large vascular occlusion (LVO) was an intractable subtype of acute ischemic stroke (AIS), which always needed rescue angioplasty and stenting and complicated the procedure of endovascular recanalization. Diagnosing ICAS-LVO accurately and early was helpful for both clinical treatment and trials. Digital subtraction angiography (DSA) was unable to provide an early and rapid diagnosis of ICAS-LVO based on current studies. A variety of pre-DSA methods had been used to distinguish ICAS-LVO with other subtypes of ischemic stroke, such as medical histories, clinical presentations, computed tomography or angiography (CT/CTA), and magnetic resonance imaging (MRI/MRA). This article briefly reviewed the status quo of the diagnosis and treatment of ICAS-LVO and summarized early diagnostic methods of ICAS-LVO from different aspects.

scholarly journals Primary multiple cerebral hydatid disease in a young patient with surgically-treated intracerebral haemorrhage

2021 ◽  
pp. 71-74
Author(s):  
Anwar N. Hafedh ◽  
Awfa A. Aktham ◽  
Zahraa F. Al-Sharshahi ◽  
Ahmed Ibrahim Al-Jorani ◽  
Sama Albairamani ◽  
...  
Keyword(s):  
Hydatid Disease ◽  
Intracerebral Haemorrhage ◽  
Right Hemisphere ◽  
Brain Magnetic Resonance Imaging ◽  
Future Research ◽  
New Findings ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
One Year ◽  
The Right

Introduction:  Cerebral hydatid disease (CHD) is rare and the multiple-cystic variety is even rarer. In this paper, we report a case of multiple CHD and explore a possible link with a preceding spontaneous intracerebral haemorrhage (ICH).   Case presentation: A 27-year old gentleman with a history of surgically-evacuated, spontaneous ICH presented with severe headache, left-sided weakness - Medical Research Council (MRC) grade II - and recurrent tonic-clonic seizures, while on a full dose of anti-epileptic medication. Brain magnetic resonance imaging (MRI) scans showed multiple intra-axial cystic lesions in the right hemisphere. The cysts were removed intact using Dowling’s technique through a large temporoparietal craniotomy. The surgery went uneventful and the patient recovered as expected. Post-operatively, a prophylactic course of albendazole (200 mg) was prescribed. On his one-year follow-up visit, the patient was symptom-free and his weakness had improved (left upper limb: MRC grade IV and full power of the left lower limb). The computed tomography (CT) scan showed no new findings.   Conclusion: Primary cerebral hydatid disease is rare and the multiple-cyst variety is even rare. In this case, a peculiar association with a surgically-treated ICH was explored with possible theories to suggest future research directions.

Interhemispheric Contralateral Transfalcine Approach for Subparacentral Arteriovenous Malformation: 3-Dimensional Operative Video

2021 ◽  
Author(s):  
Matías Baldoncini ◽  
Alvaro Campero ◽  
Sabino Luzzi ◽  
Juan F Villalonga
Keyword(s):  
Right Hemisphere ◽  
Vascular Lesion ◽  
Neurological Deficits ◽  
3 Dimensional ◽  
Postoperative Mri ◽  
Drainage Vein ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Superior Longitudinal Sinus ◽  
The Right

Abstract Neurovascular procedures along the interhemispheric fissure harbor unique features differentiating them from those arteriovenous malformations (AVMs) located at the lateral surface of the brain.1-4  The aim of this 3-dimensional operative video is to present a microsurgical resection of an AVM in a subparacentral location, operated through an interhemispheric contralateral transfalcine approach.1,3,5  This is a case of a 29-yr-old female, with headaches and history of seizures. The patient presented an interhemispheric bleeding 6 mo before the surgery. The magnetic resonance imaging (MRI) showed a vascular lesion located on the medial surface of the right hemisphere at the confluence between the cingulate sulcus and its ascending sulcus. In the cerebral angiography, a right medial AVM was observed, receiving afference from the right anterior cerebral artery and draining to the superior longitudinal sinus. The patient signed an informed consent for the procedure and agreed with the use of her images and surgical video for research and academic purposes.  The patient was in a supine position, and a left interhemispheric contralateral transfalcine approach was performed,1-3 a circumferential dissection of the nidus, and, finally, the AVM was resected in one piece.  The patient evolved without neurological deficits after the surgery. The postoperative MRI and angiography showed a complete resection of the AVM.  In the case presented, to avoid exposing the drainage vein first and to use the gravity of the exposure, the contralateral transfalcine interhemispheric approach was used,1,2 which finally accomplished the proposed objectives.

scholarly journals Acute Intravenous Calcium Antagonist for Suspected Hemiplegic Migraine – A Case Story

2017 ◽  
Vol 9 (1) ◽  
pp. 98-105 ◽  
Author(s):  
Charlotte Lützhøft Rath ◽  
Jun He ◽  
Mette Maria Nordling ◽  
Troels Wienecke
Keyword(s):  
Symptom Onset ◽  
Right Hemisphere ◽  
Young Patients ◽  
Brain Magnetic Resonance Imaging ◽  
Recombinant Tissue Plasminogen Activator ◽  
Hemiplegic Migraine ◽  
Brain Ct ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Stroke mimics, like attacks of hemiplegic migraine, are challenging in acute stroke evaluation. We present a 28-year-old woman with a suspected hemiplegic migraine attack with left-sided hemiparalysis. Brain CT with perfusion imaging 1 h 54 min after symptom onset revealed hypoperfusion in the right hemisphere. The patient was treated with intravenous recombinant tissue plasminogen activator (rtPA) with no effect. After a subsequent intravenous verapamil infusion, the patient gained full motor function within 10 min. Brain magnetic resonance imaging (MRI) performed 5 h 46 min after symptom onset revealed diffusion restriction in the same area as the hypoperfusion on CT. There were no notable changes on T2 images. The patient stayed clinically in remission, except for reduced sensation for all modalities on the extremities on the left side. Although brain CT 24 h after symptom onset revealed an edema in the same area, an MRI performed 17 days later showed no new infarctions. Young patients with a history of migraine with aura admitted with symptoms of acute ischemic stroke are at risk of insufficient treatment. Calcium antagonists might be considered if there is no effect of first-line treatment with rtPA.

scholarly journals A case of pseudotumor cerebri secondary to acute leukemia

2020 ◽  
Vol 10 (3) ◽  
pp. 105-107
Author(s):  
Turgay Demir ◽  
Filiz Koc ◽  
Seyda Erdoğan
Keyword(s):  
Acute Leukemia ◽  
Lymphoblastic Leukemia ◽  
Brain Magnetic Resonance Imaging ◽  
Pseudotumor Cerebri ◽  
Lymphoid Cells ◽  
Temporal Region ◽  
Opening Pressure ◽  
Neurological Exam ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Introduction: Idiopathic intracranial hypertension (IIH) is a rare clinical condition in which an increase in intracranial pressure is seen without a lesion in the head. The association of IIH with haematological malignencies is not well known. Case: We present 19-year-old male with frequent episodes of headache that lasted up to 24 hours, localized to the bilateral temporal region accompanied with nausea and vomiting for two months. On the neurological exam, the lateral gaze was slightly restricted. Ophthalmological exam revealed bilateral papilledema, which was more pronounced on the right. Bilateral concentric constriction, more pronounced on the right , was observed on the computerized visual field exam. Brain Magnetic Resonance Imaging (MRI) showed swelling in the optic nerve sheats, rather than on the right. In the analysis of cerebrospinal fluid (CSF), the opening pressure was 370 mmH2 Cytological examination of the CSF showed atypical lymphoid cells. The patient was diagnosed as precursor lymphoblastic leukemia/lymphoma. Conclusion: Acute leukemia–induced clinical IIH has not been reported in the literature up to now, and the present case study will contribute to the literature in this regard. This phenomenon will be noteworthy for clinicians who encounter high CSF opening pressure, abnormal CSF biochemistry, and substantial cytology in cases presenting with clinical IIH.

scholarly journals Changes of cerebral cortical structure and cognitive dysfunction in “healthy hemisphere” after stroke: a study about cortical complexity and sulcus patterns in bilateral ischemic adult moyamoya disease

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ziqi Liu ◽  
Shihao He ◽  
Yanchang Wei ◽  
Ran Duan ◽  
Cai Zhang ◽  
...  
Keyword(s):  
Cognitive Dysfunction ◽  
Moyamoya Disease ◽  
Right Hemisphere ◽  
Quantitative Description ◽  
Three Dimensional ◽  
Wide Range ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Adult Moyamoya Disease ◽  
Surface Based Morphometry

Abstract Background Moyamoya disease (MMD) is an uncommon cerebrovascular disease which leads to progressive stenosis and occlusion of the bilateral internal carotid artery and main intracerebral arteries. Concerns are always on how the hemisphere with infarction affects cognitive function, while little attention is paid to the role that the non-infarcted hemisphere plays. Therefore, we aimed to detect cortical indexes, especially cortical complexity in the left or right hemisphere separately in patients with MMD after stroke. Methods 28 patients with MMD (14 males, 14 females) and 14 healthy controls were included in this study. All participants underwent cognitive tests and magnetic resonance imaging (MRI) scan. The preprocessing of three-dimensional T1 weighted images were performed by standard surface-based morphometry. Surface-based morphometry statistical analysis was carried out with a threshold of False Discovery Rate (FDR) P < 0.05 and fractal dimension (FD) was used to provide a quantitative description of cerebral cortical complexity. Results Widespread cognitive dysfunctions were found in MMD patient with stroke. Extensive FD reduction in the left hemisphere with right-sided infarction, mainly in the superior temporal, inferior frontal, and insula, while the post central gyrus, superior parietal, and inferior parietal gyrus also showed a wide range of significant differences (FDR corrected P < 0.05). Meanwhile, FD changes in the right hemisphere with left-sided infarction are restricted to the precuneus and cingulate isthmus (FDR corrected P < 0.05). Conclusions Extensive cognitive impairment was reconfirmed in Moyamoya disease with stroke, while wild and asymmetrical decrease of cortical complexity is observed on both sides. These differences could be relative to unbalanced cognitive dysfunction, and may be the result of a long-term chronic ischemia and compensatory of the contralateral hemisphere to the infarction.

scholarly journals Altered hypothalamic microstructure in human obesity

2019 ◽  
Author(s):  
K. Thomas ◽  
F. Beyer ◽  
G. Lewe ◽  
R. Zhang ◽  
S. Schindler ◽  
...  
Keyword(s):  
Animal Studies ◽  
Energy Homeostasis ◽  
Structural Changes ◽  
Right Hemisphere ◽  
Large Samples ◽  
Weighted Magnetic Resonance Imaging ◽  
Important Regulator ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
And Diffusion

AbstractObesity is a multifactorial disorder driven by sustained energy imbalance. The hypothalamus is an important regulator of energy homeostasis and therefore likely involved in obesity pathophysiology. Animal studies suggest that obesity-related diets induce structural changes in the hypothalamus through inflammation-like processes. Whether this translates to humans is however largely unknown. Therefore, we aimed to assess obesity-related differences in hypothalamic macro- and microstructure based on a multimodal approach using T1-weighted and diffusion-weighted magnetic resonance imaging (MRI) acquired at 3 Tesla in a large well-characterized sample of the Leipzig Research Center for Civilization Diseases (LIFE) cohort (n1 = 338, 48% females, age 21-78 years, BMI 18-43 kg/m2). We found that higher body mass index (BMI) selectively predicted higher mean proton diffusivity (MD) within the hypothalamus, indicative of compromised microstructure in the underlying tissue. Results were independent from confounders and confirmed in another independent sample (n2 = 236). In addition, while hypothalamic volume was not associated with obesity, we identified a sexual dimorphism and larger hypothalamic volumes in the left compared to the right hemisphere. Using two large samples of the general population, we showed that a higher BMI specifically relates to altered microstructure in the hypothalamus, independent from confounders such as age, sex and obesity-associated co-morbidities. This points to persisting microstructural changes in a key regulatory area of energy homeostasis occurring with excessive weight. These findings may help to better understand the pathomechanisms of obesity and other eating-related disorders.

scholarly journals Effect of Gender on Development of Hippocampal Subregions From Childhood to Adulthood

2020 ◽  
Vol 14 ◽  
Author(s):  
Shu Hua Mu ◽  
Bin Ke Yuan ◽  
Li Hai Tan
Keyword(s):  
Right Hemisphere ◽  
Developmental Trajectories ◽  
Molecular Layer ◽  
Hemispheric Differences ◽  
Average Volume ◽  
Cross Sectional ◽  
Early Increase ◽  
Consistent Increase ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

The hippocampus is known to be comprised of several subfields, but the developmental trajectories of these subfields are under debate. In this study, we analyzed magnetic resonance imaging (MRI) data from a cross-sectional sample (198 healthy Chinese) using an automated segmentation tool to delineate the development of the hippocampal subregions from 6 to 26 years of age. We also examined whether gender and hemispheric differences influence the development of these subregions. For the whole hippocampus, the trajectory of development was observed to be an inverse-u. A significant increase in volume with age was found for most of the subregions, except for the L/R-parasubiculum, L/R-fimbria, and L-HATA. Gender-related differences were also found in the development of most subregions, especially for the hippocampal tail, CA1, molecular layer HP, GC-DG, CA3, and CA4, which showed a consistent increase in females and an early increase followed by a decrease in males. A comparison of the average volumes showed that the right whole hippocampus was significantly larger, along with the R-presubiculum, R-hippocampal-fissure, L/R-CA1, and L/R-molecular layer HP in males in comparison to females. Additionally, the average volume of the right hemisphere was shown to be significantly larger for the hippocampal tail, CA1, molecular layer HP, GC-DG, CA3, and CA4. However, for the presubiculum, parasubiculum, and fimbria, the left side was shown to be larger. In conclusion, the hippocampal subregions appear to develop in various ways from childhood to adulthood, with both gender and hemispheric differences affecting their development.

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