bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endovascular Trapping of a Vertebral Artery Segment to Control PICA Origin Tearing
Authors: Nguyen Thanh N. , Roy Daniel , Guilbert Francois , Raymond Jean , Weill Alain 
Published: October 2009

ABSTRACT Iatrogenic perforation or rupture during aneurysm coiling can be difficult to manage and may lead to fatal bleeding. We describe a lifesaving technique of isolating the subarachnoid segment of the vertebral artery using two balloons to trap flow to a ruptured PICA aneurysm allowing time to coil the parent artery with the aneurysm. CASE A 58‐year‐old woman presented with Hunt Hess Grade 3 subarachnoid hemorrhage due to a 3 mm left PICA aneurysm. During placement of the first coil, aneurysm perforation was noted. Despite conventional measures to manage the perforation (anticoagulation reversal, balloon inflation, placement of a second coil, and ventricular drain), contrast extravasation persisted after 45 minutes. A second balloon was positioned via the right vertebral artery at the right vertebrobasilar junction and inflated. The first balloon was pulled back, inflated, allowing trapping of the ruptured site. The aneurysm and adjacent vertebral segment were rapidly coiled to occlude the ruptured site under local flow arrest. The patient awoke with dysarthria, left‐sided hemiparesis and dysphagia. CONCLUSION Trapping an arterial segment with two balloons may help in the management of PICA origin aneurysm perforation refractory to medical and current endovascular strategies. This technique, while potentially lifesaving, may engender ischemic complications.
Worsened MRI Findings During the Early Period of Treatment with Penicillin in a Patient with General Paresis
Authors: Zhang She‐Qing , Wan Bo , Ma Xiao‐Long , Zheng Hui‐Min 
Published: October 2009

ABSTRACTA 52‐year‐old man was diagnosed with general paresis, whose HIV antibodies were negative. After initiation of treatment with penicillin on the first day, no obvious clinical Jarisch‐Herxheimer reaction was found. However, 6 days after treatment, the patient was found more irritable and was unable to fall asleep at night. On the seventh day, worsened magnetic resonance imaging (MRI) abnormalities in the bilateral medial and anterior temporal lobes were unexpectedly discovered. These worsened MRI abnormalities improved quickly after the addition of dexamethasone treatment. We consider that these transient and slight mental symptoms may be associated with the transiently worsening phenomenon in cerebral MRI findings during the early period of treatment with penicillin. This indicates that some nonspecific inflammatory process has happened in the early stage of treatment, which necessitates the use of corticosteroids after the occurrence of systemic or mental symptoms.
Proton Magnetic Resonance Spectroscopy in School‐Aged Autistic Children
Authors: Vasconcelos Marcio Moacyr , Brito Adriana Rocha , Domingues Romeu Cortes , Da Cruz Luiz Celso Hygino , Gasparetto Emerson L. , Werner Jairo , Gonçalves João Pedro Sevalho 
Published: October 2009

ABSTRACTPURPOSEThis study aims to assess cerebral metabolites in school‐aged autistic patients through proton magnetic resonance spectroscopy.METHODSThis case‐control study included 10 right‐handed male children (median age, 9.53 years ± 1.80) with autism according to DSM‐IV criteria, and 10 healthy age‐ and sex‐matched healthy controls (median age, 8.52 years ± 1.42). Imaging was performed on a 1.5‐T scanner utilizing a single voxel point‐resolved spectroscopy (PRESS) technique (TR = 1,500 ms, TE = 30 ms). Four cerebral areas were evaluated: bilateral anterior cingulate, left striatum, left cerebellar hemisphere, and left frontal lobe. Peak areas and ratios to creatine (Cr) of N‐acetylaspartate (NAA), choline (Cho), andmyo‐inositol (mI) were analyzed.RESULTSCompared with controls, autistic children showed a significant increase in mI (P= .021) and Cho (P= .042) peak areas in anterior cingulate and in mI/Cr ratio in anterior cingulate (P= .037) and left striatum (P= .035). The remaining metabolites and ratios were not significantly different between the 2 groups.CONCLUSIONSThis study found a statistically significant increase in myo‐inositol and choline in anterior cingulate and left striatum of autistic children compared with controls. In contrast to previous studies, NAA peak area and NAA/Cr and NAA/Cho ratios had no statistically significant decrease in any of the 4brain regions.
Recovery of Reversed Basilar Artery Flow as Seen by Transcranial Sonography and MRA Source Images for Vertebral Dissection
Authors: Lee Sung Ik , Yang Hyun Duk , Son Il Hong , Han Sun Jung 
Published: October 2009

ABSTRACTThe dissection of the intracranial vertebral artery (VAD) is a common cause of young age brain stem stroke. VAD can be detected by conventional angiography, but there is yet no agreement on the most effective tool to use for the detection of VAD. Here, we report a patient with VAD, who was diagnosed with an intimal flap within the left vertebral artery by the magnetic resonance angiography (MRA) source images. Transcranial Doppler (TCD) showed a reversed flow in the basilar artery. After 4 months, TCD and transcranial color‐coded Doppler (TCCD) confirmed a normal anterograde flow of the vertebro‐basilar arteries.
The Value of Diffusion‐Weighted Imaging in the Diagnosis of Marchiafava‐Bignami Disease: Apropos of a Case
Authors: Aggunlu Levent , Oner Yusuf , Kocer Belgin , Akpek Sergin 
Published: October 2009

ABSTRACTMarchiafava‐Bignami disease (MBD) is characterized by demyelination and necrosis of corpus callosum encountered in chronic alcoholic patients. Etiology is the deficiency of vitamin B complex. Magnetic resonance imaging (MRI) in MBD typically reveals focal lesions of high T2 and FLAIR signal intensity in the corpus callosum. We here present a 42‐year‐old male alcoholic diagnosed as MBD on the basis of MRI and diffusion‐weighted imaging (DWI) features. The patient totally recovered following appropriate vitamin B complex replacement therapy, despite reduced diffusion in the initial setting. This case report emphasizes on the important role played by MRI and DWI in the early diagnosis and follow‐up of this potentially fatal disease.
fMRI of Optokinetic Eye Movements With and Without a Contribution of Smooth Pursuit
Authors: Schraa‐Tam Caroline K.L , Van Der Lugt Aad , Smits Marion , Frens Maarten A. , Van Broekhoven P.C.A. , Van Der Geest Josef N. 
Published: October 2009

ABSTRACTBACKGROUND AND PURPOSE Optokinetic eye movements are elicited when tracking a moving pattern. It can be argued that a moving pattern of stripes invokes both the optokinetic and the smooth pursuit eye movement system, which may confound the observed brain activation patterns using functional magnetic resonance imaging (fMRI). A moving pattern of limited‐lifetime‐dot stimulation does not target the smooth pursuit eye movement system. METHODS fMRI was used to compare the cortical activity elicited by an optokinetic eye movement response evoked by a moving pattern of stripes and a moving pattern of limited lifetime dots. RESULTS The eye movement behavior showed that both types of stimuli evoked an adequate and similar optokinetic eye movement response, but stimulation with stripes evoked more activation in the frontal and parietal eye fields, MT/V5, and in the cerebellar area VI than stimulation with limited‐lifetime dots. CONCLUSIONS These brain areas are implicated in smooth pursuit eye movements. Our results suggest that indeed both the optokinetic and the smooth pursuit eye movement system are involved in tracking a moving pattern of stripes.
Simultaneous Bilateral Carotid Stenting in One Session in High‐Risk Patients
Authors: Wang Yao‐Hung , Hsieh Hong‐Jen , Lee Chung‐Wei , Chen Ya‐Fang , Jeng Jiann‐Shing , Liu Hon‐Man 
Published: October 2009

ABSTRACT The authors report their experience in treating a group of 6 high‐risk patients with severe bilateral carotid disease by carotid artery stenting in a single session. The patients were men aged 53 to 83 years. All had bilateral, synchronous, symptomatic ischemic disease. Five of the 6 patients had severe bilateral carotid stenoses due to atherosclerotic disease: the sixth had a dissecting aneurysm on one side. All were treated with self‐expandable stents: a distal protection device was used. All stenting procedures were technically successful. Stenoses averaged 84 ± 8% before the procedure and 10 ± 7% after. No procedure‐related complications occurred and no 30‐day postoperative complications were found. One patient experienced bradhycardia and hypotension for 1 day and was treated medically. After careful preparation and perioperative procedures in a selected group of patients, simultaneous bilateral carotid stenting procedures are feasible when required and appear to be relatively safe.
MR Imaging of Primary Spinal Germinoma: A Case Report and Review of the Literature
Authors: Lu Nan‐Han , Sandy  , Chen Cheng‐Yu , Chou Jung‐Mao , Kuo Tai‐Hung , Yeh Ching‐Hui 
Published: October 2009

ABSTRACT Germinomas in the central nervous system (CNS) are uncommon tumors and occur usually in the pineal or suprasellar regions. Primary spinal germinoma is extremely rare. Here we reported a rare case of an extramedullary germinoma in a young adult who presented with progressive paraparesis and retention of stool and urine. The MR image features with their differential diagnoses were discussed along with literature review of all previously reported 22 cases.
Microemboli in Aneurysmal Subarachnoid Hemorrhage
Authors: Romano Jose G. , Rabinstein Alejandro A. , Arheart Kristopher L. , Nathan Sandra , Campo‐Bustillo Iszet , Koch Sebastian , Forteza Alejandro M. 
Published: October 2009

ABSTRACTBACKGROUND AND PURPOSE The determinants of ischemic complications in subarachnoid hemorrhage (SAH) are not well defined. The objective of this study is to evaluate the role of microemboli in SAH‐related cerebral ischemia. METHODS Forty patients with aneurysmal SAH were monitored with transcranial Doppler (TCD) for the presence of embolic signals (ES) and vasospasm, and followed clinically for the development of cerebral ischemic symptoms, from the time the aneurysm was secured until day 14 posthemorrhage or discharge. RESULTS Microembolic signals were detected in 15/40 patients, appeared at a mean of 6.7 days after hemorrhage, and were often noted bilaterally. There was a close association between ES and cerebral ischemic symptoms (P= .003), and ES were commonly present in the distribution of the vessel with ischemic symptoms. Ultrasonographic vasospasm did not correlate with ischemia and there was no relationship between microembolic signals and vasospasm. CONCLUSIONS In this study, ES detected in over a third of SAH victims, were associated with the development of cerebral ischemic symptoms, and were not related to vasospasm, but rather appeared to be an independent risk factor for the development of ischemic symptoms in SAH.
Cutting Balloon Angioplasty for Carotid In‐Stent Restenosis: Case Reports and Review of the Literature
Authors: Shah Qaisar A. , Georgiadis Alexandros L. , Suri M. Fareed K. , Rodriguez Gustavo J. , Qureshi Adnan I. 
Published: October 2009

ABSTRACTPercutaneous stenting techniques are becoming more commonly used for treatment of carotid artery disease. One outcome of particular concern is in‐stent restenosis. Indications for treatment of in‐stent restenosis are not clearly defined. Use of traditional balloon angioplasty with or without stent placement is still considered the first option. Cutting balloon angioplasty has recently been used as an alternative treatment option for revascularization of in‐stent restenosis with higher procedural success rates and without the use of additional stents. We report our experience with cutting balloon angioplasty in treating 2 patients with carotid in‐stent restonosis, and review previous cases reported in the literature. A total of 16 patients have been treated with cutting balloon angioplasty. Among 11 patients for whom the clinical and angiographic information were available, 63% of patients were asymptomatic at the time of treatment, and more than 90% of patients showed either complete angiographic resolution or residual stenosis of less than 30%. Additional stent placement or angioplasty was required in only half of the patients, and 1 patient had recurrent stenosis. The review suggests that the procedure is safe and effective.
Transcranial Ultrasound of the Basal Ganglia in Sporadic Creutzfeldt‐Jakob Disease
Authors: Martin Müller , Thomas Treumann , Ekkehard Hewer , Katharina Stoeck 
Published: October 2009

ABSTRACTCreutzfeldt‐Jakob disease (CJD) is characterized by the core symptoms of rapid progressive dementia, myoclonus, and typical periodic sharp wave complexes (PSWC) on electroencephalography (EEG). In recent years, imaging techniques have become more and more important in the diagnostic process of CJD. Magnetic resonance imaging (MRI) is very characteristic and the most accurate imaging technique to be of help in diagnosing CJD. In this study, we applied transcranial color‐coded ultrasound (TCCS) in three cases of sporadic CJD. We found that all of them had in common a typical ultrasound tissue image of the lentiform nucleus, best to be described as a blurry inhomogeneous hyperechogenic signal pattern where usually the echogenicity is mostly homogeneously hypoechogenic.
Usefulness of 3‐Dimensional CT Angiograms Obtained by 64‐Section Multidetector Row CT Scanner for Dural Arteriovenous Fistula
Authors: Nakagawa Minoru , Sugiu Kenji , Tokunaga Koji , Tsuda Kohei , Imaoka Matsuhiro , Kawahara Atsushi , Fujiwara Kenjiro 
Published: October 2009

ABSTRACT The authors reported a case of a dural arteriovenous fistula (DAVF) in the left transverse‐sigmoid sinus, in which 3‐dimensional computed tomography (CT) angiograms (3D‐CTAs) by a 64‐section multidetector row CT scanner were useful for its diagnosis and treatment. The DAVF in the left transverse‐sigmoid sinus appeared on the digital subtraction angiogram. 3D‐CTAs were obtained by a 64‐section multidetector row CT scanner before an endovascular treatment. The feeders and draining veins of the DAVF were clearly demonstrated on the 3D‐CTAs, which clarified the relationship between the normal dural sinuses and DAVF. The DAVF was successfully treated with endovascular surgery, a transvenous embolization through the mastoid emissary vein, which was easily detected by using the 3D‐CTA, showing both the subcutaneous vein and calvalium. 3D‐CTAs by a 64‐section multidetector row CT scanner are useful for both diagnosis and treatment of DAVFs.
Central Nervous System Lymphoma Characterization by Diffusion‐Weighted Imaging and MR Spectroscopy
Authors: Zacharia T. Thomas , Law Meng , Naidich Thomas P. , Leeds Norman E. 
Published: October 2009

ABSTRACTPURPOSE The characterization and differentiation of central nervous system (CNS) lymphoma has important diagnostic, therapeutic, and prognostic significance. The purpose of this study is to characterize the diffusion‐weighted imaging (DWI) and MR spectroscopic (MRS) findings in CNS lymphoma. MATERIALS AND METHODS Twenty consecutive patients (male [n= 12], female [n= 8]) with histopathologically proven CNS lymphoma were retrospectively evaluated during this study from July 2005 to April 2007. Patients included immunocompromised (n= 9) and immunocompetent (n= 11) individuals. MR Imaging (pretreatment n= 13), pre‐ and post‐treatment (n= 7) included DWI (n= 20) (b = 1000s/mm2) and ADC (apparent diffusion coefficient) maps of all patients. MRS was performed (n= 10) with PRESS (point‐resolved spectroscopy) sequence (multivoxel n= 8, single voxel n= 2) with a TE of 144 msec. All patients were histopathologically confirmed to have lymphoma by biopsy. RESULTS Areas of restricted diffusion were observed in 90 % (n= 18/20) on pretreatment scans. The diffusion restriction was variable on post‐treatment scans. Median metabolite ratios in 10 patients were Cho/Cr‐ 2.12, NAA/Cho ‐ .49, and NAA/Cr ‐ 1.64. Presence of lactate or lipid was noted in 90 % (n= 9/10). Sites of lesion location were subcortical white matter (n= 6), basal ganglia (n= 4), corpus callosum (n= 3), extra‐axial space including cavernous sinus (n= 5), cerebellum (n= 1), and lateral ventricle (n= 1). CONCLUSION Restricted diffusion is a consistent imaging finding in CNS lymphoma in immunocompetent patients. Spectroscopy is helpful in initial imaging diagnosis and post‐treatment surveillance. These lesions are usually paraventricular in location. MR imaging appearances differ among immunocompetent and immunosuppressed individuals in most cases.
Chronic Total Symptomatic Carotid Artery Occlusion Treated Successfully with Stenting and Angioplasty
Authors: Bhatt Archit , Majid Arshad , Kassab Mounzer , Gupta Rishi 
Published: October 2009

ABSTRACTOBJECTIVE AND IMPORTANCE Treatment of symptomatic chronic totally occluded carotid artery has been limited to medical management. An ongoing clinical trial is examining the role of extracranial to intracranial bypass surgery in select patients with impaired cerebrovascular reserve based on PET imaging parameters. We describe a case utilizing stenting and angioplasty to treat a chronic total carotid occlusion as a potential alternative therapy. CLINICAL PRESENTATION A 55‐year‐old woman presented with a right hemispheric ischemic stroke in the setting due to a right internal carotid artery total occlusion. INTERVENTION She was treated medically with antiplatelet therapy and oral vasopressor agents. She returned with new symptoms 1 month later and was successfully treated with stenting and angioplasty. At the 9‐month follow‐up, she remains neurologically intact. CONCLUSION Stenting and angioplasty may be a therapeutic option in select patients with chronic total carotid occlusion. Further study is required to determine the safety profile of this treatment modality.
Combination of T2*W and FLAIR Abnormalities for the Prediction of Parenchymal Hematoma Following Thrombolytic Therapy in 100 Stroke Patients
Authors: Fiehler Jens , Siemonsen Susanne , Thomalla Goetz , Illies Till , Kucinski Thomas 
Published: October 2009

ABSTRACTINTRODUCTION The objective of our study was to determine whether the combination of hypointense spots (“cerebral microbleeds,” CMBs) with a leukoaraiosis is associated with the risk of parenchymal hematoma (PH) after thrombolytic therapy. PATIENTS AND METHODS We analyzed magnetic resonance imaging (MRI) scans acquired within 6 hours after symptom onset from 100 ischemic stroke patients. Multiparametric MRI including a T2*‐weighted (T2*w) MRI and fluid attenuated inversion recovery (FLAIR) was performed before thrombolysis in all patients. Initial T2*w imaging was rated by two independent observers for the presence of CMBs smaller than 5 mm. White matter changes were evaluated using an adapted scale of Fazekas and Schmidt. PH was defined in follow‐up imaging. FINDINGS A PH was observed in seven per 100 patients. CMBs were detected by observer 1 in 22 and observer 2 in 20 patients. We found a very low sensitivity (0.14) for prediction of PH by the presence of CMBs. We found a concordant increase in the rate of PH when the periventricular hyperintensity in FLAIR was larger than a thin lining. Sensitivity was good‐to‐perfect (0.86 and 1.00, observers 1 and 2) and specificity was substantial (0.65 and 0.66). Using the combination of a periventricular matter lesion (PVML)>1 and the presence of CMBs did not improve the prediction of PH. DISCUSSION A marked periventricular hyperintensity in FLAIR imaging seems to be associated with a substantially increased risk of PH. A combination of CMBs with leukoaraiosis scores did not appear to be beneficial for prognosis.
Retrograde Back‐Coiling Technique for a Ruptured Aneurysm of a Double‐Origin Posterior Inferior Cerebellar Artery
Authors: Vora Nirav , Thomas Ajith J. , Horowitz Michael B. , Jovin Tudor 
Published: October 2009

ABSTRACT The double origin of the posterior inferior cerebellar artery (PICA) is a variant anastomosis of a residual lateral spinal artery and native intracranial PICA that has been associated with intracranial aneurysm formation. Because of this anastomosis, both origins of the PICA serve as aneurysmal‐feeding vessels. We describe a novel technique of coiling with intracranial stent assistance to treat such a lesion that has not been described previously to our review.
Cortical Laminar Necrosis Caused by Rapidly Corrected Hyponatremia
Authors: Roh Jee Hoon , Kim Ji Hyun , Oh Kyungmi , Kim Sin Gon , Park Kun‐Woo , Kim Byung‐Jo 
Published: October 2009

ABSTRACT Cortical laminar necrosis (CLN) is radiologically characterized by hyperintense cortical lesions on unenhanced T1‐weighted images. Hypoxia is the representative cause of CLN; however, the rapid correction of hyponatremia has also been suggested as another possible cause. We present a patient who developed CLN and a permanent neurologic sequel following the rapid correction of hyponatremia without hypoxic insult, and discuss the characteristics of CLN lesions in view of osmotic demyelination syndrome based on magnetic resonance (MR) image findings.
Comparative Reliability of Total Intracranial Volume Estimation Methods and the Influence of Atrophy in a Longitudinal Semantic Dementia Cohort
Authors: Pengas George , Pereira João M. S. , Williams Guy B. , Nestor Peter J. 
Published: October 2009

ABSTRACTBACKGROUND AND PURPOSE Total intracranial volume (TIV) as a measure of premorbid brain size is often used to correct volumes of interest for interindividual differences in magnetic resonance imaging (MRI) studies. We directly compared the reliability of different TIV estimation methods to address whether such methods are influenced by brain atrophy in the neurodegenerative disease, semantic dementia. METHODS We contrasted several manual approaches using T1‐weighted, T2‐weighted, and proton density (PD) acquisitions with 2 automated methods (statistical parametric mapping 5 [SPM5] and FreeSurfer [FS]) in a cohort of semantic dementia subjects (n= 11) that had been imaged longitudinally. RESULTS Novel mid‐cranial sampling of either PD or T2‐weighted images were least susceptible to atrophy: of these, the PD method was both more precise and more user‐friendly. SPM5 also produced good results, providing automation for only a small loss in precision compared to the best manual methods. The T1 method that underestimated TIV as atrophy progressed was the least reproducible and the most labor‐intensive. Fully automated FS overestimated TIV with progressive atrophy, and the results were even worse after optimizing the transformation. CONCLUSION The mid‐cranial sampling of PD images achieved the best combination of precision, reliability, and user‐friendliness. SPM5 is an attractive alternative if the highest level of precision is not required.