bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cranial Venous Outflow Under Lower Body Positive and Negative Pressure Conditions and Head‐Up and ‐Down Tilts
Authors: Stolz Erwin , Fox Bettina C , Hoffmann Oskar , Gerriets Tibo , Blaes Franz , Kraus Jörg , Kaps Manfred 
Published: October 2009

ABSTRACTBACKGROUND Although there exists a large body of knowledge on the regulation of arterial cerebral hemodynamics, little is known about the cerebral venous outflow (CVO). METHODS In 19 healthy volunteers, the middle cerebral artery and the straight sinus were examined using transcranial Doppler sonography. Arterial and venous mean flow velocities (aFVmean, vFVmean, respectively) were registered continuously while applying lower body positive (LBPP) or negative (LBNP) pressure of 30 mmHg and performing head‐down (–20°, HDT) and ‐up (+30°, HUT) tilt manoeuvres. The arterial blood pressure was registered simultaneously with a noninvasive finger blood pressure monitor. Relative changes in parameters compared to the proceeding no‐pressure, no‐tilt baseline were used for analysis. RESULTS While aFVmean did not change significantly, vFVmean inc reased during LBPP by 10.5 ± 2.9% and decreased during LBNP by 15.1 ± 3.5% (mean ± standard error of mean [SEM], P < .01). HUT resulted in a decrease in vFVmean by 25.5 ± 3.3% and HDT, in an increase by 7.8 ± 3.2% (P < .01) without alteration in aFVmean. This may imply a decrease of cerebral blood volume (CBV) during LBPP and HDT and an increase during LBNP and HUT. CONCLUSIONS CVO cannot be neglected when studying cerebral hemodynamics because it might affect the CBV.
Empty Microcatheter Technique for the Deployment of a Self‐Expanding Stent to Treat Refractory Middle Cerebral Artery Occlusion in the Setting of Severe Proximal Tortuosity
Authors: Dabus Guilherme , Nogueira Raul G. 
Published: October 2009

ABSTRACT We report a case of an acute middle cerebral artery (M2 segment) occlusion that was refractory to intravenous tissue plasminogen activator (IV t‐PA), thrombectomy with the Merci® device, intra‐arterial infusion of urokinase and eptifibatide, and balloon angioplasty. The artery was so tortuous that over‐the‐wire stent placement failed and a salvage technique was required to place the self‐expanding stent.
Buying Time for Recanalization in Acute Stroke: Arterial Blood Infusion Beyond the Occluding Clot as a Neuroprotective Strategy
Authors: Ribó Marc , Molina Carlos , Alvarez Beatriz , Dinia Lavinia , Alvarez‐Sabin Jose , Matas Manel 
Published: October 2009

ABSTRACTBACKGROUND Acute ischemic stroke treatment is meant to induce early reperfusion before ischemic lesion becomes definitive; unfortunately, in many cases, recanalization occurs too late. We present a case in which oxygenated blood was perfused through the occluding clot during intra‐arterial (IA) thrombolysis to anticipate reperfusion. SUMMARY A 63‐year‐old woman was admitted 1 hour after acute left‐sided hemiplegia National Institutes of Health Stroke Scale (NIHSS 18). Transcranial Doppler (TCD) showed proximal right middle cerebral artery (MCA) occlusion. Systemic thrombolysis failed to recanalize MCA, so IA rescue was initiated. During the procedure, TCD recorded flow in MCA. A microcatheter was passed through the clot and 20 mL of oxygenated blood was injected over 2 minutes beyond occlusion. During blood perfusion, TCD detected nonpulsating flow in distal M2 branches. Then, tissue plasminogen activator (t‐PA) was injected directly intrathrombus; mechanic fragmentation was also attempted. No recanalization was observed, however, neurological status partially improved. The process was repeated until 6 hours after symptom onset. Only partial Thrombolysis in Cerebral Ischemia (TICI‐2a) recanalization was achieved, but physical examination revealed substantial improvement: NIHSS score of 11. Repeated TCD showed partial recanalization (9 hours) and complete recanalization (12 hours). At 24 hours, NIHSS score was 1. CONCLUSION Momentary reperfusion of ischemic penumbra with oxygenated blood is feasible and may allow to “buy time” until definitive reperfusion is achieved.
Various Origins of the Duplicated Middle Cerebral Artery
Authors: Tutar Nihal Uslu , Töre Hüseyin Gürkan , Kırbaş İsmail , Tarhan Nefise Çağla , Coşkun Mehmet 
Published: October 2009

ABSTRACTWe describe the features of a duplicated middle cerebral artery identified by computed tomographic angiography that originates from a previously undefined origin, ie, from the petrous portion of the internal carotid artery. Recognition of this anomaly is important in patients with a possible aneurysm, which was not present in our patient.
Initial Experience in Establishing an Academic Neuroendovascular Service: Program Building, Procedural Types, and Outcomes
Authors: Qureshi Adnan I. , Janardhan Vallabh , Memon Muhammad Zeeshan , Suri M. Fareed K. , Shah Qaisar A. , Miley Jefferson T. , Puchta Amy E. , Taylor Robert A. 
Published: October 2009

ABSTRACTOBJECTIVE To report our initial experience in setting up a neuroendovascular service in a university‐based comprehensive stroke center. METHODS We determined the rates of referral path, procedural type, and independently adjudicated 1‐month outcomes (actual rates) in first 150 procedures (120 patients) and subsequently compared with rates derived from pertinent clinical trials after adjustment for procedural type (predicted rates). RESULTS The patients were referred from the emergency department (n= 44), transferred from another hospital (n= 13), or admitted for elective procedures from the clinic (n= 63). The procedures included treatment of acute ischemic stroke (n= 12); extracranial carotid stent placement (n= 33); extracranial vertebral artery stent placement (n= 13); intracranial angioplasty and/or stent placement (n= 12); embolization for intracranial aneurysms (n= 35), arteriovenous malformations (n= 5), and tumors (n= 10); cerebral vasospasm treatment (n= 26); and others (n= 4). The technical success rate was 100% for intracranial aneurysm obliteration and extracranial carotid artery stent placement, and 95% for those undergoing intracranial or vertebral artery stent placements; and partial or complete recanalization was achieved in 72% of patients undergoing intra‐arterial thrombolysis. After adjusting for procedural type, the actual adverse event rate of 3% compared favorably with the predicted rate of 7% based on the results of clinical trials. CONCLUSIONS We provide estimates of procedure volumes and outcomes observed in the initial phase of setting up a neuroendovascular service with an active training program.
Selective White Matter Involvement in a Patient with Late Onset Krabbe Disease: MR, MR Spectroscopy, and Diffusion Tensor Study
Authors: Romano Andrea , De Simone Roberto , Fasoli Fabrizio , Ferrante Michele , Cipriani Valentina , Fantozzi Luigi Maria , Bozzao Alessandro 
Published: October 2009

ABSTRACT The most frequent type of Krabbe disease has an infantile onset. Unusual slowly progressive adult forms have also been described. We described a different involvement of white matter tracts where magnetic resonance signal alterations were evident in a case of a patient affected by late‐onset form of disease.
Axonal Dysfunction in the Deep White Matter in Machado‐Joseph Disease
Authors: D'Abreu Anelyssa , França Jr Marcondes , Appenzeller Simone , Lopes‐Cendes Iscia , Cendes Fernando 
Published: October 2009

ABSTRACT We evaluated spectroscopy findings at the deep white matter in Machado‐Joseph disease (MJD). We obtained brain MRI and single‐voxel proton MR spectroscopy (MRS) over the superior‐posterior region of the left hemisphere at the level of the corpus callosum in 40 patients (44.6 ± 2.3 years‐old) and 27 controls (31.4 ± 3.6 years). Four patients were excluded due to poor quality spectra. We observed a decrease in signal intensity of N‐acetylaspartate relative to creatine‐phosphocreatine signal (NAA/Cr) in MJD compared to control [1.63 ± 0.41 (1.15‐2.76) versus 1.97 ± .51 (1.50‐2.92); U test = 219.0; P < .001]. No statistical difference was observed in choline‐containing compounds relative to creatine (Cho/Cr). There was no significant correlation between NAA/Cr and clinical and genetic variables. Due to the younger age of the control group, we performed a secondary analysis in a subgroup of 15 MJD patients matched by age to 15 controls. Matching was performed blindly to MRS results and subject identification, except for age and sex. A statistically significant difference was observed in NAA/Cr ratios (U test = 44.0; P= .004), as well as Cho/Cr levels (U test = 53.0; P= .014). We conclude that the metabolic abnormalities observed in the deep white matter in MJD suggest extensive neuronal and axonal dysfunction in these patients.
Eight‐and‐a‐Half Syndrome
Authors: Sarwal Aarti , Garewal Mandeep , Sahota Sheena , Sivaraman Manjamalai 
Published: October 2009

ABSTRACT Eight‐and‐a‐half syndrome is a clinical entity comprised of one‐and‐a‐half syndrome with ipsilateral facial palsy. We report a case who presented with this constellation of findings with diffusion weighted images (DWI) and apparent diffusion coefficient (ADC) changes corresponding to the anatomical correlate in the dorsal pontine tegmentum.
Predicting the Histopathological Grade of Cerebral Gliomas Using High b value MR DW Imaging at 3‐Tesla
Authors: Alvarez‐Linera Juan , Benito‐León Julián , Escribano Jose , Rey G. 
Published: October 2009

ABSTRACTBACKGROUNDOur aim was to prospectively assess whether magnetic resonance (MR) diffusion‐weighted (DW) imaging using high b values can predict better than b value of 1,000 s/mm2 the histopathological grade of cerebral gliomas.METHODSFifty‐four patients with histologically verified brain gliomas (35 high‐grade and 19 low‐grade gliomas) underwent MR DW imaging. Isotropic DW images and apparent diffusion coefficient (ADC) were obtained with b values of 1,000 and 3,000 s/mm2. Each tumor was evaluated as being hyperintense, iso‐intense or hypointense to normal, contralateral‐hemisphere white matter.RESULTSMost of the patients with high‐ and low‐grade gliomas showed areas of increased signal intensity on their isotropic images, obtained with a b value of 1,000 s/mm2. However, with a b value of 3,000 s/mm2 the areas of increased signal intensity were seen in 97.1% of the high‐grade gliomas, while 94.7% of the low‐grade gliomas showed no area of increased signal intensity. The mean area under the ROC curve for ADC ratio, obtained with a b value of 3,000 s/mm2, was significantly higher than that obtained with 1,000 s/mm2 (.932 vs. .856, P= .04).CONCLUSIONHigh b value DW MR might be useful as a complementary tool in preoperative assessment of the histopathological grading of cerebral gliomas.
SPECT/CT Fusion Imaging in Radionuclide Cisternography for Localization of Liquor Leakage Sites
Authors: Novotny Clemens , Pötzi Christian , Asenbaum Susanne , Peloschek Philipp , Suess Erhard , Hoffmann Martha 
Published: October 2009

ABSTRACT OBJECTIVEWe report our experience with radionuclide cisternography (RC) with 111In‐diethylenthriamine penta‐acetic acid (DTPA) using a computed tomography (CT) mounted hybrid gamma camera in patients with cerebrospinal liquor leakage.METHODSSPECT/CT fusion imaging was performed in case of suspected tracer egress on planar or SPECT images in order to obtain a detailed correlation of the leakage site.RESULTSLeakage was detected in all 3 patients. Using SPECT/CT, the extradural tracer accumulation could be correlated to an anatomical structure, which had not been possible by evaluation of the scintigraphic studies alone.CONCLUSIONIntroducing SPECT/CT for radionuclide cisternography seems to be a valuable tool to facilitate the diagnosis of cerebrospinal liquor leakage.
Moyamoya Phenomenon Secondary to Intracranial Atherosclerotic Disease: Diagnosis by 3T Magnetic Resonance Imaging
Authors: Ashley, Jr William W. , Zipfel Gregory J. , Moran Christopher J. , Zheng Jie , Derdeyn Colin P. 
Published: October 2009

ABSTRACT Moyamoya phenomenon occurs in response to an occlusive vasculopathy affecting the distal internal carotid artery and its proximal branches. The nature of the occlusive vasculopathy is unknown in most patients. We present a patient in whom 3T magnetic resonance imaging was used to examine the arterial wall at the site of occlusion in a patient with unilateral moyamoya phenomenon. Signal characteristics were consistent with atherosclerotic disease. 3T magnetic resonance imaging may be useful for distinguishing the underlying etiology of moyamoya phenomenon in some patients.
Tract‐by‐Tract Morphometric and Diffusivity Analyses In Vivo of Spinocerebellar Degeneration
Authors: Terajima Kenshi , Matsuzawa Hitoshi , Shimohata Takayoshi , Akazawa Kouhei , Nishizawa Masatoyo , Nakada Tsutomu 
Published: October 2009

ABSTRACTBACKGROUND AND PURPOSE Three‐dimensional anisotropy contrast (3DAC) based on a periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) sequence on a 3.0T system is a new magnetic resonance imaging technique capable of providing images with significantly high anatomical resolution. The purpose of this study was to confirm whether this technique can characterize the degenerative processes in the brainstem of patients with spinocerebellar degeneration (SCD). METHODS 3DAC images of 13 patients with multiple system atrophy with predominant cerebellar symptoms (MSA‐C) and seven International Cooperative Ataxia Rating Scale (ICARS) score‐matched patients with Machado‐Joseph disease (MJD) were created using a diffusion‐weighted PROPELLER sequence on a 3.0T system. The section of the middle pons was chosen for morphometric and diffusivity analyses. RESULTS The above analyses showed that atrophy and increased diffusivity of the ventral portion of the pons indicated MSA‐C, whereas atrophy and increased diffusivity of the pontine tegmentum indicated MJD. Furthermore, ICARS scores significantly correlated with both the severities of the pontine atrophy and the mean diffusivity values of the ventral pontocerebellar tracts. CONCLUSIONS This study demonstrated that 3DAC PROPELLER on a 3.0T system enables in vivo “tract by tract” quantitative analysis of pontine degeneration in SCD.
Imaging Cerebral Blood Flow in the Cognitively Normal Aging Brain with Arterial Spin Labeling: Implications for Imaging of Neurodegenerative Disease
Authors: Lee Charles , Lopez Oscar L. , Becker James T. , Raji Cyrus , Dai Weiying , Kuller Lewis H. , Gach H. Michael 
Published: October 2009

ABSTRACTINTRODUCTION Arterial spin labeling (ASL) is a safe, noninvasive imaging method for evaluating cerebral blood flow (rCBF). The purpose of this article is to present ASL imaging features of 38 elderly cognitively normals (CN) with their rCBF values and an averaged profile of targeted anatomic regions rCBF values. METHODS: Thirty‐eight CN underwent MR imaging especially ASL with voxel morphometric techniques fusing the MR anatomical and ASL images to a standard reference brain (colin27). The ASL images were fused to echo planar images, which were then coregistered to high‐resolution anatomical SPGR images. rCBF was calculated per region of interest using a modified continuous arterial spin labeling (CASL) convolutional method. Anatomical regions were selected and identified by the Talairach atlas in SPM2. RESULTS We identified areas of decreased and increased perfusion (compared to the averaged rCBF of all 38 CN) corresponding to decreased and increased quantified rCBF. The most common sites for decreased perfusion were precuneus (53%), superior temporal (48%), and orbitofrontal (37%), and for increased perfusion the caudate (39%), posterior cingulate (34%), anterior cingulate (32%), and amygdala (32%). CONCLUSION There are regional variations in rCBF both increased and decreased with the posterior cingulate and precuneus cortex showing the highest averaged values and signal intensity (bright spots). These variations represent the normal profile of a CN elderly brain, with higher perfusion in areas associated with cognition, memory, and behavior. It is necessary to understand these normal variations in order to determine if there are perfusion changes in ASL detected in neurodegenerative disorders such as Alzheimer's disease.
Intravascular Ultrasound of Symptomatic Intracranial Stenosis Demonstrates Atherosclerotic Plaque with Intraplaque Hemorrhage: A Case Report
Authors: Meyers Philip M. , Schumacher H. Christian , Gray William A. , Fifi Johanna , Gaudet John G. , Heyer Eric J. , Chong Ji Y. 
Published: October 2009

ABSTRACTBACKGROUND Intracranial artery stenosis is assumed to represent atherosclerotic plaque. Catheter cerebral arteriography shows that intracranial stenosis may progress, regress, or remain unchanged. It is counterintuitive that atherosclerotic plaque should spontaneously regress, raising questions about the composition of intracranial stenoses. Little is known about this disease entity in vivo. We provide the first demonstration of in vivo atherosclerotic plaque with intraplaque hemorrhage using intravascular ultrasound (IVUS). CASE DESCRIPTION A 35‐year‐old man with multiple vascular risk factors presented with recurrent stroke failing medical therapy. Imaging demonstrated left internal carotid artery occlusion, severe intracranial right internal carotid artery stenosis, and cerebral perfusion failure. Cerebral arteriography with IVUS confirmed 85% stenosis of the petrous right carotid artery due to atherosclerotic plaque with intraplaque hemorrhage. Intracranial stent‐supported angioplasty was performed with IRB approval. The patient recovered without complication. CONCLUSIONS This case supports the premise that symptomatic intracranial stenosis can be caused by atherosclerotic plaque complicated by intraplaque hemorrhage similar to coronary artery plaque. IVUS provides additional characteristics that define intracranial atherosclerosis and high‐risk features. To our knowledge, this is the first report of stroke due to unstable atherosclerotic plaque with intraplaque hemorrhage in vivo.
Pathological Laughing As a Manifestation in a Clinically Isolated Brainstem Syndrome: A Case Report
Authors: Kocer Belgin , Oner Yusuf , Batur Hale , Nazliel Bijen , Cengiz Bulent , Tali Turgut 
Published: October 2009

ABSTRACT The prevalence of pathological laughing and crying in multiple sclerosis (MS) is 10%. It has been speculated that the anatomical lesion responsible for the pathological laughing is located in the pontine base, prefrontal cortex, and cerebellum. We report an 18‐year‐old male patient presenting with pathological laughing and hypomania. In his neurological examination, he had a euphoric effect with ataxic walking and dysarthria speech. He had a bilateral conjugated gaze limitation, with a prominent bilateral horizontal nystagmus on left gaze, dysmetria, dysdiadokokinesia, and remarkable dysfunction in a heel‐to‐shin test on the left. The IgG index in cerebrospinal fluid was normal with an oligoclonal band was present. In cranial MRI, there was a lesion on central pons which was hypointense in T1 images with contrast enhancement and hyperintense in T2 and flair images. Also another lesion in right brachium pontis which did not contrast enhancement but was hyperintense on T2 and flair images was present. There was an elevation of myoinositol/creatine ratio and choline and a reduction of NAA in proton MR spectroscopy. MR spectroscopic evaluation of the patient demonstrated the demyelination process. There has been no report of patients in whom pathological laughter was the presenting symptom of clinically isolated brainstem syndrome.
Neurological Improvement Associated with Resolution of Irradiation‐Induced Myelopathy: Serial Magnetic Resonance Imaging and Positron Emission Tomography Findings
Authors: Uchida Kenzo , Nakajima Hideaki , Takamura Takaharu , Kobayashi Shigeru , Tsuchida Tatsuro , Okazawa Hidehiko , Baba Hisatoshi 
Published: October 2009

ABSTRACT We document serial magnetic resonance imaging (MRI) and [18F] 2‐fluoro‐2‐deoxyglucose (FDG)‐positron emission tomography (PET) findings in the process of improvement from delayed radiation necrosis of the spinal cord. A 61‐year‐old woman underwent radiotherapy for an oral carcinoma. Forty‐six months later she developed a left‐sided Brown‐Séquard syndrome, suggesting incomplete cervical cord transection below the cervico‐thoracic junction. Two months after starting steroid therapy, she had gradual clinical improvement, which continues 8 years after the termination of radiotherapy. Neurological improvement was associated with gradual resolution of an extensive high‐intensity area within the cervico‐thoracic spinal cord on MRI. Initially, the FDG‐PET showed linear and uniform increase in FDG uptake throughout the cervical spinal cord with standardized uptake value of 2.68 ± 0.16 (mean ± SD), but it returned to normal value (1.90 ± 0.14) at final follow‐up. Considering that the normalization of FDG uptake correlated with neurological recovery, the uniform‐ and diffuse‐increased FDG uptake noted in the initial course of myelopathy could reflect the metabolic activity of the compromised spinal cord.
Impact of Ruptured Cerebral Aneurysm Coiling and Clipping on the Incidence of Cerebral Vasospasm and Clinical Outcome
Authors: Zaidat O. O. , Ionita C. C. , Hussain S. I. , Alexander M. J. , Friedman A. H. , Graffagnino C. 
Published: October 2009

ABSTRACTBACKGROUND This study assessed the impact of treatment modality of aneurysmal subarachnoid hemorrhage (aSAH) on the rate of vasospasm (VSP), mortality, and hospital length of stay (LOS) of patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS We analyzed patients with aSAH admitted between 1999 and 2005 undergoing either endovascular coiling (EC) or surgical clipping (SC) within 72 hours of onset. Clinical VSP was defined as neurological deficits unexplained by another etiology. Radiological VSP was defined based on transcranial Doppler (TCD) ultrasound, digital subtraction angiography (DSA), and CT criteria. Bivariate and logistic regression analysis was used to determine VSP predictors. RESULTS Of 216 patients included, 98 (45%) underwent EC and 118 (55%) underwent SC. Clinical VSP was found in 26% of EC and 40% of SC patients (P < .03). TCD VSP, angiographic VSP, and CT infarctions were all significantly higher in the SC group. Mortality was similar in both groups however the LOS was longer in the SC patients (P= .03). Multivariate analysis showed that SC doubled the risk of clinical VSP (P < .03) and tripled the risk of composite VSP (P < .0006). CONCLUSIONS Our study reveals that EC has a lower rate of VSP, shorter LOS, and comparable mortality to SC in aSAH.
Ruptured Anterior Spinal Artery Aneurysm: A Case Report
Authors: Pollock Jeffrey M. , Powers Alexander K. , Stevens E. Andrew , Sanghvi Amit N. , Wilson John A. , Morris Pearse P. 
Published: October 2009

ABSTRACT We present a case of a subarachnoid hemorrhage and vasospasm secondary to a ruptured anterior spinal artery aneurysm associated with a Chiari 1 malformation. To our knowledge this is the first reported spinal artery aneurysm with this association.
Neuromyelitis Optica Preceded by Brain Demyelinating Episode
Authors: Amemiya Shimon , Hamamoto Makoto , Kumagai Tomoaki , Ueda Masayuki , Katayama Yasuo , Tanaka Keiko 
Published: October 2009

ABSTRACT Neuromyelitis optica (NMO) is considered a distinct disease from multiple sclerosis (MS) because of its pathogenesis. It is well accepted that NMO selectively affects the spinal cord and optic nerve and is not associated with brain lesions at the onset of the disease, unlike MS. We present a unique case where the patient's initial lesion was in the brain, and optic neuritis and myelitis were revealed 6 years after the brain lesion. In addition, the patient's serum antiaquaporin 4 (AQP4) antibody was positive. We consider the brain lesion to precede abnormal lesion of NMO, and the AQP4 measurement is important for diagnostics, even if it occurs with brain lesions.