Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
-
J Stroke Cerebrovasc Dis · Nov 2013
123I-IMP-SPECT in a patient with cerebral proliferative angiopathy: a case report.
Cerebral proliferative angiopathy (CPA) is a new clinical entity demonstrating a diffuse network of densely enhanced vascular abnormalities with intermingled normal brain parenchyma and is distinguishable from classical arteriovenous malformations by specific clinical and imaging markers. However, the pathophysiological nature of this disease is unclear, and there is no consensus on the treatment. We describe cerebral perfusion abnormalities in a patient with CPA by using N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography (123I-IMP-SPECT) and perfusion-weighted magnetic resonance imaging. ⋯ In addition, acetazolamide-stressed 123I-IMP-SPECT exhibited severely impaired cerebrovascular reactivity over the affected hemisphere, suggesting that his focal neurological deficits were related to the cerebral ischemia. The perfusion abnormalities on 123I-IMP-SPECT in a CPA patient have never been previously reported. The concept of vascular malformation-related hypoperfusion is discussed.
-
J Stroke Cerebrovasc Dis · Nov 2013
Does small aneurysm size predict intraoperative rupture during coiling in ruptured and unruptured aneurysms?
Aneurysm size is a possible risk factor for intraoperative rupture (IOR) during coiling procedures. We aim to determine if aneurysm size 4 mm or smaller predicts IOR. ⋯ Aneurysm size 4 mm or smaller is a risk factor for IOR in ruptured but not unruptured aneurysms. This additional risk factor should be considered when planning the management of small, ruptured aneurysms.
-
J Stroke Cerebrovasc Dis · Oct 2013
Review Meta AnalysisBalance of symptomatic pulmonary embolism and symptomatic intracerebral hemorrhage with low-dose anticoagulation in recent ischemic stroke: a systematic review and meta-analysis of randomized controlled trials.
The current consensus is that anticoagulation therapy has no role acutely in the management of ischemic stroke, although there is still debate for specific conditions, such as cerebral venous thrombosis and cervical dissection. In addition, anticoagulation is used in the prevention of venous thromboembolic events. We assess the balance between preventing symptomatic pulmonary embolism (sPE) and causing symptomatic intracerebral hemorrhage (sICH) in patients with recent stroke who were randomized to low-dose subcutaneous anticoagulation in trials. ⋯ Prophylactic/low-dose heparin increased sICH by more than they reduced sPE in patients with recent ischemic stroke. Therefore, their routine acute use cannot be recommended, but they may still be relevant in patients at very high risk of PE (eg, morbid obesity, previous venous thromboembolism, and inherited thrombophilia) or if started later, although trials have not assessed these issues.
-
J Stroke Cerebrovasc Dis · Oct 2013
Diffusion-weighted imaging-fluid attenuated inversion recovery mismatch in nocturnal stroke patients with unknown time of onset.
More than a quarter of patients with ischemic stroke (IS) are excluded from thrombolysis because of an unknown time of symptom onset. Recent evidence suggests that a mismatch between diffusion-weighted imaging (DWI) and fluid attenuated inversion recovery (FLAIR) imaging could be used as a surrogate for the time of stroke onset. We compared used the DWI-FLAIR mismatch and the FLAIR/DWI ratio to estimate the time of onset in a group of patients with nocturnal strokes and unknown time of onset. ⋯ A large proportion of patients with nocturnal IS and an unknown time of stroke initiation have a DWI-FLAIR mismatch, suggesting a recent onset of stroke.
-
J Stroke Cerebrovasc Dis · Oct 2013
Risk of spontaneous intracranial hemorrhage in HIV-infected individuals: a population-based cohort study.
We studied the association between HIV infection, antiretroviral medications, and the risk of spontaneous intracranial hemorrhage. ⋯ The risk of intracranial hemorrhage in HIV-positive individuals seems to be mostly associated with AIDS-defining conditions, other comorbidities, or lifestyle factors. No association was found between use of antiretroviral medications and intracranial hemorrhage.