J Neuroradiology
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This prospective study aimed to evaluate the use of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) in the diagnosis of spontaneous third ventriculostomy (STV) and to compare it with phase-contrast cine magnetic resonance imaging (PC-MRI). ⋯ 3D-SPACE can provide morphological-physiological information for the evaluation of STV with no need for additional PC-MRI analysis or other sequences. As a non-invasive test, it can also be included among the first line of choices of MRI sequences for patients with obstructive hydrocephalus.
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Case Reports
Management of brain AVM procedural hemorrhagic complication by the "security" catheter technique.
Since the introduction of Onyx as a liquid embolic agent for the treatment of brain arteriovenous malformation (AVM), higher endovascular cure rates have been achieved. This may be partially attributed to its non-adhesive property, which allows longer intranidal progression of the embolic agent before solidification. However, Onyx reflux around the microcatheter can form a highly viscous plug, thereby constraining the microcatheter during its retrieval. ⋯ This report describes a new treatment strategy for the rapid management of such a complication. The technique consists of the placement of a second microcatheter about 2 cm proximal to the AVM nidus in the same artery containing the intranidal microcatheter. After conclusion of embolization, if rupture occurs during intranidal microcatheter retrieval, the second microcatheter that is already in place can promptly be used to control the bleeding.
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Intracranial large-artery atherosclerosis is considered a frequent cause of stroke worldwide, particularly in Asian populations. The current evidence suggests that symptomatic patients with severe stenosis may benefit from intracranial stents. There are two methods for calculating the degree of intracranial stenosis, Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) and North American Symptomatic Carotid Endarterectomy Trial (NASCET), but they have never been compared. ⋯ The results of this study suggest that NASCET and WASID measures are, on average, generally similar, although substantial disagreement in a given patient may be seen.
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Cerebral gas embolism may be revealed by the sudden onset of unconsciousness sometimes after surgery or after diagnostic and therapeutic procedures. The clinical diagnosis may be difficult if the context is not relevant. ⋯ Etiological diagnosis revealed the presence of a lung tumor invading the mediastinum, thus possibly allowing the migration of gas from the lung to the arterial cerebral circulation. A second MRI performed 8 days after the initial event with diffusion tensor imaging (DTI) and proton magnetic resonance spectroscopic imaging ((1)H-MRSI) allowed better comprehension of the pathophysiological mechanisms of cerebral injury secondary to gas embolism by showing two kinds of cerebral lesions: white-matter vasogenic edema and cytotoxic gray-matter edema.