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Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
The underlying pathogenesis is poorly understood. The small-caliber intracranial perforating arteries that arise from larger intracranial arteries and supply the brainstem (paramedian pontine perforating branches of the basilar artery) and deep subcortical nuclei (thalamoperforating branches of the PCA, and lenticulostriate branches of the MCA) are exposed to higher BP than more distal arteries, and this may predispose to lipohyalinosis. Other possible mechanisms include ischemia/hypoxia, hypoperfusion due to altered cerebrovascular autoregulation, blood–brain barrier leakage, inflammation, degeneration, and amyloid angiopathy.
Brain regions, lesions, and stroke syndromes
Published in Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees, Stroke in Practice, 2017
Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees
The midline basilar artery runs up in front of the pons to give off the small pontine branches, which supply, as their name betrays, the pons. The anterior inferior cerebellar artery and the labyrinthine artery are also branches of the basilar artery and supply anterior and inferior cerebellum and inner ear, respectively. The basilar artery ascends up and ends at the upper end of the pons by dividing into the superior cerebellar branches just before giving rise to the posterior cerebral arteries. The former supplies the remaining superior part of the cerebellum, as well as the mesencephalon and upper pons. The posterior cerebral artery supplies the visual cortex of the occipital lobe (but the macula can be MCA-supplied). The inferomedial portion of the temporal lobe, posterior and inferior parts of parietal, and the lateral thalamus (via the thalamogeniculate branch) are also supplied by the PCA. It should be noted that the posterior cerebral artery may receive some of its blood from the internal carotid and not the basilar, the basilar artery being a later embryological development. A number of perforating arteries arising from the posterior cerebral or the posterior communicating arteries (see below) supply the anterior part of the midbrain and aspects of subthalamus and hypothalamus. In summary, the posterior cerebral arteries are crucial to the occipital lobes, midbrain, thalamus, and parts of the temporal and parietal lobes.
The Thigh (Anterior and Medial Compartments)
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
Clean the profunda femoris (deep femoral) artery from its origin to its disappearance distally, deep to the adductor longus muscle. Several perforating branches, typically four, arise from the profunda femoris and pass medially about the femur to enter the posterior muscular compartment. The perforating arteries provide the principal sources of blood supply to the posterior chamber of the thigh. Their demonstration is optional in the dissection. The perforating tributaries to the profunda femoris vein constitute the major routes for venous drainage from the posterior chamber of the thigh to the femoral vein.
Overlapping stent-assisted coil embolization for vertebrobasilar dissecting aneurysms: a single-center study
Published in Neurological Research, 2021
Guangyao Shi, Shancai Xu, Ilgiz Gareev, Zhiyong Ji, Wu Pei, Guang Zhang, Jingtao Qi, Rui Chen, Shaodong Liang, Yan Gu, Chunlei Wang
Recurrence in VBDA patients plays an important role in its prognosis. Although DSA follow-up showed that one of the 20 patients presented with a parental arterial occlusion, the aneurysm sac of all patients was completely occluded. Therefore, our findings demonstrate that this method yielded efficacious outcomes and low recurrence rates. Overlapping stents with coiling has also shown satisfactory clinical outcomes in VBDA patients in some other studies. Suh et al. [14] treated 11 cases of ruptured VBDAs using OSCE. In their study, nine patients showed complete occlusion without in-stent restenosis or perforating arteries occlusion. Zhao et al. [15] also reported that stent-assisted embolization using 2–4 multiple overlapping stents significantly decreased VA dissecting aneurysm recurrence than stent-assisted embolization using single stent (n = 1, 2.1% in multiple stents vs. n = 9, 18.0% in single stent; p = 0.01).
Acute angle plication of optic nerve glioma as a mechanism of rapidly progressive visual loss
Published in Orbit, 2021
Andrea A. Tooley, Nailyn Rasool, Ashley Campbell, Michael Kazim
In our series of patients with progressive visual dysfunction from ONG, a structural difference was identified in those with rapid versus more gradual vision loss. Specifically, in patients who suffered from rapidly progressive visual loss, the ONG had a 90-degree or less acute plication of the ON. In patients who suffered a more gradual loss of vision, the bend in the ON was more obtuse, being greater than 105 degrees. This acute plication of the ON may adversely affect neurotransmission and axoplasmic flow through the nerve, resulting in poor vision. Alternatively, acute plication of the nerve may result in compression of vascular structures supplying the nerve. Although none of the patients presented with fundi consistent with venous or arterial occlusion, it is possible that the fundoscopic evidence of the acute vascular accident had resolved by the time an examination was performed or the plication resulted in the interruption of smaller perforating arteries.
Giant vertebrobasilar aneurysm: a rare cause of central sleep apnoea
Published in British Journal of Neurosurgery, 2019
Mark Daniel Haley, Duncan Bruce Henry Henderson, Mark Nowell, William M. Adams, Peter C. Whitfield
Siddique et al.2 recommend judicious implementation of flow diverter stent strategies while evidence for this approach is scarce. Flow diverter stents have a higher metal coverage and lower porosity which helps to prevent blood flow into an aneurysm and redirect the flow through an artificial lumen created within the parent vessel. This may however impair flow through salient perforating arteries to the vertebrobasilar region. In a case series with symptomatic fusiform vertebrobasilar aneurysms (n = 7) managed via flow diverter stents, mortality was n = 4/7.2 This was due to post procedural aneurysmal rupture (n = 2) and pre procedural brainstem infarction with withdrawal of care (n = 2). Of the survivors (n = 3), one suffered severe disability secondary to a brainstem infarct.