Stroke
Henry J. Woodford in Essential Geriatrics, 2022
Mechanical clot retrieval is a form of endovascular therapy that can directly remove blockages from cerebral arteries to restore blood flow. It can be used in acute ischaemic stroke caused by proximal intracranial vessel occlusion in the anterior circulation when there is significant persisting disability (i.e. NIHSS score six or more). The procedure usually follows intravenous thrombolysis, unless there is a contraindication. In addition to an initial standard CT scan, a CT or MR angiogram study is required to demonstrate the vessel occlusion. Conventional cerebral angiography is then performed, either under sedation or possibly general anaesthesia, usually via the femoral artery and under X-ray guidance. A clot retrieval device, attached to a guidewire, is used to re-establish blood flow. Most commonly, a metallic mesh stent is expanded within the clot to trap it and allow extraction. It should be performed as soon as possible after symptom onset and usually within six hours.15 Occasionally, it is administered between six and 24 hours of symptom onset (including ‘wake up' strokes) if potentially salvageable brain tissue has been detected by imaging techniques such as CT perfusion or DWI-MRI sequences.
Arterial Thrombosis—Diagnosis and Management
E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson in Phospholipid-Binding Antibodies, 2020
However, sudden stroke not preceded by TIA was the most common presentation noted in Levine and Welch’s 32 patients,8 and is strongly suggestive of cerebral embolism, most likely from the heart.23 Recent reports of cardiac valvular lesions in aPL-positive stroke patients15,17,24,25 provide further evidence for this pathological process. A number of valvular lesions have been described in this situation, including marantic endocarditis,12,17 Libmann-Sachs endocarditis19,25,26 and more destructive lesions leading to cardiac murmurs and mechanical insufficiency.15,24,27 Of interest in this respect, is a recent report finding high aCL levels in 11% of patients attending an anticoagulant clinic following valve replacement.28 These studies suggest endocardial disease is a frequent finding in patients with aPL and can lead to embolism causing cerebrovascular occlusion. In other cases, in situ thrombosis of large cerebral arteries appears to be the mechanism of stroke. Vasculitis does not seem to be an important process in aPL-associated events.
Neurosurgery: Cerebrovascular diseases
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Geriatric Neuroanesthesia, 2019
Hemorrhagic stroke is the third most frequent cause of stroke after AIS and TIA (2). Hypertensive hemorrhages (11%–15.5%) compared with hemorrhage due to ruptured aneurysms and vascular malformations (4.5%–7%) have a higher overall incidence in the context of the major CVD (2). Primary hypertensive ICH is the mundane “spontaneous” brain hemorrhage (9). It is predominantly due to chronic hypertension and degenerative changes in cerebral arteries. In recent decades, with increased awareness of the need to control BP, the percentage of hemorrhages caused by factors other than hypertension has greatly increased. In order of frequency, ICH is classified according to its anatomical site or presumed etiology. The most common sites of ICH are supratentorial (85%–95%), including deep (50%–75%) and lobar (25%–40%). The most common causes are hypertension (30%–60%), cerebral amyloid angiopathy (10%–30%), anticoagulation (1%–20%), and vascular structural lesions (3%–8%), while undetermined causes account for about 5%–20% of cases (27).
Gender heterogeneity in the influencing factors for cerebral microbleeds in acute ischemic stroke patients
Published in Current Medical Research and Opinion, 2023
Xin Guo, Yuan Xing, Zhenjie Teng, Zhiyuan Shen, Xiaosu Guo, Peiyuan Lv, Shujuan Tian
In this retrospective study, the data of 482 patients with AIS who were admitted to the Department of Neurology of Hebei Provincial People’s Hospital from January 2014 to December 2015 were continuously collected to investigate gender heterogeneity in the influencing factors for CMBs by studying male and female AIS patients (NCT05882123). Inclusion criteria are as follows: all participants aged 18 years and older, and must meet the diagnostic criteria for AIS as presented in the Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 201415. They must be in good physical condition and have the ability to cooperate with MRI examinations; and they must have underwent SWI. Exclusion criteria are as follows: MRI contraindications present, such as cardiac pacemaker, cardiac stents, or metal implants. Head MRI or carotid artery ultrasound suggests the presence of severe stenosis or occlusion in the intracranial or extracranial segments of the cerebral arteries; and severe comorbid diseases, such as cardiac, pulmonary, hepatic, and renal insufficiencies. Among them, 252 patients with AIS were excluded in this study due to exclusion criteria. 230 patients with AIS finally were enrolled in this study. The study was conducted in accordance with the Declaration of Helsinki and internationally accepted standards of Good Clinical Practice. Detailed descriptions of the study designs can be found in their primary reports.
Demystifying Ocular Syphilis – A Major Review
Published in Ocular Immunology and Inflammation, 2023
Khushboo Chauhan, Alex Fonollosa, Lena Giralt, Joseba Artaraz, Edward L. Randerson, Debra A. Goldstein, João M. Furtado, Justine R. Smith, Sridharan Sudharshan, Arshee S. Ahmed, Nivedita Nair, Joveeta Joseph, Carlos Pavesio, Mark Westcott, Supawat Trepatchayakorn, Ahmed B. Sallam, Abdelrahman M. Elhusseiny, Mudit Tyagi
A common misconception among neurologists and other healthcare providers is that all presentations of neurosyphilis, are tertiary manifestations of infection. In fact, neurosyphilis can occur at any stage of syphilis. Early in infection, T. pallidum disseminates widely throughout the body including the central nervous system (CNS). Studies from the modern treatment era using rabbit inoculation and polymerase chain reaction (PCR) have found that 20% to 40% of individuals with untreated primary, secondary, or early latent syphilis have detectable T. pallidum in the cerebrospinal fluid (CSF).38,39 An inflammatory CSF profile, reactive Venereal Disease Research Laboratory (VDRL), or some combination of these CSF abnormalities may also be present. Some individuals with evidence of early neuroinvasion have accompanying neurologic symptoms such as headache; however, the majority are asymptomatic. Patients with symptomatic early neurosyphilis typically present with meningitis. Cranial neuropathies, most frequently involving cranial nerves II, VII, or VIII, may accompany meningitis. Typical signs and symptoms include headache, photophobia, neck stiffness, and confusion. Syphilitic meningitis can be complicated by a vasculitis that affects both small arteries (i.e., Nissl-Alzheimer arteritis) and medium and large arteries (i.e., Heubner arteritis) of the CNS, leading to focal cerebral and, less commonly, spinal cord infarcts. Strokes in the distribution of the middle cerebral arteries are classically seen, although any vascular territory, including the vertebrobasilar system, can be involved.
Posterior reversible encephalopathy syndrome and microangiopathic haemolytic anaemia developing in a regularly haemodialysed patient with scleroderma renal crisis: a case report
Published in Modern Rheumatology Case Reports, 2019
Yuya Sato, Tomoyuki Ito, Akira Iguchi, Kazuhiro Yoshita, Yumi Ito, Naofumi Imai, Hajime Yamazaki, Takako Saeki, Ichiei Narita
PRES, initially reported by Hinchey et al. in 1996 as reversible posterior leukoencephalopathy syndrome [7], is a condition associated with characteristic subsets of neurological symptoms and reversible radiologic findings suggestive of vasogenic oedema, predominantly in the parieto-occipital lobe. Although the detailed pathogenesis of PRES remains to be elucidated, there are two widely accepted hypotheses for explaining reversible vasogenic oedema [8]. One is breakdown of auto-regulation of cerebral arteries due to a rapid rise of blood pressure. The other is endothelial dysfunction due to various cytotoxic factors such as immunosuppressive drugs. Considering that hypertension plays a key role in the pathogenesis of PRES, it is a rational consequence that SRC patients may also develop PRES.