Introduction: Logistic regression is a regression with a categorical outcome variable and predictor variables that can be either continuous or categorical. Objectives: To demonstrate the basic workflow of logistic regression using R. Materials and Methods: A real world data-set has been used to present an example for the basic workflow of logistic regression using R. Results: Accurate results were obtained including deviance for analysing the fit of the model. Conclusions: Performing basic statistical modeling in R is simple and straightforward procedure. Analysing model fit is essential to be able to report the results.
{"title":"Statistical corner: Logistic regression using R","authors":"Mikko J. Pyysalo","doi":"10.4103/jcvs.jcvs_14_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_14_21","url":null,"abstract":"Introduction: Logistic regression is a regression with a categorical outcome variable and predictor variables that can be either continuous or categorical. Objectives: To demonstrate the basic workflow of logistic regression using R. Materials and Methods: A real world data-set has been used to present an example for the basic workflow of logistic regression using R. Results: Accurate results were obtained including deviance for analysing the fit of the model. Conclusions: Performing basic statistical modeling in R is simple and straightforward procedure. Analysing model fit is essential to be able to report the results.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114346997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spontaneous intracerebral haemorrhage (SICH) is the second most common cause of stroke, accounts in contrast to ischaemic stroke and carries a high risk of morbidity and mortality. SICH refers to brain haemorrhage in the absence of trauma and is often associated with hypertension. It is a conventional belief that hypertension is the aetiology in most of the haemorrhage in the basal ganglia region, and angiography is rarely performed in such patients. This protocol carries a risk of missing potentially curable underlying vascular conditions such as arteriovenous malformations and aneurysms, especially in younger patients without a history of hypertension. Performing an angiogram for all patients however is an overkill and unnecessary waste of resources. The role of cerebral angiography to distinguish a primary SICH from secondary SICH in all patients with SICH is thus controversial. Hence, it is the choice of the type of angiogram between digital subtraction angiogram Digital Subtraction Angiography (DSA) and computerised tomography angiogram Computerised Tomography Angiography (CTA). This article attempts to review the current diagnostic angioimaging guidelines for intracerebral haemorrhage with an aim to evolve a management protocol.
{"title":"Role of angiography in primary capsulo-ganglionic haemorrhage: A review","authors":"Saurabh Beedkar, Ajay Hegde, G. Menon","doi":"10.4103/jcvs.jcvs_16_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_16_21","url":null,"abstract":"Spontaneous intracerebral haemorrhage (SICH) is the second most common cause of stroke, accounts in contrast to ischaemic stroke and carries a high risk of morbidity and mortality. SICH refers to brain haemorrhage in the absence of trauma and is often associated with hypertension. It is a conventional belief that hypertension is the aetiology in most of the haemorrhage in the basal ganglia region, and angiography is rarely performed in such patients. This protocol carries a risk of missing potentially curable underlying vascular conditions such as arteriovenous malformations and aneurysms, especially in younger patients without a history of hypertension. Performing an angiogram for all patients however is an overkill and unnecessary waste of resources. The role of cerebral angiography to distinguish a primary SICH from secondary SICH in all patients with SICH is thus controversial. Hence, it is the choice of the type of angiogram between digital subtraction angiogram Digital Subtraction Angiography (DSA) and computerised tomography angiogram Computerised Tomography Angiography (CTA). This article attempts to review the current diagnostic angioimaging guidelines for intracerebral haemorrhage with an aim to evolve a management protocol.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127617098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Basilar artery (BA) fenestration is an uncommon congenital variant associated with aneurysms and posterior circulation infarcts. We present a 42-year-old male, smoker and hypertensive who came with acute onset vertigo and gait ataxia. Cerebellar signs were positive on the left side. Diffusion-weighted brain magnetic resonance imaging showed acute infarct in the left anterior inferior cerebellar artery (AICA) territory. Computed tomography angiography showed BA double adjacent fenestration of proximal segment of BA, without thrombus, dissection/aneurysm. To the best of our knowledge, only three cases of double adjacent BA fenestration have been described so far. The association between vertebro-BA fenestrations and posterior circulation stroke is controversial. It has been suggested that turbulent flow at the site of fenestration predisposes to thrombus formation, which may be cause of stroke. This rare anatomic variant of the posterior circulation is important to recognize and may have associated neurologic consequences (double BA fenestrations are rare yet known congenital variants associated with aneurysms and associated neurological implications) (double adjacent BA fenestration presenting with AICA infarct are still rarer with only three cases reported across the world).
{"title":"Double adjacent basilar artery fenestration with cerebellar infarct: Case report and new classification of double basilar fenestrations","authors":"T. Srivastava, Ashwini Hiremath","doi":"10.4103/jcvs.jcvs_12_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_12_21","url":null,"abstract":"Basilar artery (BA) fenestration is an uncommon congenital variant associated with aneurysms and posterior circulation infarcts. We present a 42-year-old male, smoker and hypertensive who came with acute onset vertigo and gait ataxia. Cerebellar signs were positive on the left side. Diffusion-weighted brain magnetic resonance imaging showed acute infarct in the left anterior inferior cerebellar artery (AICA) territory. Computed tomography angiography showed BA double adjacent fenestration of proximal segment of BA, without thrombus, dissection/aneurysm. To the best of our knowledge, only three cases of double adjacent BA fenestration have been described so far. The association between vertebro-BA fenestrations and posterior circulation stroke is controversial. It has been suggested that turbulent flow at the site of fenestration predisposes to thrombus formation, which may be cause of stroke. This rare anatomic variant of the posterior circulation is important to recognize and may have associated neurologic consequences (double BA fenestrations are rare yet known congenital variants associated with aneurysms and associated neurological implications) (double adjacent BA fenestration presenting with AICA infarct are still rarer with only three cases reported across the world).","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129422055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Aneurysms of the vertebrobasilar system comprise approximately 10%–15% of all intracranial aneurysms and most occur at the bifurcation of the basilar artery. Posterior circulation perforator artery aneurysms are sparsely reported in the literature. The natural history of these rare lesions remains unclear and their diagnosis and management are not well defined. Materials and Methods: All case reports and case series from the past 20 years were analysed, and the results tabulated. Based on broad trends, guidelines were proposed for management. Results: Forty-two cases from 22 case reports and case series were analysed. Most were managed endovascularly, with a complication rate approaching 43%. Observation was another popular treatment option with however a comparable morbidity of 42% only surgery proved to be better overall. Aneurysm size was inversely correlated with complication rate with smaller lesions more prone to rupture and complications. The nature of the perforating artery was also found to be a factor, where direct brain stem perforators from the upper two-third of the basilar artery were found to be difficult to treat both by surgery and endovascular methods, leading to significant failures and complications as compared to the wider circumflex perforating arteries. Conclusion: Scarce published literature that addresses the limited understanding of the natural course of this entity lead to difficulties in proposing broad-based recommendations that are fail proof. Nevertheless, we hope this analysis of 20 years of data helps in shedding light on this difficult disease and its possible treatment options along with risks and outcomes.
{"title":"Diagnosis and treatment of basilar artery perforator aneurysm: A 20-year review with proposed treatment guidelines","authors":"S. Ganapathy, T. Lingaraju","doi":"10.4103/jcvs.jcvs_26_20","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_26_20","url":null,"abstract":"Introduction: Aneurysms of the vertebrobasilar system comprise approximately 10%–15% of all intracranial aneurysms and most occur at the bifurcation of the basilar artery. Posterior circulation perforator artery aneurysms are sparsely reported in the literature. The natural history of these rare lesions remains unclear and their diagnosis and management are not well defined. Materials and Methods: All case reports and case series from the past 20 years were analysed, and the results tabulated. Based on broad trends, guidelines were proposed for management. Results: Forty-two cases from 22 case reports and case series were analysed. Most were managed endovascularly, with a complication rate approaching 43%. Observation was another popular treatment option with however a comparable morbidity of 42% only surgery proved to be better overall. Aneurysm size was inversely correlated with complication rate with smaller lesions more prone to rupture and complications. The nature of the perforating artery was also found to be a factor, where direct brain stem perforators from the upper two-third of the basilar artery were found to be difficult to treat both by surgery and endovascular methods, leading to significant failures and complications as compared to the wider circumflex perforating arteries. Conclusion: Scarce published literature that addresses the limited understanding of the natural course of this entity lead to difficulties in proposing broad-based recommendations that are fail proof. Nevertheless, we hope this analysis of 20 years of data helps in shedding light on this difficult disease and its possible treatment options along with risks and outcomes.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122216248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amit Sharma, A. Jagetia, A. Srivastava, Daljit Singh
Kissing aneurysms (KAs) are rare and cause various problems when clipping of these aneurysms is attempted because they often partially adhere to each other. A 65-year-old female presented with subarachnoid haemorrhage due to a ruptured aneurysm originating from the left internal carotid artery (ICA)-posterior communicating artery A. She also had an unruptured aneurysm arising from the bifurcation of a left ICA-anterior choroidal artery A. Intraoperative findings revealed that these were KAs. Surgical clipping was performed. The postoperative period was uneventful. In this case report, we would like to stress the rarity of KAs and the difficulty in the diagnosis and management of such cases.
{"title":"Kissing aneurysms of the internal carotid artery","authors":"Amit Sharma, A. Jagetia, A. Srivastava, Daljit Singh","doi":"10.4103/jcvs.jcvs_17_20","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_17_20","url":null,"abstract":"Kissing aneurysms (KAs) are rare and cause various problems when clipping of these aneurysms is attempted because they often partially adhere to each other. A 65-year-old female presented with subarachnoid haemorrhage due to a ruptured aneurysm originating from the left internal carotid artery (ICA)-posterior communicating artery A. She also had an unruptured aneurysm arising from the bifurcation of a left ICA-anterior choroidal artery A. Intraoperative findings revealed that these were KAs. Surgical clipping was performed. The postoperative period was uneventful. In this case report, we would like to stress the rarity of KAs and the difficulty in the diagnosis and management of such cases.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127780779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Panchariya, G. Singhal, A. Jagetia, A. Srivastava
Aneurysm in paediatric population is a relatively less reported vascular pathology. In contrary to degenerative and dysplastic causes as in their adult counterpart, the mechanism lies either in a congenital defect in vessel wall or following some traumatic event. Traumatic intracranial aneurysms (TICA) are again not a common occurrence. TICAs constitute <1% of all intracranial aneurysms. They can occur following blunt or penetrating head trauma and are more common in the paediatric population. Traumatic aneurysms are typically associated with an acute episode of delayed intracranial haemorrhage with an average time from initial trauma to aneurysm haemorrhage of approximately 21 days. The youngest case reported for a traumatic distal anterior cerebral artery (ACA) aneurysm is of a 6-week old child due to shaken baby syndrome. We report an interesting and rare case of a traumatic distal ACA aneurysm in a 3-year-old child.
{"title":"Traumatic distal anterior cerebral artery aneurysm in a 3-year-old child: An uncommon but notable case","authors":"P. Panchariya, G. Singhal, A. Jagetia, A. Srivastava","doi":"10.4103/jcvs.jcvs_24_20","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_24_20","url":null,"abstract":"Aneurysm in paediatric population is a relatively less reported vascular pathology. In contrary to degenerative and dysplastic causes as in their adult counterpart, the mechanism lies either in a congenital defect in vessel wall or following some traumatic event. Traumatic intracranial aneurysms (TICA) are again not a common occurrence. TICAs constitute <1% of all intracranial aneurysms. They can occur following blunt or penetrating head trauma and are more common in the paediatric population. Traumatic aneurysms are typically associated with an acute episode of delayed intracranial haemorrhage with an average time from initial trauma to aneurysm haemorrhage of approximately 21 days. The youngest case reported for a traumatic distal anterior cerebral artery (ACA) aneurysm is of a 6-week old child due to shaken baby syndrome. We report an interesting and rare case of a traumatic distal ACA aneurysm in a 3-year-old child.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127975563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 31-year-old male presented with subarachnoid haemorrhage due to a basilar tip aneurysm associated with an incidental coarctation of the aorta (CoA). The aneurysm was treated with endovascular coiling. Patients with CoA frequently harbour intracranial aneurysms at a young age. The occurrence of basilar tip aneurysm associated with CoA is extremely rare. The relevant literature on the subject is discussed.
{"title":"Basilar aneurysm and coarctation of the aorta","authors":"Shrikant K. Kalbagwar, P. Barve, T. Nadkarni","doi":"10.4103/jcvs.jcvs_27_20","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_27_20","url":null,"abstract":"A 31-year-old male presented with subarachnoid haemorrhage due to a basilar tip aneurysm associated with an incidental coarctation of the aorta (CoA). The aneurysm was treated with endovascular coiling. Patients with CoA frequently harbour intracranial aneurysms at a young age. The occurrence of basilar tip aneurysm associated with CoA is extremely rare. The relevant literature on the subject is discussed.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133313231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Indocyanine green video angiography in vascular neurosurgery","authors":"J. Dil","doi":"10.4103/jcvs.jcvs_1_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_1_21","url":null,"abstract":"","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130463697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anterior choroidal artery (AChoA) aneurysms are rare intracranial aneurysms which pose considerable challenge both for surgical clipping and endovascular coiling. The small size of the parent artery, variability in its point of origin from the internal carotid artery and the high rate of ischemic complications make AChoA aneurysms formidable surgical challenge. We present two cases of aneurysm highlighting the technical challenges involved in the microsurgical clipping of AChoA aneurysms.
{"title":"Microsurgical clipping of anterior choroidal artery aneurysms: Tips and tricks","authors":"K. Singh, Vinod Kumar, Debish Anand, R. Menon","doi":"10.4103/jcvs.jcvs_23_20","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_23_20","url":null,"abstract":"Anterior choroidal artery (AChoA) aneurysms are rare intracranial aneurysms which pose considerable challenge both for surgical clipping and endovascular coiling. The small size of the parent artery, variability in its point of origin from the internal carotid artery and the high rate of ischemic complications make AChoA aneurysms formidable surgical challenge. We present two cases of aneurysm highlighting the technical challenges involved in the microsurgical clipping of AChoA aneurysms.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128467693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Foot drop is defined as the weakness of the tibialis anterior muscle and is frequently accompanied by weakness of the extensor hallucis longus and extensor digitorum longus. Dural arteriovenous (AV) fistula present mainly as progressive myelopathy, though it can also appear as amalgam of upper and lower motor involvement signs. Digital subtraction angiography is the definitive radiological procedure in the pre-treatment evaluation of vascular malformation. Treatment modalities include surgical resection or angiographically guided embolisation of malformation. We are reporting a case of spinal AV fistula presenting as unilateral foot drop, which showed significant improvement following the neuro-radiological intervention. Here, we report a rare presentation of spinal AV fistula as foot drop, showing good recovery following glue embolisation.
{"title":"Foot drop – Common entity, uncommon aetiology","authors":"R. Jain, Y. Jain, T. Desai, T. Srivastav","doi":"10.4103/jcvs.jcvs_1_20","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_1_20","url":null,"abstract":"Foot drop is defined as the weakness of the tibialis anterior muscle and is frequently accompanied by weakness of the extensor hallucis longus and extensor digitorum longus. Dural arteriovenous (AV) fistula present mainly as progressive myelopathy, though it can also appear as amalgam of upper and lower motor involvement signs. Digital subtraction angiography is the definitive radiological procedure in the pre-treatment evaluation of vascular malformation. Treatment modalities include surgical resection or angiographically guided embolisation of malformation. We are reporting a case of spinal AV fistula presenting as unilateral foot drop, which showed significant improvement following the neuro-radiological intervention. Here, we report a rare presentation of spinal AV fistula as foot drop, showing good recovery following glue embolisation.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122253329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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