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Correlation does not mean causation: Proofs of COVID-19 associated strokes! 相关性并不意味着因果关系:COVID-19相关中风的证据!
Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-01 DOI: 10.1016/j.hest.2022.10.006
Cristian Deana , Luigi Vetrugno , Daniele Bagatto
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引用次数: 0
Spot the adenoma after pituitary apoplexy following a SARS-CoV-2 vaccination 在接种SARS-CoV-2疫苗后发现垂体中风后的腺瘤
Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-01 DOI: 10.1016/j.hest.2022.10.001
Josef Finsterer , Fulvio A. Scorza , Antonio-Carlos G. de Almeida

Pituitary apoplexy often manifests with a severe headache and is often caused by bleeding in a pituitary adenoma, which is common and often undiagnosed. The pituitary gland is damaged when the tumour suddenly enlarges due to bleeding. Bleeding into the pituitary can block blood supply to the pituitary gland. The larger the tumour, the higher the risk of a future pituitary apoplexy. Since only few cases have been reported, the SARS-CoV-2 vaccine is unlikely to cause pituitary apoplexy. Patients with new-type headache require neurological evaluation and may require cerebral imaging to rule out bleeding, ischemia, venous sinus thrombosis, meningitis, encephalitis, pituitary apoplexy, reversible cerebral vasoconstriction syndrome, dissection, or migraine.

垂体卒中通常表现为严重头痛,通常由垂体腺瘤出血引起,垂体腺瘤出血很常见,通常未被诊断。当肿瘤因出血而突然增大时,垂体就会受损。脑垂体出血会阻断脑垂体的血液供应。肿瘤越大,将来发生垂体卒中的风险就越高。由于只有少数病例报告,严重急性呼吸系统综合征冠状病毒2型疫苗不太可能导致垂体卒中。新型头痛患者需要进行神经系统评估,可能需要进行脑部成像以排除出血、局部缺血、静脉窦血栓形成、脑膜炎、脑炎、垂体卒中、可逆性脑血管收缩综合征、夹层或偏头痛。
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引用次数: 0
Apropos of menstrual changes and abnormal uterine bleeding after COVID-19 vaccination COVID-19疫苗接种后月经改变和子宫异常出血的适宜性
Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-01 DOI: 10.1016/j.hest.2022.11.001
Luca Roncati, Antonio Manenti

It is news of 28 October 2022 that the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency has recommended to add heavy menstrual bleeding among the side effects of unknown frequency inside the package insert of nucleoside-modified messenger ribonucleic acid vaccines to prevent coronavirus disease 2019 (COVID-19). The decision has been made in the light of the numerous reports of unexpected menstrual changes or abnormal uterine bleeding following COVID-19 vaccination. Here we advance a possible involvement of the particular adenohypophyseal microcirculation in these strange and still unexplained events.

据2022年10月28日消息,欧洲药品管理局药物警戒风险评估委员会建议在核苷修饰信使核糖核酸疫苗的包装插入物中添加频率未知的严重月经出血副作用,以预防2019冠状病毒病(新冠肺炎)。这一决定是根据新冠肺炎疫苗接种后意外月经变化或异常子宫出血的大量报告做出的。在这里,我们提出了一个可能涉及特定的腺垂体微循环在这些奇怪的,仍然无法解释的事件。
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引用次数: 1
Establishing causality between SARS-CoV-2 and stroke/bleeding requires a temporal relationship and plausible pathophysiology 建立SARS-CoV-2与中风/出血之间的因果关系需要时间关系和合理的病理生理学
Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-01 DOI: 10.1016/j.hest.2022.10.004
Josef Finsterer , Fulvio A. Scorza , Antonio-Carlos G. de Almeida

Cerebrovascular events are increasingly recognized as a complication of SARS-CoV-2 infections. They can be due to hypercoagulability, vasculopathy, cardiac involvement in the infection, or autonomic dysfunction. However, establishing a causal relationship between cerebrovascular events and viral infection is not always easy and requires thorough investigation and documentation of a close temporal relationship between SARS-CoV-2 infection and the onset of cerebral impairment. Establishing a causal relationship between SARS-CoV-2 infection and cerebrovascular events is desirable as it can guide therapeutic management and determine the outcome.

脑血管事件越来越被认为是严重急性呼吸系统综合征冠状病毒2型感染的并发症。它们可能是由于高凝状态、血管病变、心脏感染或自主神经功能障碍引起的。然而,确定脑血管事件和病毒感染之间的因果关系并不总是容易的,需要彻底调查和记录严重急性呼吸系统综合征冠状病毒2型感染与脑损伤发作之间的密切时间关系。建立严重急性呼吸系统综合征冠状病毒2型感染与脑血管事件之间的因果关系是可取的,因为它可以指导治疗管理并确定结果。
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引用次数: 0
Telerehabilitation-based exercises with or without transcranial direct current stimulation for pain, motor and cognitive function in older adults with mild cognitive impairments post-stroke: A multi-arm parallel-group randomized controlled trial study protocol 基于远程康复的运动,有或没有经颅直流电刺激,对中风后轻度认知障碍的老年人疼痛、运动和认知功能:一项多臂平行组随机对照试验研究方案
Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-01 DOI: 10.1016/j.hest.2023.01.004
Tolulope Adeniji , Thayananthee Nadasan , Oladapo Michael Olagbegi , Olumide Dada

Background

Cognitive impairments, pain, and motor dysfunction are daunting challenges for stroke survivors, clinicians, and caregivers during rehabilitation programmes. There is a dearth of studies investigating the effectiveness of combining neurodevelopmental technique telerehabilitation-based exercises with transcranial direct current stimulation (tDCS) for stroke survivors with mild cognitive impairments post-stroke.

Objectives

The primary aim of this study is to investigate and compare the effects of Telerehabilitation-Based Exercises with or without Transcranial Direct Current Stimulation (tDCS) on pain, motor and cognitive function in older adults with mild cognitive impairments post-stroke.

Methods

A multi-arm parallel-group (three groups) randomized controlled trial study involving a minimum of 87 participants (29 per group) will be conducted. Participants will be randomized into either telerehabilitation programmes with tDCS, telerehabilitation programmes alone or conventional physiotherapy programmes. All participants will be treated 3 times weekly for 8 weeks (45 min of intervention per session).

Discussion

The findings in this study are expected to guide the provision of effective and affordable rehabilitation for stroke survivors with mild cognitive impairment.

背景认知障碍、疼痛和运动功能障碍是中风幸存者、临床医生和护理人员在康复计划中面临的严峻挑战。目前缺乏研究将神经发育技术远程康复训练与经颅直流电刺激(tDCS)相结合对中风后轻度认知障碍的中风幸存者的有效性。目的本研究的主要目的是调查和比较有无远程康复训练的效果经颅直流电刺激(tDCS)对患有轻度认知障碍的老年人中风后疼痛、运动和认知功能的影响。方法将进行一项多臂平行组(三组)随机对照试验研究,涉及至少87名参与者(每组29人)。参与者将被随机分配到有tDCS的远程康复计划、单独的远程康复方案或传统理疗方案中。所有参与者将在8周内每周接受3次治疗(每次干预45分钟)。讨论本研究的发现有望指导为轻度认知障碍的中风幸存者提供有效且负担得起的康复。
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引用次数: 1
Effectiveness of telerehabilitation-based exercises plus transcranial direct current stimulation for stroke rehabilitation among older adults: A scoping review 远程康复训练加经颅直流电刺激对老年人脑卒中康复的有效性:一项范围综述
Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-01 DOI: 10.1016/j.hest.2022.11.002
Tolulope Adeniji , Oladapo M. Olagbegi , Thayananthee Nadasan , Olumide Dada

Objective

Physiotherapy rehabilitation of patients with stroke is challenging for the patient, their informal caregivers and the therapist involved. A telerehabilitation programme combined with transcranial direct current stimulation (tDCS) may be the more appealing approach that may save rehabilitation time and improve treatment outcomes. This study performs a scoping review on the effect of telerehabilitation-based exercises plus tDCS among older adults with stroke.

Methods

This scoping adopts the Joana Briggs Institute guidelines for conducting a scoping review. Using Keywords and related MeSH terms to telerehabilitation-based exercises and tDCS among older adults with stroke, the following databases were searched: Cochrane, PubMed, Scopus, and Web of Science. Additional seven other databases (Academic Search Complete; PsycInfo; Health Source-Consumer Edition; Health Source: Nursing/Academic Edition; MEDLINE with Full Text; Academic Search Ultimate) were searched via EBSCOhost. The articles identified were imported to Mendeley for deduplication and then to Rayyan for further deduplication, title and abstract screening.

Results

Out of 216 total articles retrieved, 6 met the study’s inclusion criteria and were extracted for this study. The evidence shows that the telerehabilitation-based exercise intervention with tDCS improves upper limb motor function among older adult patients with stroke.

Discussion & conclusion

Most of the evidence found focused on a combination of virtual reality-based exercises plus tDCS, and none of the telerehabilitation exercise interventions follows the neurorehabilitation techniques such as the Brunnstrom approach and Bobath technique. While it can be concluded that the evidence points towards improving upper limb motor functions with virtual reality and tDCS for stroke rehabilitation among older adults, there is no evidence of its effect on non-motor symptoms such as pain and cognitive functions possibly due to unavailability of relevant studies. There is also a dearth of evidence for t he telerehabilitation programme that uses neurodevelopmental techniques such as Brunnstrom and Bobath approaches with tDCS. This is paramount in providing effective care to older adult patients with stroke.

目的脑卒中患者的物理治疗康复对患者、其非正式护理人员和相关治疗师来说都是一项挑战。远程康复计划与经颅直流电刺激(tDCS)相结合可能是更具吸引力的方法,可以节省康复时间并改善治疗结果。本研究对基于远程康复的锻炼加tDCS在老年中风患者中的影响进行了范围审查。方法本范围界定采用Joana Briggs研究所指南进行范围界定审查。使用Keywords和相关的MeSH术语在老年中风患者中进行基于远程康复的锻炼和tDCS,检索了以下数据库:Cochrane、PubMed、Scopus和Web of Science。另外七个其他数据库(学术搜索完成;PsycInfo;健康来源消费者版;健康来源:护理/学术版;MEDLINE全文;学术搜索终极版)通过EBSCOhost进行搜索。将确定的文章导入Mendeley进行重复数据消除,然后导入Rayyan进行进一步的重复数据消除、标题和摘要筛选。结果在检索到的216篇文章中,有6篇符合本研究的纳入标准,并被提取用于本研究。有证据表明,基于远程康复的tDCS运动干预改善了老年中风患者的上肢运动功能。讨论&;结论大多数证据集中在基于虚拟现实的锻炼加tDCS的组合上,并且没有一种远程康复锻炼干预遵循神经康复技术,如Brunnstrom方法和Bobath技术。虽然可以得出结论,有证据表明,虚拟现实和tDCS有助于改善老年人中风康复的上肢运动功能,但没有证据表明其对疼痛和认知功能等非运动症状有影响,这可能是由于缺乏相关研究。也缺乏证据表明远程康复计划使用神经发育技术,如Brunnstrom和Bobath方法和tDCS。这对于为老年中风患者提供有效的护理至关重要。
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引用次数: 1
Immunotherapy as a treatment for Stroke: Utilizing regulatory T cells 免疫疗法治疗中风:利用调节性T细胞
Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-01 DOI: 10.1016/j.hest.2023.02.003
Yuanwei Li , Devin W. McBride , Yingxin Tang , Desislava Doycheva , John H. Zhang , Zhouping Tang

Stroke, a cerebrovascular disease with a high mortality rate, is categorized as either ischemic or hemorrhagic. Current existing therapies have limitations, including a narrow time window for treatment. As stroke induces a rapid and large immune response, immune cells and inflammatory mediators have become promising therapeutic targets for both ischemic and hemorrhagic strokes. In recent years, T cells have been investigated for their role in the pathogenesis of secondary injury and their therapeutic potential after stroke. And regulatory T cells, as one of the subpopulations of T cells, have been proved neuroprotective at both acute and recovery stages. In this review, we summarize the existing roles of Tregs in stroke and the various methods available for Treg intervention, and then provide a perspective for the future of immunotherapy in stroke.

中风是一种死亡率很高的脑血管疾病,可分为缺血性或出血性。目前现有的治疗方法有局限性,包括治疗时间窗口狭窄。随着中风诱导快速而大的免疫反应,免疫细胞和炎症介质已成为缺血性和出血性中风的有前途的治疗靶点。近年来,人们对T细胞在脑卒中后继发性损伤的发病机制中的作用及其治疗潜力进行了研究。调节性T细胞作为T细胞的亚群之一,已被证明在急性期和恢复期具有神经保护作用。在这篇综述中,我们总结了Treg在中风中的现有作用以及Treg干预的各种方法,然后为中风免疫治疗的未来提供了一个前景。
{"title":"Immunotherapy as a treatment for Stroke: Utilizing regulatory T cells","authors":"Yuanwei Li ,&nbsp;Devin W. McBride ,&nbsp;Yingxin Tang ,&nbsp;Desislava Doycheva ,&nbsp;John H. Zhang ,&nbsp;Zhouping Tang","doi":"10.1016/j.hest.2023.02.003","DOIUrl":"https://doi.org/10.1016/j.hest.2023.02.003","url":null,"abstract":"<div><p>Stroke, a cerebrovascular disease with a high mortality rate, is categorized as either ischemic or hemorrhagic. Current existing therapies have limitations, including a narrow time window for treatment. As stroke induces a rapid and large immune response, immune cells and inflammatory mediators have become promising therapeutic targets for both ischemic and hemorrhagic strokes. In recent years, T cells have been investigated for their role in the pathogenesis of secondary injury and their therapeutic potential after stroke. And regulatory T cells, as one of the subpopulations of T cells, have been proved neuroprotective at both acute and recovery stages. In this review, we summarize the existing roles of Tregs in stroke and the various methods available for Treg intervention, and then provide a perspective for the future of immunotherapy in stroke.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 3","pages":"Pages 147-153"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49746800","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}
引用次数: 2
Hematological indices as predictors of intracerebral hematoma expansion detected on serial computed tomography 血液学指标作为连续计算机断层扫描检测到的脑内血肿扩大的预测指标
Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-01 DOI: 10.1016/j.hest.2023.02.004
K. Suprasanna , H.B. Sridevi , S.R. Ravikiran , Ishank Jain , Varun Holla

Objective

Hematoma expansion is associated with unfavourable neurological outcomes in intracranial haemorrhage. We aimed to study association of red blood cell (RBC) indices, platelet indices, and their ratios with hematoma expansion, detected by serial computed tomography (CT).

Methods

Hospital-based observational study of 88 patients with intracerebral hematoma referred for serial CT head with patients grouped as having progression/ no change/ resolution of hematoma. Baseline hematological indices and ratios were analysed.

Results

40 patients (45.5 %) had resolution, 20 patients (22.7 %) had no change and 28 patients (31.8 %) had progression of hematoma. RBC distribution width (RDW) (p value 0.001) and Plateletcrit (p-value 0.009) showed statistically significant difference among the groups. RBC distribution width (RDW) to PC ratio (RPR) showed statistically significant increase (p < 0.001) in patients with progression. Receiver operating characteristic curve with RPR as test variable in predicting progression of hematoma showed cut-off value as 0.0615 (64.3 % sensitivity, 63.3 % specificity). Patients with RPR > 0.0615 had greater chances of hematoma progression {OR 3.1 (95 % CI 1.22 to 7.91); p = 0.0174}

Conclusion

Raised RPR was most significant parameter with higher RDW, lower plateletcrit values in patients with progression of intra-parenchymal hematoma. These readily available indices can aid in prompt prognostication of intracerebral haemorrhage cases.

目的颅内出血的血肿扩张与不良的神经系统结果有关。我们的目的是研究红细胞(RBC)指数、血小板指数及其比值与连续计算机断层扫描(CT)检测到的血肿扩张的关系。分析了基线血液学指标和比率。结果血肿消退40例(45.5%),无改变20例(22.7%),血肿进展28例(31.8%)。红细胞分布宽度(RDW)(p值0.001)和血小板压积(p值0.009)在各组之间显示出统计学上的显著差异。RBC分布宽度(RDW)与PC比率(RPR)在进展患者中显示出统计学上显著增加(p<0.001)。以RPR作为预测血肿进展的测试变量的受试者操作特征曲线显示截止值为0.0615(敏感性64.3%,特异性63.3%)。RPR患者>;0.0615有更大的血肿进展机会{OR 3.1(95%CI 1.22-7.91);p=0.0174}结论在实质内血肿进展的患者中,RPR升高是RDW较高、红细胞压积值较低的最显著参数。这些现成的指标可以帮助及时预测脑出血病例。
{"title":"Hematological indices as predictors of intracerebral hematoma expansion detected on serial computed tomography","authors":"K. Suprasanna ,&nbsp;H.B. Sridevi ,&nbsp;S.R. Ravikiran ,&nbsp;Ishank Jain ,&nbsp;Varun Holla","doi":"10.1016/j.hest.2023.02.004","DOIUrl":"https://doi.org/10.1016/j.hest.2023.02.004","url":null,"abstract":"<div><h3>Objective</h3><p>Hematoma expansion is associated with unfavourable neurological outcomes in intracranial haemorrhage. We aimed to study association of red blood cell (RBC) indices, platelet indices, and their ratios with hematoma expansion, detected by serial computed tomography (CT).</p></div><div><h3>Methods</h3><p>Hospital-based observational study of 88 patients with intracerebral hematoma referred for serial CT head with patients grouped as having progression/ no change/ resolution of hematoma. Baseline hematological indices and ratios were analysed.</p></div><div><h3>Results</h3><p>40 patients (45.5 %) had resolution, 20 patients (22.7 %) had no change and 28 patients (31.8 %) had progression of hematoma. RBC distribution width (RDW) (p value 0.001) and Plateletcrit (p-value 0.009) showed statistically significant difference among the groups. RBC distribution width (RDW) to PC ratio (RPR)<!--> <!-->showed statistically significant increase (p &lt; 0.001) in patients with progression.<!--> <!-->Receiver operating characteristic curve with RPR as test variable in predicting progression of hematoma showed cut-off value as 0.0615 (64.3 % sensitivity, 63.3 % specificity). Patients with RPR &gt; 0.0615 had greater chances of hematoma progression {OR 3.1 (95 % CI 1.22 to 7.91); p = 0.0174}</p></div><div><h3>Conclusion</h3><p>Raised RPR was most significant parameter with higher RDW, lower plateletcrit values in patients with progression of intra-parenchymal hematoma. These readily available indices can aid in prompt prognostication of intracerebral haemorrhage cases.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 3","pages":"Pages 111-115"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49746901","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}
引用次数: 0
Intracranial hemorrhage and Covid-19: A retrospective analysis of 1675 hospitalized Covid-19 Brazilian patients 颅内出血与Covid-19:巴西1675例住院Covid-19患者的回顾性分析
Q4 CLINICAL NEUROLOGY Pub Date : 2023-06-01 DOI: 10.1016/j.hest.2023.01.002
Artur Eduardo Martio, Pedro de Moraes Rêgo Soares, Octávio Ruschel Karam, Wagner Lazaretto Padua, Luciano Bambini Manzato, Paulo Moacir Mesquita Filho

Objective

The present study seeks to overcome the lack of data on Covid-19 associated intracranial hemorrhage (ICH) in Brazil.

Methods

This is a retrospective, single-center case series of consecutive patients. It is a subanalysis of a larger study still in progress, which covers all neurological manifestations that occurred in patients admitted between March 1st, 2020 and June 1st, 2022, with active SARS-CoV-2 infection confirmed by polymerase chain reaction test. All patients with non-traumatic ICH were included.

Results

A total of 1675 patients were evaluated: 917 (54.75 %) had one or more neurological symptoms and 19 had non-traumatic ICH, comprising an incidence of 1.13 %. All patients had one or more risk factors for ICH. The presence of neurological manifestations before the ICH and ICU admission showed a statistically significant relationship with the occurrence of ICH (X2 = 6.734, p = 0.0095; OR = 4.47; CI = 1.3–15.4; and FET = 9.13; p = <0.001; OR = 9.15; CI = 3.27–25.5 respectively).

Conclusion

Our findings were largely congruent with the world literature. We believe that the assessment of risk factors can accurately predict the subgroup of patients at increased risk of ICH, but further studies are needed to confirm these hypotheses.

目的本研究旨在克服巴西新冠肺炎相关颅内出血(ICH)数据的缺乏。这是一项仍在进行中的更大规模研究的亚分析,该研究涵盖了2020年3月1日至2022年6月1日期间入院的患者的所有神经系统表现,这些患者通过聚合酶链式反应检测证实了活动性严重急性呼吸系统综合征冠状病毒2型感染。所有非创伤性脑出血患者均包括在内。结果对1675例患者进行了评估:917例(54.75%)有一种或多种神经系统症状,19例有非创伤性脑出血,发生率为1.13%。ICH和ICU入院前的神经系统表现与ICH的发生具有统计学意义(X2=6.734,p=0.00.95;OR=4.47;CI=1.3-15.4;FET=9.13;p=<;0.001;OR=9.15;CI=3.27-25.5)。结论我们的研究结果与世界文献基本一致。我们认为,风险因素的评估可以准确预测脑出血风险增加的患者亚组,但还需要进一步的研究来证实这些假设。
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引用次数: 0
Complete basilar artery occlusion following ventriculoperitoneal shunt placement for giant aneurysm complicated by concurrent obstructive hydrocephalus: A case report 脑室腹腔分流术后基底动脉完全闭塞治疗巨大动脉瘤并发阻塞性脑积水1例
Q4 CLINICAL NEUROLOGY Pub Date : 2023-06-01 DOI: 10.1016/j.hest.2022.10.003
Molly Monsour , Elliot Neal , Davide Marco Croci , Maxim Mokin , Waldo Guerrero , Kunal Vakharia , Siviero Agazzi , Harry Van Loveren

Objective

Giant aneurysms are infrequently complicated with obstructive hydrocephalus (HC), however, when concurrent, effective treatments are unestablished. There are incredibly few reports of HC due to basilar artery giant aneurysms and fewer reports regarding ventriculoperitoneal (VP) shunt complications in these patients.

Case presentation

We report the case of a gentleman in his 70 s who presented with a fusiform aneurysm of the entire basilar artery and mild intra-aneurysmal thrombosis. HC, secondary to the aneurysm, indicated VP shunt placement. Within 12 h following shunt placement, however, the patient deteriorated rapidly due to complete basilar artery occlusion and widespread brainstem ischemia. Endovascular intervention was unsuccessful due to extremely high clot burden. He unfortunately expired 2 days afterwards.

Conclusion

Hydrocephalus due to aneurysms is not uncommon, and VP shunt placement should be optimized to avoid unforeseen complications like the one described. We suspect that the shunt placement aggravated the already aberrant flow within the aneurysm, propagating a pro-thrombotic environment. With further reports of this complication, a standardized method to place VP shunts for patients with giant aneurysms while minimizing the risk of thrombotic occlusion could be established.

目的巨大动脉瘤很少并发梗阻性脑积水(HC),然而,当同时治疗时,却无法找到有效的治疗方法。在这些患者中,由于基底动脉巨大动脉瘤导致HC的报道非常少,关于脑室-腹腔(VP)分流并发症的报道也很少。病例介绍我们报告了一位70多岁的绅士的病例,他表现为整个基底动脉的梭形动脉瘤和轻度动脉瘤内血栓形成。继发于动脉瘤的HC表明放置了VP分流器。然而,在分流术后12小时内,由于基底动脉完全闭塞和广泛的脑干缺血,患者病情迅速恶化。由于血栓负荷极高,血管内介入治疗不成功。不幸的是,他在两天后就去世了。结论动脉瘤引起的脑积水并不罕见,应优化VP分流的位置,以避免出现上述不可预见的并发症。我们怀疑分流放置加重了动脉瘤内已经异常的流量,传播了促血栓形成的环境。随着对这种并发症的进一步报道,可以建立一种标准化的方法,为巨大动脉瘤患者放置VP分流器,同时将血栓闭塞的风险降至最低。
{"title":"Complete basilar artery occlusion following ventriculoperitoneal shunt placement for giant aneurysm complicated by concurrent obstructive hydrocephalus: A case report","authors":"Molly Monsour ,&nbsp;Elliot Neal ,&nbsp;Davide Marco Croci ,&nbsp;Maxim Mokin ,&nbsp;Waldo Guerrero ,&nbsp;Kunal Vakharia ,&nbsp;Siviero Agazzi ,&nbsp;Harry Van Loveren","doi":"10.1016/j.hest.2022.10.003","DOIUrl":"https://doi.org/10.1016/j.hest.2022.10.003","url":null,"abstract":"<div><h3>Objective</h3><p>Giant aneurysms are infrequently complicated with obstructive hydrocephalus (HC), however, when concurrent, effective treatments are unestablished. There are incredibly few reports of HC due to basilar artery giant aneurysms and fewer reports regarding ventriculoperitoneal (VP) shunt complications in these patients.</p></div><div><h3>Case presentation</h3><p>We report the case of a gentleman in his 70 s who presented with a fusiform aneurysm of the entire basilar artery and mild intra-aneurysmal thrombosis. HC, secondary to the aneurysm, indicated VP shunt placement. Within 12 h following shunt placement, however, the patient deteriorated rapidly due to complete basilar artery occlusion and widespread brainstem ischemia. Endovascular intervention was unsuccessful due to extremely high clot burden. He unfortunately expired 2 days afterwards.</p></div><div><h3>Conclusion</h3><p>Hydrocephalus due to aneurysms is not uncommon, and VP shunt placement should be optimized to avoid unforeseen complications like the one described. We suspect that the shunt placement aggravated the already aberrant flow within the aneurysm, propagating a pro-thrombotic environment. With further reports of this complication, a standardized method to place VP shunts for patients with giant aneurysms while minimizing the risk of thrombotic occlusion could be established.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 2","pages":"Pages 72-76"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49744528","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}
引用次数: 0
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Brain Hemorrhages
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