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Off-label use of Woven EndoBridge device in vertebro-basilar junction aneurysm and a review of the literature 标签外应用Woven EndoBridge装置治疗椎基底交界处动脉瘤及文献回顾
Q2 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.hest.2022.10.007
Shail Thanki , Hannah Goldman-Daleo , Kunal Vakharia

An intrasaccular flow diverter, the Woven EndoBridge device has emerged as an alternate intervention for complex aneurysms of the ACA, MCA, ICA, and basilar artery. However, few studies report the use of the WEB device in off-label locations. This case report aims to contribute to this limited collection of data. We present a case of a 53-year-old male presenting with occipital headaches, found to have vertebrobasilar junction aneurysm. The WEB device was successfully used to embolize a large aneurysm of the vertebrobasilar junction, a current off-label location. This represents a new use of the WEB device, as well as an approach that addresses the limitations of other techniques used for vertebrobasilar junction aneurysms.

Woven EndoBridge装置是一种accular内分流器,已成为ACA、MCA、ICA和基底动脉复杂动脉瘤的替代干预措施。然而,很少有研究报告在标签外位置使用WEB设备。本案例报告旨在为这一有限的数据收集做出贡献。我们报告一例53岁男性枕部头痛,发现有椎基底动脉瘤。WEB装置成功地用于栓塞椎基底动脉交界处的大动脉瘤,这是目前的一个标签外位置。这代表了WEB设备的一种新用途,以及一种解决椎基底动脉瘤其他技术局限性的方法。
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引用次数: 0
A case of subarachnoid hemorrhage due to perimedullary arteriovenous fistula with multiple feeders at the craniocervical junction cured by treating the common draining vein and a review of the literature 颅颈交界处多管动静脉瘘所致蛛网膜下腔出血1例,经共同引流静脉治疗并文献复习
Q2 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.hest.2023.01.003
Sho Sato, Satoshi Fujita, Yu Hiramoto, Morito Hayashi, Naoki Kushida, Nozomi Hirai, Haruo Nakayama, Norihiko Saito, Keisuke Ito, Takatoshi Sakurai, Satoshi Iwabuchi

Objective

Craniocervical junction arteriovenous fistula (CCJ-AVF) is a rare disease, and preoperative imaging evaluation is important in developing treatment strategies due to the complexity of the vascular architecture, such as the feeding vessels, shunt points, and draining veins. In the present study, we report a case of hemorrhagic perimedullary CCJ-AVF with multiple feeding vessels in which the common single draining vein was dissected by craniotomy and completely treated.

Case presentation

A 71-year-old woman presented with subarachnoid hemorrhage (Hunt & Kosnik, grade II). Cerebrovascular CTA showed no intracranial cerebral aneurysm and findings suggestive of shunt disease at the CCJ. Based on cerebral angiography, the patient was diagnosed with perimedullary CCJ AVF, with the right radicular and the left anterior spinal arteries as feeders which drain into a common dilated coronary vein through a shunt located on the ventral side of the spinal cord and then drain into the ascending and descending anterior spinal veins. Ventricular drainage was performed for acute hydrocephalus, and arteriovenous fistula was dissected electively by craniotomy on day 17 after onset. A clip was applied to the single draining vein, which had been evaluated using preoperative imaging diagnosis. Intraoperative digital subtraction angiography (DSA) confirmed the disappearance of shunt blood flow, and the surgery was completed. The follow-up DSA did not show shunt blood flow, and the patient was transferred to a rehabilitation hospital with a modified Rankin scale score of 2.

Conclusion

CCJ-AVF cases often have a complex vascular architecture, and it is important to use various modalities to understand the vascular anatomy in detail and develop an appropriate treatment strategy.

目的脑颈交界动静脉瘘(CCJ-AVF)是一种罕见的疾病,由于其血管结构(如供血血管、分流点和引流静脉)的复杂性,术前影像学评估对制定治疗策略具有重要意义。在本研究中,我们报告了一例出血性髓周CCJ-AVF伴多条供血血管,其中通过开颅术解剖并完全治疗了常见的单一引流静脉。病例介绍:一位71岁的女性出现蛛网膜下腔出血(Hunt&;Kosnik,II级)。脑血管CTA未显示颅内脑动脉瘤,提示CCJ存在分流疾病。根据脑血管造影,患者被诊断为髓周CCJ AVF,以右神经根和左脊髓前动脉为馈线,通过位于脊髓腹侧的分流器流入共同扩张的冠状静脉,然后流入上行和下行的脊髓前静脉。急性脑积水行心室引流,发病后第17天选择性开颅解剖动静脉瘘。将夹子应用于单一引流静脉,该静脉已通过术前影像学诊断进行了评估。术中数字减影血管造影术(DSA)证实分流血流消失,手术完成。随访DSA未显示分流血流,患者被转移到康复医院,改良Rankin量表评分为2。结论CCJ-AVF病例通常具有复杂的血管结构,使用各种方法详细了解血管解剖结构并制定适当的治疗策略很重要。
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引用次数: 0
Neurological complications and effects of COVID-19: Symptoms and conceivable mechanisms 新冠肺炎的神经并发症和影响:症状和可能的机制
Q2 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.hest.2023.02.001
Elif Sarıoğlu, Sezen Yılmaz Sarıaltın, Tülay Çoban

A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China. The new coronavirus disease (COVID-19) was declared a global pandemic by the World Health Organization (WHO) in March 2020. SARS-CoV-2 can invade the nervous system aside from infecting the respiratory system as its primary target. The most common nervous system symptoms of COVID-19 are stated as headache, myalgia, fatigue, nausea, vomiting, sudden and unexplained anosmia, and ageusia. More severe conditions such as encephalomyelitis, acute myelitis, thromboembolic events, ischemic stroke, intracerebral hemorrhage, Guillain-Barré-syndrome, Bell's palsy, rhabdomyolysis, and even coma have also been reported. Cohort studies revealed that neurological findings are associated with higher morbidity and mortality. The neurological symptoms and manifestations caused by SARS-CoV-2 and COVID-19 are examined and summarized in this article.

2019年12月,在中国武汉首次发现了一种新型冠状病毒,即严重急性呼吸综合征冠状病毒2(SARS-CoV-2)。2020年3月,世界卫生组织(世界卫生组织)宣布新型冠状病毒疾病(新冠肺炎)为全球大流行。严重急性呼吸系统综合征冠状病毒2型除了作为主要目标感染呼吸系统外,还可以入侵神经系统。新冠肺炎最常见的神经系统症状是头痛、肌痛、疲劳、恶心、呕吐、突然和不明原因的嗅觉缺失和老年痴呆。更严重的情况,如脑脊髓炎、急性脊髓炎、血栓栓塞事件、缺血性中风、脑出血、格林-巴利综合征、贝尔麻痹、横纹肌溶解症,甚至昏迷也有报道。队列研究显示,神经系统的发现与更高的发病率和死亡率有关。本文综述了严重急性呼吸系统综合征冠状病毒2型和新冠肺炎引起的神经系统症状和表现。
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引用次数: 0
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!
Q2 Medicine 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
Q2 Medicine 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
Q2 Medicine 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
Q2 Medicine 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
Q2 Medicine 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
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
Q2 Medicine 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。
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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
Q2 Medicine 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。
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引用次数: 0
期刊
Brain Hemorrhages
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