Reversible cerebral vasoconstriction syndrome (RCVS) is a heterogeneous group of cerebrovascular disease. The pathophysiology of RCVS is unknown, but a disturbance in cerebral vascular tone is one of hypothesis. Long-term use of Gonadotropin-releasing hormone (GnRH) agonists can induce a pseudomenopausal state in which estrogen production are suppressed. It might lead to reduced arterial relaxation by estrogen withdrawal. We report a case of RCVS after the injection of synthetic analogue of GnRH.
Cerebral Hemorrhage ; Cerebrovascular Disorders ; Estrogens ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Hemorrhage* ; Injections, Subcutaneous* ; Relaxation ; Vasoconstriction*

The devices and methods of endovascular recanalization therapy (ERT) have been rapidly developed and changed since PROACT II trial. Emerging as a treatment option in addition to intravenous or intra-arterial thrombolysis, mechanical thrombectomy is currently being further developed and investigated as a potential first-line and stand-alone treatment. This review highlights and summarizes the recent clinical series and trials of the available devices and methods of ERT focusing on the multimodal approach.
Brain ; Cerebrovascular Disorders ; Endovascular Procedures ; Mechanical Thrombolysis ; Stroke ; Thrombectomy ; Thrombolytic Therapy

The duplicated origin of vertebral artery (VA) is a very rare condition. It could be easily misdiagnosed as an arterial dissection on selective catheter angiography, especially in a patient with acute cerebellar infarction of unknown etiology. We report a patient with an acute cerebellar infarction and duplicated origin of the left VA, which was found during the selective catheter angiography.
Angiography ; Catheters ; Humans ; Infarction ; Vertebral Artery*

Central retinal artery occlusion (CRAO) causes severe visual loss in affected eye and vision does not recover in more than 90% of the patients. It is believed that it occurs by occlusion of the central retinal artery with small emboli from atherosclerotic plaque of internal cerebral artery. Retina is a part of the brain, thus basically CRAO is corresponding to acute occlusion of intracerebral artery and retinal ischemia is to cerebral stroke. Therefore, intra-arterial thrombolysis (IAT) has been considered as a treatment method in CRAO. Recently, we treated 2 patients diagnosed as CRAO and could achieve complete recanalization on fundus fluorescein angiogram with IAT. Of them, one recovered visual acuity to 20/25. We report our 2 CRAO cases treated with IAT and discuss technical aspects for IAT and management of patient. To the best of our knowledge, this is the first Korean report of IAT for CRAO.

Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HA-injected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions.
Adipose Tissue/transplantation ; Adult ; Aged ; Arterial Occlusive Diseases/*etiology/*radiography/therapy ; Cerebral Angiography ; Cosmetic Techniques/adverse effects ; Dermal Fillers/administration & dosage/*adverse effects ; Face ; Female ; Humans ; Hyaluronic Acid/administration & dosage/adverse effects ; Hyaluronoglucosaminidase/administration & dosage ; Injections, Subcutaneous ; Ophthalmic Artery/*radiography ; Retinal Artery Occlusion/*etiology/*radiography/therapy ; Retrospective Studies ; Transplantation, Autologous/adverse effects ; Young Adult

beta-fluoroethyl acetate rodenticide intoxication can manifest as several different clinical abnormalities such as respiratory, neurologic, cardiologic and fluid-electrolyte problems. We report here on the MR findings of a case that showed symmetric cytotoxic edema in the white matter of the cerebral hemispheres after the ingestion of beta-fluoroethyl acetate rodenticide by a woman who was attempting suicide.
Brain ; Cerebrum ; Eating ; Edema ; Female ; Humans ; Suicide

PURPOSE: A coated coil system, covered with a bioabsorbable polymeric material (polyglycolic acid/lactide copolymer, PGLA), was developed to accelerate intra-aneurysmal clot organization and fibrosis, and thereby to reduce aneurysm recanalization. As a continuation of a previously published study that included analysis of short-term outcomes of endosaccular coil embolization of intracranial saccular aneurysm within 6 months, the purpose of this study was to evaluate the mid-term results of PGLA-coated coils in patients with intracranial aneurysms and to compare results with those of bare platinum coils. PATIENTS AND METHODS: Fifty-one patients harboring 56 intracranial aneurysms underwent endovascular embolization with PGLA-coated coils. The control group included 78 consecutive patients, harboring 87 aneurysms, who underwent coil embolization with bare platinum coils. The authors compared mid-term follow-up results in these two groups retrospectively. RESULTS: The median follow-up interval for radiologic evaluation was 12 months (range 5 to 18 months) and 14 months (range 6 to 30 months) in the PGLA-coil group and the bare-coil group, respectively. Major aneurysm recanalization occurred in 9 of 43 aneurysms (20.9%) in the PGLA-coil group and in 13 of 64 aneurysms (20%) in the bare-coil group. Notably, the rate of major recanalization (46.2%) in the PGLA coil group with a packing density of <25% was significantly higher than that of the bare coil group (17.8%). CONCLUSION: In spite of a similar incidence of recanalization between the PGLA-coated coil and bare platinum coil groups, the major recanalization rate of this group was significantly higher than that of the bare coil group, if packing density of more than 25% was not achieved using PGLA-coated coils. So we can conclude that dense packing is more likely to have an effect on treatment result rather than does biological effect of PGLA in case of endosaccular coil embolization using PGLA-coated coils.
Aneurysm ; Embolization, Therapeutic ; Fibrosis ; Follow-Up Studies ; Humans ; Incidence ; Intracranial Aneurysm* ; Platinum* ; Polymers ; Retrospective Studies

Traumatic carotid carvenous fistula (CCF) associated with cerebral aneurysm is a rare condition. Early detection of the traumatic cerebral aneurysm (TCA) before traumatic CCF occlusion is difficult, largely because of steal phenomenon of the fistula, masking by complex venous drains and a nearby parent artery, and a latent period of the TCA. In addition, traumatic CCF caused by a combined aneurysm rupture is an extremely rare condition. It is a dangerous condition in which treatment should be performed immediately or even on an emergency basis. A 31-year-old man developed traumatic CCF after traffic accident. Cerebral angiography revealed a direct CCF communicated with an intradural aneurysm on the origin of right posterior communicating artery (PcomA). Successful transarterial coil embolization was achieved after consecutive two trials.
Accidents, Traffic ; Adult ; Aneurysm* ; Arteries ; Cerebral Angiography ; Embolization, Therapeutic ; Emergencies ; Fistula* ; Humans ; Intracranial Aneurysm ; Masks ; Parents ; Rupture*

Congenital intracranial pial arteriovenous fistula complicated with high output heart failure is a rare disease of the cerebral vasculature. Like vein of Galen malformation, it can cause high output cardiac failure, but the treatment strategy is different. To lead a neonate with severe heart failure to normally grow with the brain and body, a rapid treatment is mandatory and has to target on removing the fistula. The authors report on a neonate with congenital pial arteriovenous fistula complicated with high output heart failure, which recovered with transarterial embolization and allowed the neonate to thrive.
Arteriovenous Fistula* ; Brain ; Cerebral Veins ; Estrogens, Conjugated (USP)* ; Fistula ; Heart Failure* ; Humans ; Infant, Newborn* ; Rare Diseases

Dural sinus malformation (DSM) with arteriovenous fistula (AVF) is very rare in pediatric group. We experienced one case of DSM and treated AVF by endovascular embolization. Herein we report this rare case occurred in infant.
Arteriovenous Fistula ; Humans ; Infant*