Ischemic strokes result from thrombotic or embolic occlusion of one of the vessels that supply blood to the brain. The primary constituents of the initial thrombus are platelets and fibrin, with erythrocytes and other blood cells becoming trapped as thrombosis continues. Therefore, the recent improvements in therapy have focused on inhibiting platelets and dissolving fibrin. A new generation of thrombolytic agents (plasminogen activators) has been developed over the last decade. However, the clinical improvement has at best been marginal and the frequency of serious intracranial hemorrhage remains unchanged. Therefore, we have extensively reviewed the medical literature to determine the reason for the unsatisfactory clinical outcomes with current pharmacological therapies.
Blood Cells ; Brain ; Erythrocytes ; Fibrin ; Fibrinolytic Agents ; Intracranial Hemorrhages ; Stroke* ; Thrombolytic Therapy ; Thrombosis

In the management of carotid cavernous fistula, detachable balloon has become the treatment of choice.However, technical difficulties are not uncommon, and transarterial balloon embolization fail in 5% to 10% ofcases. Failure occurs because in some patients, the fistula orifice may be too small to allow entry. Using atracker catheter system with Guglielmi detachable coils, we achieved successful transarterial occlusion of acarotid cavernous fistula with a small fistula.
Balloon Occlusion ; Catheters ; Fistula* ; Humans

Fishbones are the most common upper aerodigestive and esophageal foreign body found in adults. Usually these bones pass, but when complications arise, they can be catastrophic and may include neck abscesses, mediastinitis, and esophago-aortic or esophagocarotid fistulas. We report the radiologic findings of fishbone injury occurring in a 48-year-old man in whom a globefish bone had penentrated the hypopharynx and migrated to the sternocleidomastoid muscle.
Abscess ; Adult ; Fistula ; Foreign Bodies ; Humans ; Hypopharynx ; Mediastinitis ; Middle Aged ; Neck

PURPOSE: MR is the most useful imaging method in evaluating the anatomic changes of the optic chiasm (OC). The purpose of this study is to investigate the relationship between the OC displacement and visual manifestations. MATERIALS AND METHODS: We retrospectively reviewed 44 patients who showed displacement of OC on brain MR. The pattern of OC displacement was classified into 3 groups according to following criteria: group A included the patients with OC displacement only due to empty sella;group B represented the patients with OC displacement by a lesion and the border between the lesion and OC was distinct;and group C was the patients with OC displacement by a lesion and had a indistinct border or thinning of the OC. RESULTS: Visual symptoms and signs were noted in 12 patients and the most common sign was bitemporal hemianopsia. In group A(7 patients), the visual symptoms and signs were seen in only one patient(14%), in whom contracted visual fields persisted since previous pituitary apoplexy had developed. In group B(30 patients), the visual symptoms and signs were seen in 4 patients(13%) who had tumorous conditions except one case of cysticercosis. In group C(7 patients), the visual symptoms and signs were seen in all patients (100%). CONCLUSION: The more OC is compressed, the more the prevalence of visual symptoms and signs increases. However, there was no correlation between the occurrence of visual symptoms and the presence of OC displacement only without compression.
Brain ; Cysticercosis ; Hemianopsia ; Humans ; Optic Chiasm* ; Pituitary Apoplexy ; Prevalence ; Retrospective Studies ; Visual Fields

PURPOSE: To compare the usefulness of three-dimensional multislice CT angiography(CTA) and digital subtraction angiography (DSA) in the evaluation of intracranial aneurysmal neck. MATERIALS AND METHODS: Nineteen patients with intracranial aneurysm (23 cases) underwent DSA and subsequent CTA. Using a multislice CT scanner and the SSD(shaded surface display) technique, clipping, cutting and the MPR technique, three-dimensional images were obtained. These were (a) external, (b) internal, from the direction of the parent artery, (c) internal, from the direction of the aneurysmal dome, and (d) an aneurysmal cutting image. The CTA findings were retrospectively compared with the DSA images. RESULTS: Twenty aneurysms were small and three were large. In eleven cases aneurysm neck was small, in nine it was wide, and in three it was relatively wide. For aneurysnal neck evaluation, CTA was superior to DSA in six of nine wide-neck aneurysms and all three large-sized wide-neck aneurysms. In small neck aneurysms 8 of 11 cases and in relatively wide neck all 3 cases showed similarly good images by both modalities. Of the 23 cases demonstrated by four different images, 14 cases showed the best image in internal image from parent artery direction and 6 cases showed similarly good image in both aneurysmal cutting image and internal image from parent artery direction. In the evaluation of wide neck aneurysms, 7 of 9 cases showed the best image at internal image from parent artery direction, compared with other three different images. In two cases of aneurysms, calcification was visible in the aneurysmal wall, so it was difficult to evaluate the aneurysmal neck. CONCLUSION: CTA was superior to DSA in the evaluating the intracranial aneurysmal neck. CTA maybe an additional available modality to evaluate the aneurysmal neck which is difficult to detect by the DSA. And the information of intracranial aneurysmal neck through CTA will be of value in surgical and endovascular treatment.
Aneurysm ; Angiography* ; Angiography, Digital Subtraction* ; Arteries ; Humans ; Imaging, Three-Dimensional ; Intracranial Aneurysm* ; Neck* ; Parents ; Retrospective Studies

OBJECTIVE: In order to assess the incidence of thromboembolic events and their clinical presentations, the present study prospectively examined routine brain magnetic resonance images (MRI) taken within 48 hours after a coil embolization of cerebral aneurysms. METHODS: From January 2006 to January 2008, 163 cases of coil embolization of cerebral aneurysm were performed along with routine brain MRI, including diffusion-weighted magnetic resonance (DW-MR) imaging, within 48 hours after the embolization of the aneurysm to detect the silent thromboembolic events regardless of any neurological changes. If any neurological changes were observed, an immediate brain MRI follow-up was performed. High-signal-intensity lesions in the DW-MR images were considered as acute thromboembolic events and the number and locations of the lesions were also recorded. RESULTS: Among the 163 coil embolization cases, 98 (60.1%) showed high-signal intensities in the DW-MR imaging follow-up, 66 cases (67.0%) involved the eloquent area and only 6 cases (6.0%) showed focal neurological symptoms correlated to the DW-MR findings. The incidence of DW-MR lesions was higher in older patients (> or =60 yrs) when compared to younger patients (<60 yrs) (p=0.002, odd s ratio=1.043). The older patients also showed a higher incidence of abnormal DW-MR signals in aneurysm-unrelated lesions (p=0.0003, odd's ratio=5.078). CONCLUSION: The incidence of symptomatic thromboembolic attacks after coil embolization of the cerebral aneurysm was found to be lower than that reported in previous studies. While DW-MR imaging revealed a higher number of thromboembolic events, most of these were clinically silent and transient and showed favorable clinical outcomes. However, the incidence of DW-MR abnormalities was higher in older patients, along with unpredictable thromboembolic events on DW-MR images. Thus, in order to provide adequate and timely treatment and to minimize neurological sequelae, a routine DW-MR follow-up after coil embolization of cerebral aneurysms might be helpful, especially in older patients.
Aneurysm ; Brain ; Diffusion Magnetic Resonance Imaging ; Follow-Up Studies ; Humans ; Incidence ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Prospective Studies ; Thromboembolism

A ruptured brain arteriovenous malformation (bAVM) presenting with a hematoma may have unseen parts of the shunts in diagnostic angiography in the acute phase, which may lead to innate incomplete evaluation for the whole angioarchitecture of the bAVM. Even though it is generally accepted that the nidus of a ruptured bAVM may be underestimated in angiography during the acute phase due to hematoma compression, documentation of the underestimated parts has not been described in the literature. The authors report 2 cases of ruptured bAVMs in which the obscured segments were cast with liquid embolic material, which suggests a potential presence of obscured segments in bAVMs.

PURPOSE: The main factor limiting endovascular treatment of intracranial aneurysms is the shape of the a-neurysmal sac, especially the width of the neck. We describe an early experience and technical aspects of treating wide-necked cerebral aneurysm using a Guglielmi detachable coil (GDC) and simultaneous application of a temporary balloon. MATERIALS AND METHODS: Four cases of unruptured wide-necked cerebral aneurysm were treated with GDC, with simultaneous application of a temporary balloon. Patients were aged between 29 and 49 years. On admission, clinical presentation was subarachnoid hemorrhage (SAH) in all cases. Hunt and Hess grade was II in two cases, III in one case, and traumatic SAH in one case. In all patients angiography revealed an asymptomatic a-neurysm after rupture of another aneurysm or traumatic SAH. The aneurysms were occluded with GDC-10, and a Cirrus balloon occlusion system was used simultaneously. All procedures were performed under endo-tracheal general anesthesia and systemic heparinization. RESULTS: All cases were treated successfully, without parent artery compromise. The occlusion rate at the end of the procedure was total in three cases and subtotal in one. In one case a heparin-related hematoma occurred during post-procedural treatment and the patient eventually expired. One patient underwent follow-up angiography after 6 months, and the coil was not changed. CONCLUSION: An aneurysm may not be completely occluded, but with regard to coil compaction and parent artery preservation, the technique is an attractive alternative.
Anesthesia, General ; Aneurysm ; Angiography ; Arteries ; Balloon Occlusion ; Follow-Up Studies ; Hematoma ; Heparin ; Humans ; Intracranial Aneurysm* ; Neck ; Parents ; Rupture ; Subarachnoid Hemorrhage

Carney complex is an autosomal dominant disease that displays such characteristic features as cardiac and cutaneous myxomas and spotty pigmentation of the skin. We report here on a case of Carney complex that was accompanied by increased myxoid fibroadenomas in the breast and multiple intracranial aneurysms.
Adult ; Breast Neoplasms/*complications/diagnosis ; Female ; Fibroadenoma/*complications/diagnosis ; Humans ; Intracranial Aneurysm/*complications ; Magnetic Resonance Imaging ; Pigmentation Disorders/*complications ; Syndrome

Spinal dural arteriovenous fistula (SDAVF) is rare but still the most commonly encountered vascular malformation of the spinal cord. A 31-year-old male developed gait disturbance due to weakness of his lower extremities, voiding difficulty and sexual dysfunction with a progressive course since 3 months. He showed areflexia in both knees and ankles. Electromyographic findings were suggestive of multiple root lesions involving bilateral L2 to S4 roots of moderate degree. Magnetic resonance images showed high signal intensity with an ill-defined margin in T2-weighted images and intensely enhanced by a contrast agent through the lumbosacral spinal cord. Selective spinal angiography confirmed a dural arteriovenous fistula with a nidus at the L2 vertebral level. After selective endovascular embolization, his symptoms drastically improved except sexual dysfunction. We report a rare case of cauda equina syndrome due to spinal arteriovenous fistula with drastic improvement after endovascular embolization.
Adult ; Angiography ; Animals ; Ankle ; Arteriovenous Fistula ; Cauda Equina ; Central Nervous System Vascular Malformations ; Gait ; Humans ; Knee ; Lower Extremity ; Magnetic Resonance Spectroscopy ; Male ; Polyradiculopathy ; Spinal Cord ; Vascular Malformations