A 38-year-old woman with twin pregnancy was referred after detection of hydrocephalus in one fetus at 23+1 weeks' gestation. Sonography showed hydrocephalus, a scalloping of the frontal bone giving a lemon-like configuration, and meningocele. The affected twin was terminated by ultrasonographically guided intracardiac injection of 4 ml (8 mEq/L) potassium chloride solution at 24+5 weeks' gestation. Chromosomal analysis of the other fetus showed normal findings (46, XX). Serial ultrasound scans and coagulopathy tests were unremarkable. Preterm premature rupture of the membrane was developed at 33+3 weeks' gestation, and emergency Cesarian section was done. A healthy 1360 g female was born, with Apgar scores of 7 and 8 at one and five minutes, respectively.
Adult ; Arnold-Chiari Malformation* ; Emergencies ; Female ; Fetus ; Frontal Bone ; Humans ; Hydrocephalus ; Membranes ; Meningocele ; Pectinidae ; Potassium Chloride ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Pregnancy, Twin ; Rupture ; Twins, Dizygotic* ; Ultrasonography

OBJECTIVE: Protocols for posterior circulation ischemic stroke have not been established by randomized clinical trials. Mechanical endovascular thrombectomy (MET) devices are evolving, and many of these devices already developed or in development are suitable for posterior circulation MET. MATERIALS AND METHODS: We investigated the medical records of patients who underwent MET for posterior circulation ischemic stroke from January 2012 to August 2016. Fifteen patients were included. MET was performed in patients with or without injected intravenous tissue plasminogen activator. MET was considered in patients with a National Institute of Health Stroke Scale score of 4 or more, older than 18 years, with definite occlusion of the basilar artery or posterior cerebral artery (PCA), and who arrived at the hospital within 24 hours from onset. RESULTS: The direct catheter aspiration technique was used in five cases, and the stent retrieval technique was used in seven cases. The stent retrieval technique with the direct aspiration technique was used in three cases. Recanalization failed in two cases. Basilar occlusion without PCA involvement is the only effective factor of successful recanalization (p = 0.03). Successful recanalization (p = 0.005) and the presence of a posterior communicating artery (p = 0.005) affected the good outcome at discharge. CONCLUSION: An early diagnosis and active MET may improve the patient outcome. MET may help recanalization and good flow restoration and the potential for a good outcome.
Arteries ; Basilar Artery ; Catheters ; Early Diagnosis ; Humans ; Medical Records ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery* ; Stents ; Stroke ; Thrombectomy* ; Tissue Plasminogen Activator