1/47. Monitoring of the extracranial and intracranial course of single emboli of cardiac origin: a preliminary report.Simultaneous monitoring of emboli in extracranial and intracranial arteries recorded with identical probes, in a patient with an artificial cardiac valve, allowed the identification and characterization of pairs of signals, which most likely represent single emboli flowing through the common carotid artery into the middle cerebral artery. This technique offers new insight into emboligenesis with obvious therapeutic implications.- - - - - - - - - - ranking = 1keywords = cord (Clic here for more details about this article) |
2/47. Ocular massage in a case of central retinal artery occlusion the successful treatment of a hitherto undescribed type of embolism.BACKGROUND: The pathogenesis of central retinal artery occlusions (CRAO) varies, depending upon the underlying disease. An embolic origin of an occlusion often occurs. PATIENT AND methods: A 50-year-old man with an occlusion of the left internal carotid artery was examined because of a left central retinal artery occlusion. fluorescein angiography revealed that in no blood vessel could any circulation of blood be demonstrated. The slight vascular filling with dye mainly came from collateral circulation at the disc. RESULTS: Ocular massage was carried out. After a delay of several minutes, the vessels of the fundus became increasingly filled with blood. The patient noticed continuing recovery in the vision of his left eye. During fluorescein angiography, carried out one day later, white embolic clots appeared in the arteries of the papilla, some of them moving with the velocity of the blood flow through the retinal vessels and reaching the periphery of the retina and immediately disappearing. Others moved more slowly. This was seen repeatedly over several minutes. CONCLUSIONS: In this patient we have recorded in a fluorescein angiogram bright boluses visible in the blood of the retinal arteries. We suggest that conglomerations of blood cells can also cause an obstruction of blood flow. The observation of this kind of bright clots (boluses) visible in the blood of the retinal arteries we did not find described in the literature. In such a situation ocular massage is extremely helpful. Therefore, ocular massage should be carried out in every patient with CRAO.- - - - - - - - - - ranking = 1keywords = cord (Clic here for more details about this article) |
3/47. life-threatening intraabdominal arterial embolization after histoacryl injection for bleeding gastric ulcer.N-butyl-cyanoacrylate (Histoacryl) injection has become the treatment of choice for acutely bleeding esophagogastric varices, and is the only effective option for endoscopic treatment of gastric varices. Recent reports confirm the ability of Histoacryl injection therapy to achieve immediate hemostasis in cases of gastric ulcer bleeding or Dieulafoy ulcer, where conventional endoscopic hemostatic treatment had failed. Although the overall safety record of Histoacryl injection has been relatively good, there have been scattered cases of serious complications. Here, we present two patients showing life-threatening intraabdominal arterial embolization after Histoacryl injection. They had chronic gastric ulcers with active arterial bleeding. In spite of attempts at hemostatic treatment, complete hemostasis was not achieved. We injected Histoacryl, diluted with Lipiodol, into bleeding gastric ulcers, resulting in successful hemostasis. Soon after the procedure, intraabdominal arterial embolization developed in both patients. One patient survived and the other died. Based on these experiences, we would like to warn gastrointestinal endoscopists to be alert to these fatal complications, and we propose that less diluted Histoacryl seems to be preferable in cases of bleeding peptic ulcers.- - - - - - - - - - ranking = 1keywords = cord (Clic here for more details about this article) |
4/47. Adrenal tissue in the placenta: a heterotopia caused by migration and embolism?Heterotopic adrenal tissue is not uncommon, especially in the urogenital system. Adrenocortical tissue in the placenta, however, is presumably very rare. To our knowledge, four cases have been published. There are several different theories to explain such a heterotopia. According to our findings, an embolic spread of adrenal precursor cells via fetal vascular shortcuts is the most likely mechanism. Apart from that hypothesis, the possibility of a monodermal teratoma as well as of an aberrant differentiation of cells of the extraembryonic mesoderm are considered in the literature.- - - - - - - - - - ranking = 1keywords = cord (Clic here for more details about this article) |
5/47. "Dual pathology" and the significance of surgical outcome in "Dostoewsky's epilepsy".A patient with a right occipital arterio-venous malformation (AVM) and seizures heralded by "lights", and experiencing "ecstasy" underwent a right occipital lobectomy after the AVM was embolized. Thereafter, seizures began with motor arrest and lip smacking, but never again with "light and ecstasy". A right temporal lobectomy and electrocorticogram (E.Co.G) were performed under local anesthesia four years after occipital lobectomy. Abundant spiking activity was recorded from the right hippocampus which showed gliosis and neuronal loss in the pathology studies. Electrical stimulation of the lateral and basal temporal cortices failed to elicit the vision of "lights" or the experience of "ecstasy". The patient has had two seizures in the last two years as a result of a lapse in taking his anti-convulsant medication. He now lives alone, seizure-free. The possible abnormally induced functional network organization and structures involved in the production of the "ecstasy" phenomenon are discussed.- - - - - - - - - - ranking = 1keywords = cord (Clic here for more details about this article) |
6/47. Acute-onset nontraumatic paraplegia in childhood: fibrocartilaginous embolism or acute myelitis?Fibrocartilaginous embolus causing acute spinal cord infarction is a rare cause of acute-onset paraplegia or quadriplegia. Few cases of survivors have been reported in the neurosurgical literature, with most reports involving postmortem or biopsy findings. There is little information on MRI findings in such patients. We present the youngest patient ever reported, and discuss the important differences between fibrocartilaginous embolus and acute myelitis of childhood. A 6-year-old girl with a history of back pain presented with sudden-onset nontraumatic paraplegia, with a clinical anterior spinal artery syndrome. Initial MRI scan revealed intervertebral disc disease at L1-2 and an incidental thoracic syrinx, but no cause for her acute-onset paraplegia was identified. cerebrospinal fluid and other investigations were all negative. Sequential MRI scans revealed development of spinal cord expansion from T10 to the conus medullaris, with increased cord signal in the anterior aspect of the spinal cord. The intervertebral disc disease was unchanged. The imaging and clinical findings were caused by fibrocartilaginous embolus, which meant there was no need for spinal cord biopsy. The report describes the clinical and imaging criteria for diagnosis of fibrocartilaginous embolus, highlighting the case for avoiding an unnecessary biopsy. The clinical pattern in the paediatric group is discussed, with features differentiating it from acute myelitis of childhood.- - - - - - - - - - ranking = 92.477148955522keywords = spinal cord, myelitis, cord (Clic here for more details about this article) |
7/47. Trophoblastic microemboli as a marker for preeclampsia-eclampsia in sudden unexpected maternal death: a case report and review of the literature.The authors report the case of a 25-year-old white woman at 7 months' gestation who died suddenly and unexpectedly at home. Anatomic findings at autopsy included a tongue contusion, glomerulonephritis, changes indicative of systemic hypertension, and trophoblastic microemboli in the lungs. review of the prenatal care record disclosed 3 proteinuria 2 days before death. The features of the postmortem examination were consistent with clinically undiagnosed preeclampsia-eclampsia and glomerulonephritis. The authors discuss the rarity of fatal preeclampsia-eclampsia, the contribution of concomitant glomerulonephritis, and the significance of trophoblastic microemboli in the lungs.- - - - - - - - - - ranking = 1keywords = cord (Clic here for more details about this article) |
8/47. lower extremity paraparesis or paraplegia subsequent to endovascular management of abdominal aortic aneurysms.lower extremity paraplegia or paraparesis is an extremely rare event after operative repair of infrarenal abdominal aortic aneurysms (AAAS). We report two such cases that occurred after endovascular repair or attempted endovascular repair of routine AAAS. To our knowledge, these are the first two cases reported specifically in the literature. These cases may have significant implications with regard to the endovascular management of AAAS, because atheroembolization to the spinal cord appears to be the underlying cause.- - - - - - - - - - ranking = 15.407060335304keywords = spinal cord, cord (Clic here for more details about this article) |
9/47. Delayed neurologic deficit after endovascular abdominal aortic aneurysm repair.paraplegia or paraparesis secondary to spinal cord ischemia is an extremely rare complication after elective repair of abdominal aortic aneurysm. We report delayed paraparesis after endovascular abdominal aortic aneurysm repair in which one hypogastric artery was unintentionally occluded due to atheroembolism. A spinal catheter was immediately inserted after onset of paraplegia to promote cerebrospinal fluid drainage, which partially reversed the neurologic deficit. Our case underscores both the importance of the critical spinal collateral supply from the hypogastric artery and the role of spinal fluid drainage to maximize spinal cord perfusion in the setting of spinal cord ischemia.- - - - - - - - - - ranking = 46.221181005913keywords = spinal cord, cord (Clic here for more details about this article) |
10/47. Embolization of disc occluder of a Wada-Cutter mitral prosthesis with survival.The second recorded survivor following emergency prosthesis replacement after embolization of the Teflon disc occluder of a Wada-Cutter mitral valve is reported. Difficulties encountered while attempting to locate the missing occluder are presented and a useful operative technique for aortic control is described. A plea is made for incorporation of a radiopaque material during manufacture of all future valve poppets.- - - - - - - - - - ranking = 1keywords = cord (Clic here for more details about this article) |
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