1/346. popliteal artery occlusion as a late complication of liquid acrylate embolization for cerebral vascular malformation.Occlusion of arteriovenous malformations of the brain (BAVMs) by means of an endovascular approach with liquid acrylate glue is an established treatment modality. The specific hazards of this procedure are related to the central nervous system. In the case of unexpectedly rapid polymerization of the cyanoacrylate glue and adhesion of the delivering microcatheter to the BAVM, severing the catheter at the site of vascular access is considered an acceptable and safe management. We present a unique complication related to this technique that has not been described yet. Fragmentation and migration of the microcatheter, originally left in place, had caused popliteal artery occlusion, which required saphenous vein interposition, in a 25-year-old man. Suggestions for avoiding this complication are discussed.- - - - - - - - - - ranking = 1keywords = brain, central nervous system, nervous system (Clic here for more details about this article) |
2/346. Severe cerebral venous sinus thrombosis and dural arteriovenous fistula in an infant with protein s deficiency.A 12-month-old infant presented with cerebral seizures and neurological deficits. MRI scan of the brain and angiography showed massive cerebral venous sinus thrombosis complicated by a dural arteriovenous fistula. Subsequent clotting analysis revealed a protein s deficiency. Screening for inherited coagulation inhibitor deficiency is recommended in children with unexplained or atypical thrombotic events.- - - - - - - - - - ranking = 0.79694045644245keywords = brain (Clic here for more details about this article) |
3/346. Endoscopic procedures for resection of arteriovenous malformations.BACKGROUND: Resection of arteriovenous malformations (AVMs), particularly those located in functional areas, requires precision. To enhance that precision, endoscope-assisted microsurgery has been employed at loma Linda University. methods: Twenty-five consecutive cases of AVM were treated microsurgically with endoscopic assistance. patients were divided into two groups: (1) those having AVMs in functional areas, and (2) those whose AVMs extended into the ventricle, either in the trigonal area or the capsulocaudatothalamic area. The endoscope was inserted into the subarachnoid space to interrupt communicating venules around the major draining vein and into the cleavage developed between the AVM venous loops and surrounding brain tissue as shunting arterioles and communicating venules were interrupted. For surgery of intraventricular AVMs, the curved endoscope was inserted into the ventricle, providing visualization of the AVM core, which was dissected from the ventricular side. RESULTS: AVMs were totally resected in all cases except for two patients with capsulocaudatothalamic AVMs, which were decreased in size sufficiently to receive radiosurgery. CONCLUSION: Endoscope-assisted microsurgery enhances magnification, illumination, and technical precision while the surgeon is dissecting the AVM core vessels and while operating on AVMs extending into the ventricle.- - - - - - - - - - ranking = 0.79694045644245keywords = brain (Clic here for more details about this article) |
4/346. patients with spinal cord cavernous malformations are at an increased risk for multiple neuraxis cavernous malformations.OBJECTIVE: To determine the prevalence of multiple neuraxis cavernous malformations in patients who initially presented with intramedullary spinal cord (IMSC) cavernous malformations without knowledge of cavernous malformations elsewhere in the neuraxis. methods: hospital records and radiographic files were analyzed for 17 patients who subsequently underwent surgical resection of an IMSC cavernous malformation (histologically proven) and also underwent brain magnetic resonance imaging studies. These 17 patients represented a subset of 32 patients who underwent surgical resection of an IMSC cavernous malformation during the same period. RESULTS: Of 17 patients, 8 (47%) harbored multiple cavernous malformations. This group was composed of five women and three men (mean age, 35.9 yr). There were four Caucasian and four Hispanic patients. CONCLUSION: The prevalence of multiple cavernous malformations in the neuraxis seems to be increased in patients who harbor IMSC cavernous malformations. This finding has important implications for the evaluation and management of these patients and, in some cases, their family members.- - - - - - - - - - ranking = 0.79694045644245keywords = brain (Clic here for more details about this article) |
5/346. Intracranial dural arteriovenous fistula (DAVF) presenting progressive dementia and parkinsonism.We studied three patients with dural arteriovenous fistula (DAVF). Major symptoms were progressive dementia and parkinsonism, both of which progressed in step-wise fashion. Two of the three patients showed diffuse cerebral white matter lesions on brain CT and MRI. Progressive dementia and parkinsonism in our patients could be caused by diffuse cerebral parenchymal disturbance: impaired cerebral circulation due to severe venous hypertension. DAVF is important for the differential diagnosis in patients with progressive dementia and parkinsonism.- - - - - - - - - - ranking = 0.79694045644245keywords = brain (Clic here for more details about this article) |
6/346. Cerebral arteriovenous malformation in pregnancy: presentation and neurologic, obstetric, and ethical significance.Cerebral arteriovenous malformations infrequently complicate pregnancy. We sought to determine the neurologic, obstetric, and ethical significance of such malformations. We present the clinical course of 2 pregnant women with arteriovenous malformations who experienced cerebral hemorrhage and a loss of capacity for decision making. We also review the neurologic and obstetric significance of arteriovenous malformations in pregnancy. Various treatment options with concern for pregnancy and the prognosis for arteriovenous malformations are outlined. The ethical issues involved for pregnant patients whose decisional capacity is compromised as a result of cerebral injury are explored. A review of persistent vegetative state and brain death (death by neurologic criteria) occurring in pregnancy allows us to explore many issues that are applicable to decisionally incapacitated but physiologically functioning pregnant women. We outline a document, the purpose of which is to obtain advance directives from pregnant women regarding end-of-life decisions and to appoint a surrogate decision maker. We believe that evaluation and treatment of the arteriovenous malformation may be undertaken without regard for the pregnancy and that the pregnancy should progress without concern for the arteriovenous malformation.- - - - - - - - - - ranking = 0.79694045644245keywords = brain (Clic here for more details about this article) |
7/346. Cavernous-venous malformation of brain stem--report of a case and review of literature.BACKGROUND: Because of improved imaging techniques, the association of cavernous and venous malformations is now being seen more often in neurosurgical practice. However, only a few cases have been subjected to surgery. Surgical excision of the cavernous malformation, sparing the venous component, has been the method of choice advocated by most authors. This, however, is not possible when the components are intimately associated with each other. It thus becomes important to predict the surgical outcome in such lesions, especially when they are located in an eloquent area. A surgically excised case of cavernous-venous malformation in the dorsal pontomedullary region is presented here; the histology confirmed the intimate association of both components. The relevant literature is also discussed. CASE DESCRIPTION: This 20-year-old male presented with episodic vomiting, giddiness, and persistent cerebellar signs over a six-year period. neuroimaging studies-computed tomography scan/magnetic resonance imaging (CT/MRI) were suggestive of a cavernous malformation. MRI also showed a draining vein close to the lesion. Following total excision, histopathology confirmed the intimate association of both cavernous and venous malformations. The patient made an uneventful recovery. MRI at follow up confirmed total excision. CONCLUSIONS: The presence of venous channels draining into a lesion that otherwise appears to be a cavernous malformation may indicate an intimately associated venous component. Selective surgical excision of the cavernous component may be difficult in such cases. Surgical outcome, though favorable in this case, will be difficult to comment upon unless more such cases are reported. This may be of greater significance in lesions located in eloquent areas.- - - - - - - - - - ranking = 3.1877618257698keywords = brain (Clic here for more details about this article) |
8/346. Coexistence of intracranial arteriovenous malformation with Turcot's syndrome: a case report.Turcot's syndrome is a combination of multiple adenomatous gastrointestinal polyps and neuroepithelial tumors of the central nervous system (CNS). A 16-year-old man presented with Turcot's syndrome consisting of nonfamilial colorectal polyposis and multiple fibrillary astrocytomas accompanied by ruptured intracranial arteriovenous malformation (AVM) manifesting as generalized epileptic activity. Multiple CNS tumors are extremely unusual in Turcot's syndrome. This is the first description of Turcot's syndrome associated with an intracranial AVM. This case may correspond to a new phenotypic variant of colonic polyposis syndrome.- - - - - - - - - - ranking = 0.20305954355755keywords = central nervous system, nervous system (Clic here for more details about this article) |
9/346. Stereotactic radiosurgery. VIII. The classification of postradiation reactions.Postradiation reactions in the CNS are well described and catalogued in the conventional radiotherapy literature; acute, subacute and late CNS reactions are recognized. Tumours predispose to these normal tissue reactions by the oedema and pressure epiphenomena that occur in their environs, and probably by other mechanisms associated with tissue breakdown. That late normal tissue reactions (particularly permanent late sequelae--universally referred to as 'necrosis') occur in the normal nervous system is in the complication list of every radiosurgery centre. This article, for the first time, places postradiosurgery observations within or without the existing classification of reactions, and draws attention to the fact that previous 'radiosurgery risk factor' papers in the literature may be wrong to pool different 'reactions' in the formulation of risk formulae for normal brain damage following single shot radiotherapy. Acute reactions occur in the same manner as described for conventional radiotherapy, being a transient swelling phenomenon that occurs 12-48 h after therapy; they are fully reversible and do not usually augur late problems; routine administration of short duration steroids around the time of radiosurgery may prevent or delay the clinical signs. Subacute reactions occur 3-10 months later (a later time than the subacute reactions following conventionally fractionated radiotherapy), and may prove fully or partially reversible, or progress to permanent sequelae; the difference between these and late sequelae (which tend to be permanent themselves) then becomes blurred. That tumour swelling occurs in the subacute phase and is associated with oedema in the surrounding normal brain is an interesting observation (occurring in extra- and intra axial slow-growing tumours); it denotes tumour damage and has not been encountered in the conventionally-fractionated radiotherapy literature. Tumour shrinkage occurs later, with subsidence of the surrounding oedema, and this phenomenon may therefore be regarded (paradoxically) as a good prognostic sign, a point about which the referring clinician should be made aware. Similarly, contrast enhancement in the tumour perimeter at this time reflects a host reactive response and not tumour activity. Persistent clinical neurological signs and MRI changes (best seen on the T2 weighted sequences) beyond 2 years, indicate late damage or reaction. Usually, this represents scarring or coagulative necrosis without mass effect, but if there is a low signal area with mass effect and considerable surrounding oedema, liquefactive necrosis has occurred and (as in the brachytherapy literature) surgical decompression is very occasionally needed.- - - - - - - - - - ranking = 1.6424417029678keywords = brain, nervous system (Clic here for more details about this article) |
10/346. Facilitation of ipsilateral motor pathways during recovery from hemiplegia in two adolescent patients.In two hemiplegic patients with acquired cerebral lesions, transcranial magnetic stimulation (TMS) was carried out to examine the contribution of the ipsilateral motor pathways to recovery from hemiplegia. A 13-year-old girl (patient 1) had acute hemiplegia due to a rupture of an arteriovenous malformation, and a 13-year-old boy (patient 2) had subacute hemiplegia due to a brain tumour. They showed complete upper limb palsy but recovered after therapy; patient 1 had slightly disabled motor function of the arm, and patient 2 recovered completely. Motor evoked potentials (MEPs) were recorded from the biceps brachii muscles on both sides. The MEPs of the paretic biceps were only elicited by TMS of the intact hemisphere at the beginning of recovery from hemiplegia, but not by TMS of the affected hemisphere. The MEP amplitudes increased and cortical representation areas for the paretic biceps by TMS were enlarged temporarily during recovery. They regressed in patient 1 and MEPs were not evoked at all in patient 2 after recovery. Conversely, MEPs were obtained by TMS of the affected hemisphere after recovery in both patients. These data indicate that ipsilateral motor pathways play a role in recovery from hemiplegia, especially at the beginning, and become inactivated when the contralateral motor pathways recover.- - - - - - - - - - ranking = 0.79694045644245keywords = brain (Clic here for more details about this article) |
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