The posterior communicating arteries in the patients with sudden deafness: evaluation with magnetic resonance imaging (MRA)

BACKGROUND: A strong association was suggested between a non-functioning posterior communicating artery (Pcom) of the circle of Willis and sudden deafness (SD). The purpose of this study was to determine the rate of depiction of Pcom on magnetic resonance angiography (MRA) in patients with SD. METHODS: Sixteen patients with SD (47.7 +/- 13.3 years; range, 24 – 76 years; nine males) were evaluated with intracranial MRA as well as magnetic resonance imaging (MRI) of the head. The depiction of Pcom on MRA was correlated with the laterality of SD. One hundred twenty-eight controls (49.1 +/- 8.4 years; range, 22 – 66 years; 87 male) were selected from neurologically normal subjects who underwent MR examinations as a part of an annual medical check-up in our hospital. RESULTS: Four (25%) of 16 SD patients had bilateral Pcom on MRA, four patients had unilateral Pcom and eight patients had bilaterally absent Pcom These results were not significantly different from the controls (p = 0.96). In 6 (37.5 %) of 16 SD patients, the ipsilateral Pcom was present on MRA, and 104 (40.6%) of 256 Pcom were present in 128 normal controls (p = 0.81). CONCLUSION: Since there was no link between the occurrence of SD and the absence of the ipsilateral Pcom, our results cannot support the hypothesis that the absence of Pcom may be a risk factor for the occurrence of SD

Types of the cerebral arterial circle (circle of Willis) in a Sri Lankan Population

<p>Abstract</p> <p>Background</p> <p>The variations of the circle of Willis (CW) are clinically important as patients with effective collateral circulations have a lower risk of transient ischemic attack and stroke than those with ineffective collaterals. The aim of the present cadaveric study was to investigate the anatomical variations of the CW and to compare the frequency of prevalence of the different variations with previous autopsy studies as variations in the anatomy of the CW as a whole have not been studied in the Indian subcontinent.</p> <p>Methods</p> <p>The external diameter of all the arteries forming the CW in 225 normal Sri Lankan adult cadaver brains was measured using a calibrated grid to determine the prevalence in the variation in CW. Chisquared tests and a correspondence analysis were performed to compare the relative frequencies of prevalence of anatomical variations in the CW across 6 studies of diverse ethnic populations.</p> <p>Results</p> <p>We report 15 types of variations of CW out of 22 types previously described and one additional type: hypoplastic precommunicating part of the anterior cerebral arteries (A1) and contralateral posterior communicating arteries (PcoA) 5(2%). Statistically significant differences (p < 0.0001) were found between most of the studies except for the Moroccan study. An especially notable difference was observed in the following 4 configurations: 1) hypoplastic precommunicating part of the posterior cerebral arteries (P1), and contralateral A1, 2) hypoplastic PcoA and contralateral P1, 3) hypoplastic PcoA, anterior communicating artery (AcoA) and contralateral P1, 4) bilateral hypoplastic P1s and AcoA in a Caucasian dominant study by Fisher versus the rest of the studies.</p> <p>Conclusion</p> <p>The present study reveals that there are significant variations in the CW among intra and inter ethnic groups (Caucasian, African and Asian: Iran and Sri Lanka dominant populations), and warrants further studies keeping the methods of measurements, data assessment, and the definitions of hypoplasia the same.</p

Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm

Background: The aim of this study was to develop a 48-h mortality risk score, which included morphology data, for patients with ruptured abdominal aortic aneurysm presenting to an emergency department, and to assess its predictive accuracy and clinical effectiveness in triaging patients to immediate aneurysm repair, transfer or palliative care. Methods: Data from patients in the IMPROVE (Immediate Management of the Patient With Ruptured Aneurysm: Open Versus Endovascular Repair) randomized trial were used to develop the risk score. Variables considered included age, sex, haemodynamic markers and aortic morphology. Backwards selection was used to identify relevant predictors. Predictive performance was assessed using calibration plots and the C-statistic. Validation of the newly developed and other previously published scores was conducted in four external populations. The net benefit of treating patients based on a risk threshold compared with treating none was quantified. Results: Data from 536 patients in the IMPROVE trial were included. The final variables retained were age, sex, haemoglobin level, serum creatinine level, systolic BP, aortic neck length and angle, and acute myocardial ischaemia. The discrimination of the score for 48-h mortality in the IMPROVE data was reasonable (C-statistic 0·710, 95 per cent c.i. 0·659 to 0·760), but varied in external populations (from 0·652 to 0·761). The new score outperformed other published risk scores in some, but not all, populations. An 8 (95 per cent c.i. 5 to 11) per cent improvement in the C-statistic was estimated compared with using age alone. Conclusion: The assessed risk scores did not have sufficient accuracy to enable potentially life-saving decisions to be made regarding intervention. Focus should therefore shift to offering repair to more patients and reducing non-intervention rates, while respecting the wishes of the patient and family