Leczenie mózgowych malformacji tętniczo-żylnych metodą przezskórnej embolizacji

Background: In this paper we present our results of treating cerebral arteriovenous malformations implementing percutaneous embolization between 2001-2003. Material/Methods: From year 2001 to 2003, a group of 34 patients underwent endovascular embolization of cerebral arteriovenous malformations. This group consisted of 10 female and 24 male patients aged 15 to 78 (mean: 45.3). DSA examination was performed to assess the possibility of percutaneous embolization. Microcatheters 1.2 F, 1.5 F, or 1.8 F were used in accordance with the dimensions of the malformation. The tip of the catheter was placed close to the nidus of the malformation. Results: Cerebral arteriovenous malformations were localized mainly in the temple region (38%) or in the parietal region (27%). Primary embolization resulted in total occlusion in 41% of AVMs fed by up to three vessels, Repeated interventions led to occlusion of the additional hemangiomas in up to 70.5% of all lesions. In cases of AMVs fed by more than 4 vessels, the second embolization did not result in total occlusion of the hemangiomas. Curative results were obtained in only 12 patients (35%). Total or partial occlusion resulted in the partial reduction of the diameters of the malformations by 30 to 80% (mean: 74%). Conclusions: The best results of embolization were achieved in cases of small and medium malformations fed by 1-3 vessels (70.5% of cases). In our opinion, percutaneous embolization could be applied as an independent curative method in adult patients with small and medium arteriovenous malformations, grades I - III of the Spetzler-Martine scale

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Proton MR spectroscopy in mild traumatic brain injury

Background: To assess the role of 1H MRS in the detection of changes in cerebral metabolite levels in pyramidal tracts after mild traumatic brain injury (MTBI) and to compare metabolite alterations to the clinical status (Glasgow Coma Scale). Material/Methods: Study group consisted of 25 patients after mild traumatic brain injury, with a score of 11 to 15 in GCS. The MR studies were performed with a 1.5 T scanner. The results of spectra approximation (presented as metabolite ratios: NAA/Cr, NAA/Cho, Cho/Cr, lac/Cr, lip/Cr, Glx/Cr) were subjected to statistical analysis. MR spectra were recorded from a normal-appearing brain region: internal capsules and cerebral peduncles. Spectra from traumatic patients were compared with a control group including 34 healthy volunteers recorded with the same techniques. Results: The statistical analysis revealed significant differences between the data obtained from various brain regions of the same patients after an MTBI and between the study and the control group. Proton MR spectroscopy detects changes in cerebral metabolite levels in apparently normal regions. In pyramidal tracts (internal capsules, cerebral peduncles), we noticed a significant reduction of NAA /Cho, lip/Cr, lac/Cr and Glx/Cr. Conclusions: In patients with mild brain injury, we can detect some metabolite abnormalities in normalappearing brain structures. Proton MRS is a very useful tool for evaluation of major changes in metabolite levels in pyramidal tracts after mild traumatic brain injury

Cerebrovascular Manifestations of Lyme Neuroborreliosis—A Systematic Review of Published Cases

BackgroundLyme neuroborreliosis (LNB) is a disease caused by spirochete Borrelia burgdorferi, involving the nervous system. It usually manifests as lymphocytic meningoradiculitis, but in rare cases, it can also lead to cerebrovascular complications. We aimed to perform a systematic review of all reported cases of LNB complicated by central nervous system vasculitis and stroke or transient ischemic attack (TIA).Materials and methodsWe conducted a systematic review of literature between May 1987 and December 2016 with patients who presented with cerebrovascular course of LNB.ResultsThis study included 88 patients with a median age of 46 years. The median interval from onset of symptoms suggesting Lyme disease to first symptoms of cerebrovascular manifestations of LNB was 3.5 months. The most common cerebrovascular manifestation of LNB was ischemic stroke (76.1%), followed by TIA (11.4%). The posterior circulation was affected alone in 37.8% of patients, the anterior circulation in 24.4% of patients, and in 37.8% of cases, posterior and anterior circulations were affected simultaneously. The most common affected vessels were middle cerebral artery—in 19 cases, basilar artery—in 17 cases, and anterior cerebral artery—in 16 cases. A good response to antibiotic treatment was achieved in the vast number of patients (75.3%). The overall mortality rate was 4.7%.ConclusionCerebral vasculitis and stroke due to LNB should be considered, especially in patients who live in or have come from areas with high prevalence of tick-borne diseases, as well as in those without cardiovascular risk factors, but with stroke-like symptoms of unknown cause