Akutna subarohnoidna krvavitev

Background. We wanted to determine the diagnostic accuracy, sensitivity and specificity of computed tomographic angiography (CTA) of intracranial vessels,and to establish the advantages and disadvantages of CTA compared to digital subtraction angiography (DSA) as the gold standard in patients with acute subarachnoid haemorrhage (SAH). Patients and methods. We prospectively studied 52 patients with acute SAH. Confirmation of the haemorrhage by a conventional computed tomography (CT) scan was immediately followed by intracranial CTA. DSA was performed after the CTA examination and so did not influence the interpretation of CTA images. The sensitivity, specificity and diagnostic accuracy of CTA were determined by comparing the results with the data from DSA and with the surgical findings. Cases where the CTA and DSA results did not match were analysed, and the advantages and disadvantages of intracranial CTA were determined. Results. The diagnostic accuracy of CTA was 95%, its sensitivity was 93%, and its specificity was 98%. False-negative results were obtained in three patients who harboured small aneurysms, two in the region of the cavernous sinus and one at the division of pericallosal and callosomarginal arteries. In one patient with a false-positive result, DSA showed an infundibular widening of the posterior communicating artery. In all seven patients who underwent operations on the basis of CTA results, the surgical findings confirmed the presence of aneurysms as well as the intracranial vessel anatomy demonstrated by CTA. Conclusions. Intracranial CTAis a fast and minimally invasive method with a high diagnostic accuracy, sensitivity and specificity, which has an important place in the detection andpreoperative evaluation of intracranial aneurysms in patients with acute SAH.Izhodišče. Namen študije je bil oceniti diagnostično zanesljivost, občutljivost in specifičnost ter prednosti in slabosti računalniškotomografskepreiskave arterij (CTA) intrakranialnih žil glede na digitalno subtrakcijsko angiografsko preiskavo (DSA) (zlati standard) pri bolnikih z akutno subarahnoidno krvavitvijo (SAK). Bolniki in matode. V prospektivno študijo smo vključili 52 bolnikov z akutno subarahnoidno krvavitvijo, pri katerih smo takoj, ko smo krvavitev dokazali s konvencionalnoračunalniško tomografijo (CT) glave, naredili še CTA preiskavo intrakranialnih arterij, tako da rezultati DSA preiskave niso mogli vplivati na rezultate CTA preiskave. Glede na rezultate DSA preiskave in nevrokirurške rezultate smo ocenili diagnostično zanesljivost, senzitivnost in specifičnost CTA preiskave intrakranialnih arterij. Analizirali smo primere, kjer se rezultati CTA preiskave in DSA preiskave niso ujemali. Opredelili smo prednosti in slabosti CTA preiskave. Rezultati. Diagnostična zanesljivost CTA preiskave je bila 95%, občutljivost 93% in specifičnost 98%. Pri treh bolnikihje bila CTA preiskava lažno negativna. Pri dveh bolnikih z lažno negativnim izvidom CTA preiskave je bila manjša anevrizma v področju kavernoznega sinusa, pri enem pa ob razcepišču perikalozne in kalozomarginalnearterije. Pri bolniku z lažno pozitivnim izvidom CTA preiskavesmo z DSA preiskavo pokazali, da gre za infundibularno razširjenje posteriorne komunikantne arterije. Pri vseh sedmih bolnikih, ki so bili operirani samo na podlagi rezultatov CTA preiskave, smo dobro prikazali anevrizmo in intrakranialne arterije. Zaključek. Pri bolnikih z akutno SAK imalahko CTA preiskava pomembno vlogo pri odkrivanju in preoperativni evaluaciji intrakranialnih anevrizem, ker dobimo rezultate hitro in na minimalno invaziven način. CTA preiskava intrakranialnega žilja ima visoko diagnostično zanesljivost, občutljivost in specifičnost

DURAL CAROTID-CAVERNOUS FISTULAS

Background. Dural carotid-cavernous sinus fistulas (CCF) are communications fed by meningeal branches of the intracavernous internal carotid artery (ACI) or/and external carotid artery (ACE). In contrast to typical CCF, the arteriovenous shunting of blood is usually low flow and low pressure. Spontaneous dural CCF are more common in postmenopausal women. Aetiology is unknown, but congenital malformation or rupture of thin-walled dural arteries within venous sinuses is believed to be the cause.Case reports. 3 cases lacking the typical clinical signs of CCF who had been treated as chronic conjunctivitis, myositis of the extraocular muscle and orbital pseudotumour are presented. Clinical presentation depends on the direction and magnitude of fistular flow and on the anatomy of the collateral branches. If increased blood flow is directed anteriorly in ophthalmic veins the signs of orbito-ocular congestion are present (»redeyed shunt syndrome«). Drainage primarly in the inferior petrosal sinus may cause painful oculomotor and abducens palsies without signs of ocular congestion (»white-eyed shunt syndrome«). Also different therapeutic approaches as well as possible complications are described.Conclusions. For definite diagnosis angiography is obligatory and is also therapeutic as one third to one half of dural CCF close spontaneously. Because of potential severe eye and systemic complications, surgical intervention is indicated only in cases with uncontrolled secondary glaucoma and hypoxic retinopathy.</p

An Intermodal Correlation Study among Imaging, Histology, Procedural and Clinical Parameters in Cerebral Thrombi Retrieved from Anterior Circulation Ischemic Stroke Patients

The precise characterization of cerebral thrombi prior to an interventional procedure can ease the procedure and increase its success. This study investigates how well cerebral thrombi can be characterized by computed tomography (CT), magnetic resonance (MR) and histology, and how parameters obtained by these methods correlate with each other as well as with the interventional procedure and clinical parameters. Cerebral thrombi of 25 patients diagnosed by CT with acute ischemic stroke were acquired by mechanical thrombectomy and, subsequently, scanned by a high spatial-resolution 3D MRI including T1-weighted imaging, apparent diffusion coefficient (ADC), T2 mapping and then finally analyzed by histology. Parameter pairs with Pearson correlation coefficient more than 0.5 were further considered by explaining a possible cause for the correlation and its impact on the difficulty of the interventional procedure and the treatment outcome. Significant correlations were found between the variability of ADC and the duration of the mechanical recanalization, the deviation in average Hounsfield units (HU) and the number of passes with the thrombectomy device, length of the thrombus, its RBC content and many others. This study also demonstrates the clinical potentials of high spatial resolution multiparametric MRI in characterization of thrombi and its use for interventional procedure planning