Exclusion of the anterior communicating artery with endovascular flow diverters – A possible treatment method of a wide-necked aneurysm

Introduction: We describe a case of a patient with severe subarachnoid hemorrhage from the rupture of difficult-to-treat morphology, a suspected partially thrombosed anterior communicating artery aneurysm. Case presentation: The patient was admitted with World Federation of Neurosurgeons (WFNS) score of 4 and a Fisher grade IV hemorrhage. Angiography demonstrated a wide neck anterior communicating artery aneurysm not suitable for the standard coiling and surgical treatment. On the 10th day after the bleeding, endovascular treatment was performed to exclude the anterior communicating artery from the circulation by implanting flow diverters to A2 to A1 on both sides. On Day 18, a CT scan showed communicating hydrocephalus, and thus the patient was treated with a ventriculoperitoneal shunt. At the four-month follow-up, angiography showed O'Kelly-Marotta grade D aneurysm occlusion, and the patient's modified Rankin score was 0. The patient made a complete recovery. Discussion: Even though this was a rare application of the flow diverter, other treatment approaches, including detachable coil, stent implantation, and surgical clipping were considered less safe and less effective treatment in this case of anterior communicating artery aneurysm. Conclusion: Endovascular exclusion of the anterior communicating artery from the circulation may be a safe and effective treatment approach in cases without significant perforant artery branches where the conventional endovascular treatment is not considered to be applicable. © 2023 The Author

Temporal disparity of action potentials triggered in axon initial segments and distal axons in the neocortex

Neural population activity determines the timing of synaptic inputs, which arrive to dendrites, cell bodies, and axon initial segments (AISs) of cortical neurons. Action potential initiation in the AIS (AIS-APs) is driven by input integration, and the phase preference of AIS-APs during network oscillations is characteristic to cell classes. Distal regions of cortical axons do not receive synaptic inputs, yet experimental induction protocols can trigger retroaxonal action potentials (RA-APs) in axons distal from the soma. We report spontaneously occurring RA-APs in human and rodent cortical interneurons that appear uncorrelated to inputs and population activity. Network-linked triggering of AIS-APs versus input-independent timing of RA-APs of the same interneurons results in disparate temporal contribution of a single cell to in vivo network operation through perisomatic and distal axonal firing

Carotis bifurcatio stenosisok kezelése percután transluminaris angioplasticával (PTA) és / vagy stent behelyezéssel. = Carotid bifurcation stenosis: treatment by percutaneous transluminar angioplasty (PTA) and / or stent implantation.

Az új többszeletes CT készülékekkel végzett carotis CT-angiographiával a hagyományos diagnosztikus digitalis subtractios angiographia (DSA) vizsgálat gyakorlatilag kiváltható, ezzel csökkentve a betegek orvosi beavatkozások általi veszélyeztetettségét, és a betegellátás költségeit. A betegeket lényegesen kevésbé terhelő, postoperatív intenzív ellátás nem igénylő, 1 napos lábadozási idővel járó Carotis Artéria Stentelése (CAS) a Carotis Endarterectomia (CEA) biztonságos és hatásos alternatívája, s a legtöbb atheroscleroticus eredetű carotis interna szűkülettel rendelkező betegnél az ACAS tanulmányhoz hasonlóan alacsony szövődményrátával kivitelezhető. Ennek egyik alapfeltétele az elérhető leginkább atraumatikus végződésű, megfelelő fizikai paraméterekkel rendelkező eszközök alkalmazása. Elengedhetetlen az aneszteziológus segítsége, s a megfelelő klinikai háttér. | Diagnostic digital subtraction angiography for the carotid arteries can successfully be substituted by multislice CT angiography. Carotid Artery Stenting, this one-day-care procedure is a safe alternative to carotid endarterectomy for most patients with primary atherosclerotic stenosis, as it can be carried out with clinical complication rate as low as published in the ACAS trial. Prerequisite are stents with atraumatic ending and excellent physical properties. The aid of an anesthesiologist and proper clinical background is inevitable

Kinetics of the cellular immune response following closed head injury

Background Tube-feeding or nutritional support is a therapy for people who can’t get enough nutrition by eating or drinking. You may need it if you have difficulty swallowing, loss of appetite, are severely malnourished or have inability to absorb nutrients through your digestive system. There are several diagnoses associated with tube-feeding, depending on the persons diagnose and users state the user can be tied to the tube-feeding equipment from 3 to 18 hours a day. In Sweden there are around 1500-3000 adults in need of tube-feeding outside the hospitals.   Method This report is made by Cindy Sjöblom and is an individual student’s work. The project is her dissertation and final project at the two year Masters program Advanced Product Design at Umeå Institute of Design. The project has been executed during 20 weeks the spring 2015. The project is based on the design process which includes the following phases; Research & Analysing, Ideation & Concept’s and Detailing & Visualization. The Research & Analysis phase has included; Product analysis, user interviews & observations, market outlook, anatomical knowledge, problem listing and opportunity findings. The Ideation & Concept’s phase has included; Inspiration, persona creation, creative workshop, sketching, concepts creation, mock-up building, user testing & feedback. The Detailing & Visualization phase has included; 3D modelling, moodboard creation, sketching, final model building, photo shooting, video recording, documentation, presentation and a poster and exhibition stand at Umeå Institute of Design and at Semcon, Gothenburg. Result Tubie is an ambulatory tube-feeding system to facilitate an active everyday life for people in need of enteral nutrition. Tubie consists out of six parts; A nutrition pump and a wireless charging station, a nutrition bag and an external tubing, a wearable waist band and an application for a smart device to be able to control the pump. Unlike traditional enteral nutritions systems, Tubie is designed with a focus on the users in a home environment and their need for a more active lifestyle and discreet usage in social environments. Tubie is simply discreet due to its wearable features that allows the user to wear it underneath the clothing as well as control the pump via a smart device with an adaptable pre-alarm that sounds like any other text message or ring tone

Brain abscess caused by trauma of the rhinobasis: an endoscopic challenge

Brain abscess is a rare but life-threatening infection of the brain. It often occurs as a complication of infection, trauma, or surgery. This case presents a brain abscess in a 22-month-old boy that developed after a transnasal injury with a foreign body. A minimal-invasive, transnasal, endoscopic-controlled technique was used, during which the foreign object was removed and the abscess drained. Bacteriological samples were obtained and the abscess cavity irrigated. Postoperative care included antibiotics and daily irrigation of the abscess cavity. Follow-up MRI scans showed reduction in abscess size. A spinal drain was inserted temporarily to address rhino-liquorrhoea. The patient remained asymptomatic during one-year of follow-up. This case report highlights the occurrence of a brain abscess in childhood following a transnasal injury and demonstrates a minimal-invasive, transnasal, endoscopic-controlled surgical technique. The findings underscore the importance of considering brain abscess as a potential complication in cases of head trauma, particularly in atypical presentations

CSF and Plasma Amyloid-beta Temporal Profiles and Relationships with Neurological Status and Mortality after Severe Traumatic Brain Injury

The role of amyloid-β (Aβ) neuropathology and its significant changes in biofluids after traumatic brain injury (TBI) is still debated. We used ultrasensitive digital ELISA approach to assess amyloid-β1-42 (Aβ42) concentrations and time-course in cerebrospinal fluid (CSF) and in plasma of patients with severe TBI and investigated their relationship to injury characteristics, neurological status and clinical outcome. We found decreased CSF Aβ42 levels in TBI patients acutely after injury with lower levels in patients who died 6 months post-injury than in survivors. Conversely, plasma Aβ42 levels were significantly increased in TBI with lower levels in patients who survived. A trend analysis showed that both CSF and plasma Aβ42 levels strongly correlated with mortality. A positive correlation between changes in CSF Aβ42 concentrations and neurological status as assessed by Glasgow Coma Scale (GCS) was identified. Our results suggest that determination of Aβ42 may be valuable to obtain prognostic information in patients with severe TBI as well as in monitoring the response of the brain to injury