Intermittent Downbeat Nystagmus Due to Vertebral Artery Compression

A 64 year old man developed downbeat nystagmus whenever he rotated his neck to the left. Cerebral angiography demonstrated a hypoplastic right vertebral artery. Selective injection of the left vertebral showed normal flow with the head in neutral position or turned to the right, but severe narrowing at C5/6 with stasis of contrast distally. Computerized tomography of the cervical spine revealed osteophyte formation at the oncovertebral process of C6 and inferior aspect of C5 with indentation of the foramen transversarium. Osteophytectomy with fusion of C5/6 was performed

J. Magn. Magn. Mater.

The present study describes the preparation and analysis of a highly concentrated hydrophobic oleic acid-coated magnetite gel. By contrast to conventional techniques to prepare magnetic fluids, herein the oleic acid was introduced as a reactant during the initial crystallization phase of magnetite that was obtained by the co-precipitation of Fe(II) and Fe(III) salts by addition of ammonium hydroxide. The resulting gelatinous hydrophobic magnetite was characterized in terms of morphology, particle size, magnetic properties, crystal structure, and hydrophobicity/hydrophilicity. This magnetic gel exhibited superparamagnetism with a saturation magnetization of 46.0 emu/g at room temperature and could be well dispersed both in polar and nonpolar carrier liquids. This protocol produced highly concentrated hydrophobic magnetic gel for biopolymer encapsulations. (C) 2006 Elsevier B.V. All rights reserved.The present study describes the preparation and analysis of a highly concentrated hydrophobic oleic acid-coated magnetite gel. By contrast to conventional techniques to prepare magnetic fluids, herein the oleic acid was introduced as a reactant during the initial crystallization phase of magnetite that was obtained by the co-precipitation of Fe(II) and Fe(III) salts by addition of ammonium hydroxide. The resulting gelatinous hydrophobic magnetite was characterized in terms of morphology, particle size, magnetic properties, crystal structure, and hydrophobicity/hydrophilicity. This magnetic gel exhibited superparamagnetism with a saturation magnetization of 46.0 emu/g at room temperature and could be well dispersed both in polar and nonpolar carrier liquids. This protocol produced highly concentrated hydrophobic magnetic gel for biopolymer encapsulations. (C) 2006 Elsevier B.V. All rights reserved

Lower Complication Rates Associated with Transradial vs. Transfemoral Flow Diverting Stent Placement

INTRODUCTION Observational studies have demonstrated the safety and feasibility of the transradial approach for neurointerventional procedures. However, there are no large-scale studies in the neurointerventional literature which have compared safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. METHODS We retrospectively analyzed flow diversion cases for treatment of cerebral aneurysms from 14 institutions from 2010 to 2019. Pooled analysis of proportions was calculated using weighted analysis with 95% CI to account for results from multiple centers. Access site complication rate and overall procedure-related complication rate were compared between the two approaches. RESULTS A total of 2,311 patients who underwent endovascular flow diversion were analyzed with 134 (5.86%) treated with TRA and 2,151 (94.14%) via TFA. The two groups shared similar demographic composition, comorbidities, clinical presentation, and aneurysm characteristics. Cross-over from TRA to TFA was documented in 12 (8.63%) patients due to radial artery spasm, vessel tortuosity, or inadequate support. There were no access site complications in the TRA group. There was a significantly higher access site complication rate in the TFA cohort compared to TRA (2.48% 95% CI 2.40-2.57 vs. 0%, P = .039). Of the 53 access site complications, 6 patients (0.28%) required blood transfusion. One death resulted from a femoral access site complication. Overall complications rate was also higher in the TFA group (9.02%; 95% CI 8.15-9.89) compared with the TRA group (3.73%; 95% CI 3.13-4.28; P = .035). CONCLUSION TRA is a safer approach for flow diversion to treat cerebral aneurysms at a wide range of locations. Both access site complication rate and overall complication rate were lower with TRA compared with TFA. The results of this study support the transition to a radial-first approach for endovascular flow diversion

Lower complication rates associated with transradial versus transfemoral flow diverting stent placement

BackgroundCurrently, there are no large-scale studies in the neurointerventional literature comparing safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. This study aims to assess complication rates in a large multicenter registry for TRA versus TFA flow diversion.MethodsWe retrospectively analyzed flow diversion cases for cerebral aneurysms from 14 institutions from 2010 to 2019. Pooled analysis of proportions was calculated using weighted analysis with 95% CI to account for results from multiple centers. Access site complication rate and overall complication rate were compared between the two approaches.ResultsA total of 2,285 patients who underwent flow diversion were analyzed, with 134 (5.86%) treated with TRA and 2151 (94.14%) via TFA. The two groups shared similar patient and aneurysm characteristics. Crossover from TRA to TFA was documented in 12 (8.63%) patients. There were no access site complications in the TRA group. There was a significantly higher access site complication rate in the TFA cohort as compared with TRA (2.48%, 95% CI 2.40% to 2.57%, vs 0%; p=0.039). One death resulted from a femoral access site complication. The overall complications rate was also higher in the TFA group (9.02%, 95% CI 8.15% to 9.89%) compared with the TRA group (3.73%, 95% CI 3.13% to 4.28%; p=0.035).ConclusionTRA may be a safer approach for flow diversion to treat cerebral aneurysms at a wide range of locations. Both access site complication rate and overall complication rate were lower for TRA flow diversion compared with TFA in this large series

Worldwide Organization of Neurocritical Care: Results from the PRINCE Study Part 1

Introduction: Neurocritical care focuses on the care of critically ill patients with an acute neurologic disorder and has grown significantly in the past few years. However, there is a lack of data that describe the scope of practice of neurointensivists and epidemiological data on the types of patients and treatments used in neurocritical care units worldwide. To address these issues, we designed a multicenter, international, point-prevalence, cross-sectional, prospective, observational, non-interventional study in the setting of neurocritical care (PRINCE Study). Methods: In this manuscript, we analyzed data from the initial phase of the study that included registration, hospital, and intensive care unit (ICU) organizations. We present here descriptive statistics to summarize data from the registration case report form. We performed the Kruskal–Wallis test followed by the Dunn procedure to test for differences in practices among world regions. Results: We analyzed information submitted by 257 participating sites from 47 countries. The majority of those sites, 119 (46.3%), were in North America, 44 (17.2%) in Europe, 34 (13.3%) in Asia, 9 (3.5%) in the Middle East, 34 (13.3%) in Latin America, and 14 (5.5%) in Oceania. Most ICUs are from academic institutions (73.4%) located in large urban centers (44% > 1 million inhabitants). We found significant differences in hospital and ICU organization, resource allocation, and use of patient management protocols. The highest nursing/patient ratio was in Oceania (100% 1:1). Dedicated Advanced Practiced Providers are mostly present in North America (73.7%) and are uncommon in Oceania (7.7%) and the Middle East (0%). The presence of dedicated respiratory therapist is common in North America (85%), Middle East (85%), and Latin America (84%) but less common in Europe (26%) and Oceania (7.7%). The presence of dedicated pharmacist is highest in North America (89%) and Oceania (85%) and least common in Latin America (38%). The majority of respondents reported having a dedicated neuro-ICU (67% overall; highest in North America: 82%; and lowest in Oceania: 14%). Conclusion: The PRINCE Study results suggest that there is significant variability in the delivery of neurocritical care. The study also shows it is feasible to undertake international collaborations to gather global data about the practice of neurocritical care