Symptomatic Cerebral Vasospasm after Surgical Ligation of Unruptured Aneurysms

Background Cerebral artery vasospasm accounts for the majority of delayed neurological deficits in ruptured aneurysm patients. We report two cases and review the literature of patients who developed symptomatic vasospasm after treatment for unruptured cerebral artery aneurysms with clip ligation. Pre- and post-operative imaging and studies revealed absence of subarachnoid or focal hemorrhage. Case Description In a series of 104 consecutive cerebral artery aneurysm patients that underwent uncomplicated ligation without intra-operative rupture, two patients developed delayed neurologic deficits due to severe cerebral vasospasm. Both patients had no stigmata of rupture and were treated electively. Post-operative transcranial dopplers and angiography facilitated the early recognition of vasospasm. Permanent neurologic injury was prevented with the use of hypertensive, hemodilution and hyperdynamic (HHH) therapy along with endovascular treatment, intra-arterial papaverine and angioplasty. Conclusion After uncomplicated treatment of unruptured intracranial aneurysms, the cerebral vasculature may proceed to severe vasospasm by an unrecognized mechanism. This can be reversed with institution of HHH and endovascular therapy

Ventral Intramedullary Cervical Spinal Cord AVM

Background Cerebral artery vasospasm accounts for the majority of delayed neurological deficits in ruptured aneurysm patients. We report two cases and review the literature of patients who developed symptomatic vasospasm after treatment for unruptured cerebral artery aneurysms with clip ligation. Pre- and post-operative imaging and studies revealed absence of subarachnoid or focal hemorrhage. Case Description In a series of 104 consecutive cerebral artery aneurysm patients that underwent uncomplicated ligation without intra-operative rupture, two patients developed delayed neurologic deficits due to severe cerebral vasospasm. Both patients had no stigmata of rupture and were treated electively. Post-operative transcranial dopplers and angiography facilitated the early recognition of vasospasm. Permanent neurologic injury was prevented with the use of hypertensive, hemodilution and hyperdynamic (HHH) therapy along with endovascular treatment, intra-arterial papaverine and angioplasty. Conclusion After uncomplicated treatment of unruptured intracranial aneurysms, the cerebral vasculature may proceed to severe vasospasm by an unrecognized mechanism. This can be reversed with institution of HHH and endovascular therapy

Behind the Technology: CT Perfusion in the Setting of Acute Stroke Management

Computed Tomography Perfusion (CTP) is an imaging modality that generates parametric maps of cerebral hemodynamics which are useful in the assessment of suspected acute ischemic stoke. However, the technology underlying CTP is complex and serious controversy surrounds the safety of CTP tests and the reproducibility and validity of CTP results. This report briefly outlines the history of CTP, its current clinical applications for stroke management, the main controversies surrounding CTP, and future directions for this technology

Case Report: Signal Drop on MRA Imaging of the Internal Carotid Artery after Neuroform Stent Placement

Magnetic resonance angiography (MRA) is an important tool in evaluating the patency of vessels which have previously been stented. Neuroform stents (Boston Scientific, Natick, MA, U.S.A.) are utilized to provide a scaffold across the neck of an aneurysm. These stents are synthesized from Nitinol (nickel and titanium) and thus cause minimal distortion upon imaging with MRA. Patients who have undergone Neuroform stent assisted coiling of aneurysms are routinely followed with MRA to delineate stenosis of the stented segment of vessel as well as recurrence of the aneurysms. While numerous reports show that Neuroform stents do not lead to MRA imaging artifact, we report of a case where the utilization of the Neuroform stent led to a signal drop out at the site of the stent upon evaluation with MRA and thus led to further invasive radiological procedures

Tracking transplanted bone marrow stem cells and their effects in the rat MCAO stroke model.

In this study, rat bone marrow stromal stem cells (BMSCs) were tracked after IV administration to rats with experimental stroke caused by middle cerebral artery occlusion (MCAO). In addition, the effects of BMSC treatment on blood cell composition, brain glia and sensorimotor behavior was studied and compared to that which occurred spontaneously during the normal recovery process after stroke. We found that the vast majority of radiolabeled or fluorescently labeled BMSCs traveled to and remained in peripheral organs (lungs, spleen, liver) 3 days after IV injection in the MCAO rat. Once in the circulation, BMSCs also produced rapid alterations in host blood cell composition, increasing both neutrophil and total white blood cell count by 6 hours post-injection. In contrast, few injected BMSCs traveled to the brain and almost none endured there long term. Nonetheless, BMSC treatment produced dramatic changes in the number and activation of brain astroglia and microglia, particularly in the region of the infarct. These cellular changes were correlated with a marked improvement in performance on tests of sensory and motor function as compared to the partial recovery of function seen in PBS-injected control rats. We conclude that the notable recovery in function observed after systemic administration of BMSCs to MCAO rats is likely due to the cellular changes in blood and/or brain cell number, activation state and their cytokine/growth factor products

Clinical Applications of the Pipeline Embolization Device

No abstract availabl

Endovascular Treatment of Cerebral Mycotic Aneurysm: A Review of the Literature and Single Center Experience

The management of mycotic aneurysm has always been subject to controversy. The aim of this paper is to review the literature on the intracranial infected aneurysm from pathogenesis till management while focusing mainly on the endovascular interventions. This novel solution seems to provide additional benefits and long-term favorable outcomes

Neurogenesis is enhanced by stroke in multiple new stem cell niches along the ventricular system at sites of high BBB permeability

AbstractPrevious studies have established the subventricular (SVZ) and subgranular (SGZ) zones as sites of neurogenesis in the adult forebrain (Doetsch et al., 1999a; Doetsch, 2003a). Work from our laboratory further indicated that midline structures known as circumventricular organs (CVOs) also serve as adult neural stem cell (NSC) niches (Bennett et al., 2009, 2010). In the quiescent rat brain, NSC proliferation remains low in all of these sites. Therefore, we recently examined whether ischemic stroke injury (MCAO) or sustained intraventricular infusion of the mitogen bFGF could trigger an up-regulation in NSC proliferation, inducing neurogenesis and gliogenesis. Our data show that both stroke and bFGF induce a dramatic and long-lasting (14day) rise in the proliferation (BrdU+) of nestin+Sox2+GFAP+ NSCs capable of differentiating into Olig2+ glial progenitors, GFAP+nestin-astrocyte progenitors and Dcx+ neurons in the SVZ and CVOs. Moreover, because of the upsurge in NSC number, it was possible to detect for the first time several novel stem cell niches along the third (3V) and fourth (4V) ventricles. Importantly, a common feature of all brain niches was a rich vasculature with a blood–brain-barrier (BBB) that was highly permeable to systemically injected sodium fluorescein. These data indicate that stem cell niches are more extensive than once believed and exist at multiple sites along the entire ventricular system, consistent with the potential for widespread neurogenesis and gliogenesis in the adult brain, particularly after injury. We further suggest that because of their leaky BBB, stem cell niches are well-positioned to respond to systemic injury-related cues which may be important for stem-cell mediated brain repair