Endovascular Cure of a Locked-In Patient

We report the case of a 60 year-old right-handed gentleman who became acutely “Locked-In” several days after a lower extremity orthopedic procedure. He underwent emergent endovascular treatment and had complete resolution of his neurologic findings except for mild dysarthria and dysphagia. Endovascular intervention for posterior circulation thrombosis is highly effective when patients are treated within 24 hours

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

The evolution of the treatment of traumatic cerebrovascular injury during wartime.

The approach to traumatic craniocervical vascular injury has evolved significantly in recent years. Conflicts prior to Operations Iraqi and Enduring Freedom were characterized by minimal intervention in the setting of severe penetrating head injury, in large part due to limited far-forward resource availability. Consequently, sequelae of penetrating head injury like traumatic aneurysm formation remained poorly characterized with a paucity of pathophysiological descriptions. The current conflicts have seen dramatic improvements with respect to the management of severe penetrating and closed head injuries. As a result of the rapid field resuscitation and early cranial decompression, patients are surviving longer, which has led to diagnosis and treatment of entities that had previously gone undiagnosed. Therefore, in this paper the authors\u27 purpose is to review their experience with severe traumatic brain injury complicated by injury to the craniocervical vasculature. Historical approaches will be reviewed, and the importance of modern endovascular techniques will be emphasized

Outcomes of 33 patients from the wars in Iraq and Afghanistan undergoing bilateral or bicompartmental craniectomy.

OBJECT: There are no published long-term data for patients with penetrating head injury treated with bilateral supratentorial craniectomy, or supra- and infratentorial craniectomy. The authors report their experience with 33 patients treated with bilateral or bicompartmental craniectomy from the ongoing conflicts in Iraq and Afghanistan. METHODS: An exploratory analysis of Glasgow Outcome Scale (GOS) scores at 6 months in 33 patients was performed. Follow-up lasting a median of more than 2 years was performed in 30 (91%) of these patients. The association of GOS score with categorical variables was explored using the Wilcoxon rank-sum test or Kruskal-Wallis analysis of variance. The Spearman correlation coefficient was used for ordinal/continuous data. To provide a clinically meaningful format to present GOS scores with categorical variables, patients with GOS scores of 1-3 were categorized as having a poor outcome and those with scores of 4 and 5 as having a good outcome. This analysis does not include the patients who died in theater or in Germany who underwent bilateral decompressive craniectomy because those figures have not been released due to security concerns. RESULTS: All patients were men with a median age of 24 years (range 19-46 years) and a median initial Glasgow Coma Scale (GCS) score of 5 (range 3-14). At 6 months, 9 characteristics were statistically significant: focus of the initial injury, systemic infection, initial GCS score, initial GCS score excluding patients with a GCS score of 3, GCS score on arrival to the US, GCS score on dismissal from the medical center, Injury Severity Score, and patients with cerebrovascular injury. Six factors were significant at long-term follow-up: focus of initial injury, systemic infection, initial GCS score excluding patients with a GCS score of 3, GCS score on arrival to the US, and GCS score on dismissal from the medical center. At long-term follow-up, 7 (23%) of 30 patients had died, 5 (17%) of 30 had a GOS score of 2 or 3, and 18 (60%) of 30 had a GOS score of 4 or 5. CONCLUSIONS: In this selected group of patients who underwent bilateral or bicompartmental craniectomy, 60% are independent at long-term follow-up. Patients with bifrontal injury fared best. Systemic infection and cerebrovascular injury corresponded with a worse outcome