Cortical laminar necrosis after subarachnoid hemorrhage

Кортикалната ламинарна некроза е рядко наблюдавана при пациент след емболизиране на мозъчна аневризма. Съобщаваме случай на 51-годишна пациентка, която след емболизация на мозъчната аневризма на дясната средна мозъчна артерия остава в коматозно състояние.От извършения ядрено-магнитен резонанс имаше висок интензитет на сигнала в темпоралния лоб на мозъка на T2- изображенията, и линеарен хиперинтензитет по протежение на мозъчните кората на T1-изображенията с дифузно усилване на мозъчната кора.Cortical laminar necrosis has rarely been observed in a patient after coil embolization. We report a 51-year-old female patient who became comatose after the embolization of an aneurysm in the right middle cerebral artery. There were high signal intensities in the temporal brain on T2-weighted MRI images and linear hyperintensities along the cerebral cortices on T1-weighted images with a diffuse gyriform enhancement

Embolization of bronchial arteries in cases of life-threatening bleeding

Massive hemoptysis is a frightening and potentially life-threatening clinical event. Hemoptysis represents a sig­nificant clinical entity with high morbidity and potential mortality. Bronchial artery angiography with embolization has become a mainstay in the treatment of hemoptysis. Bronchial artery embolization offers a minimally invasive procedure for even the most compromised patient serving as first-line treatment for hemorrhage as well as providing a bridge to more definitive medical or surgical intervention focused upon the etiology of the hemorrhage

Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies

Отворената хирургия е златен стандарт за лечение на хепатоцелуларен карцином (НСС) и чернодробни метастази от рак на дебелото черво. Днес чернодробната резекция е все още само лечебен вариант за пациенти с рак на черния дроб, с 5-годишната преживяемост между 25-60%, в сравнение с 0% 5-годишна преживяемост без никакви лечение. Само 5-15% от пациентите с НСС или с чернодробни метастази могат да бъдат подложени на чернодробна резекция поради различни противопоказания: голям брой тумори, тумори на труднодостъпни места, недостатъчен чернодробен обем за резекция.Open surgery is a gold standard for treating hepatocellular carcinoma (HCC) and hepatic metastases of colorectal cancer. Today, liver resection is still only a radically option for patients with liver cancer, with a 5-year survival rate of 25-60%, compared with 0% 5-year survival without any treatment. Only 5-15% of patients with HCC or liver metastases may undergo hepatic resection due to different contraindications: a large number of tumors, tumors in hard-to-reach places, insufficient hepatic volume for resection

Neurotoxicity of cancer agents

Невротоксичните ефекти на химиотерапията се появяват относително често и са причина за модификация на дозата на медикаментите - дозолимитираща токсичност. Рискът от развитие на невротоксичност се увеличава с повишаване на приложената доза и за разлика от миелотоксичността (основния ограничаващ фактор при повечето химиотерапевтични режими), която може да бъде преодоляна с растежни фактори или трансплантация на костен мозък, няма стандартно поведение, което да я ограничи.Противотуморните препарати водят до два типа токсичност - периферна невротоксичност, състояща се основно от периферна невропатия и централна невротоксичност, която включва от незначителни когнитивни увреждания и дефицити до енцефалопатия с деменция или дори кома.Не съществуват утвърдени алгоритми за поведения и профилактика на невротоксичността, причинена от противотуморните препарати. Поведението основно се свежда до редукция на дозата или отлагане във времето на приложението, особено при пациенти, които са с по-висок риск от развитие на невротоксични странични ефекти. На този етап не съществуват невропротективни агенти, които се препоръчват за стандартна употреба при развитие на невротоксичност.Neurotoxic side effects of chemotherapy occur frequently and are often a reason to limit the dose of chemotherapy. Chemotherapy dosing is often limited due to a frequently occurring side effect of the treatment - neurotoxic. The risk of neurotoxicity is increased by the possibility of higher dose usage, since bone marrow toxicity (the major limiting factor in most chemotherapeutic regimens) can be overcome with growth factors or bone marrow transplantation.Chemotherapy may cause both peripheral neurotoxicity, consisting mainly of a peripheral neuropathy, and central neurotoxicity, ranging from minor cognitive deficits to encephalopathy with dementia or even coma. Neurotoxicity caused by the chemotherapy can be of two types - peripheral, mainly consisting of peripheral neuropathy and central, from minor cognitive deficits through encephalopathy with dementia to even coma.Data management and neuroprotective agents are still in discussion and there are no current accepted guidelines yet. Management mainly consists of cumulative dose-reduction or lower dose-intensities, especially in patients who are at higher risk to develop neurotoxic side effects. None of the specific neuroprotective agents can be recommended in daily practice for standard use at the moment, and further studies are needed to confirm their beneficial effects

Minimally invasive ablative techniques of liver tumors

Само 5-15% от пациентите с НСС или с чернодробни метастази могат да бъдат подложени на чернодробна резекция, поради различни противопоказания: голям брой тумори, тумори на трудно достъпни места, недостатъчен чернодробен обем за резекция. Вариантите за перкутанно лечение могат да бъдат: Химичната аблация: инжектиране на етанол или оцетна киселина; Термалната аблация: (а) криохирургични аблация (CSA/КХА): използване на течен азот, аргон, или NO2; (б) коагулационната: използване на радиочестотен ток (RFA/РФА); Микровълнова аблация (MWA/МВ); лазерна интерстициална термотерапия (ЛИТТ) или високоинтензивен фокусиран ултразвук (HIFU/ ВФУ); Необратима електропорация (IRE).Only 5-15% of patients with HCC or liver metastases may undergo hepatic resection due to different contraindications: a large number of tumors, tumors in hard-to-reach places, insufficient hepatic volume for resection. The options for percutaneous treatment can be: Chemical Ablation: Injection of Ethanol or Acetic Acid; Thermal ablation: (a) cryosurgical ablation (CSA): use of liquid nitrogen, argon, or NO2; (b) Coagulation: Radio Frequency Ablation (RFA); Microwave ablation (MWA); Laser Interstitial Thermotherapy (LITT) or High Intensive Focused Ultrasound (HIFU); Irreversible electroporation (IRE)

Spontaneous thrombosis of type II vein of Galen aneurysmal malformation: a case report

Vein of Galen malformations (VGAMs) are rare and complex congenital brain vascular anomalies that pose significant diagnostic and treatment challenges. The natural history of this type of vascular anomaly is very poor, with many patients succumbing to complications such as congestive heart failure, hydrocephalus, and brain parenchymal injury. Although the clinical course of most VGAMs was considered unfortunate, with meticulous imaging, a group of lesions with a more placid presentation and course can be identified. We present a case of spontaneous thrombosis of VGAM where no embolization or surgical repair was attempted, with excellent clinical outcomes. This case also highlights the possibility of spontaneous thrombosis in VGAM, even in the absence of clinical symptoms, and emphasizes the importance of a regular imaging follow-up in patients with known vascular malformations

Developmental venous anomaly causing obstructive hydrocephalus due to aqueductal stenosis: а case report

Cerebral developmental venous anomalies are asymptomatic benign cerebrovascular malformations that are commonly found accidentally on brain magnetic resonance imaging. It is not uncommon for cerebrospinal fluid flow to be obstructed at the level of the aqueduct of Sylvius, causing an obstructive non-communicating hydrocephalus. Most notable reasons for such an obstruction at that level are tumors, congenital etiology, or post-inflammatory gliotic atresia. Herein we present the case of a 65-year-old male patient with an unusual symptomatic developmental venous anomalies causing stenosis and obstruction of the aqueduct of Sylvius at the level of the mesencephalon. Features of this case are discussed together with its implications, including recognizing, diagnosing, and treating such a finding

Spontaneous thrombosis of type II vein of Galen aneurysmal malformation: a case report

Vein of Galen malformations (VGAMs) are rare and complex congenital brain vascular anomalies that pose significant diagnostic and treatment challenges. The natural history of this type of vascular anomaly is very poor, with many patients succumbing to complications such as congestive heart failure, hydrocephalus, and brain parenchymal injury. Although the clinical course of most VGAMs was considered unfortunate, with meticulous imaging, a group of lesions with a more placid presentation and course can be identified. We present a case of spontaneous thrombosis of VGAM where no embolization or surgical repair was attempted, with excellent clinical outcomes. This case also highlights the possibility of spontaneous thrombosis in VGAM, even in the absence of clinical symptoms, and emphasizes the importance of a regular imaging follow-up in patients with known vascular malformations

Spontaneous Direct Carotid-Cavernous Fistula in an Elderly Patient

We describe the case of an 83-year-old woman with left-sided ophthalmoplegia. She had no family history of connective tissue disease. The computed tomography study found a dilated left cavernous sinus. The conventional cerebral panangiography confirmed the diagnosis - a direct carotid-cavernous fistula (CCF), with no evidence of ruptured aneurysm. The woman underwent endovascular treatment with coiling of the cavernous sinus in combination with application of the Onyx embolic agent in the fistula. During the first 48 hours after the embolization the local pain, exophthalmos and conjunctival injection of the left eye were significantly ameliorated. The pulsatile tinnitus on the left disappeared and the ptosis of the left eyelid partially recovered. Selective angiography is the best method for the diagnosis and classification of CCF. Currently, treatment is possible with low mortality and morbidity rates. The endovascular intervention is able to completely occlude the fistula and maintain adequate blood fl ow through the carotid artery

Critical Angiographic and Sonographic Analysis of Intra Aneurysmal and Downstream Hemodynamic Changes After Flow Diversion

IntroductionSuccessful treatment of intracranial aneurysms after flow diversion (FD) is dependent on the flow modulating effect of the device. We aimed to investigate the intra-aneurysmal and parent vessel hemodynamic changes, as well as the incidence of silent emboli following treatment with various FD devices.MethodsWe evaluated the appearance of the eclipse sign in nine distinct phases of cerebral angiography before and immediately after FD placement in correlation with aneurysm occlusion. Angiographic and clinical data of consecutive procedures were analyzed retrospectively. Patients who had successful FD procedure without adjunctive coiling, visible eclipse sign on post embolization angiography, and reliable follow-up angiographic data were included in the analysis. Detailed analysis of hemodynamic data from transcranial doppler after FD was performed in selected patients, such as monitoring for silent emboli.ResultsAmong all patients (N = 65) who met inclusion criteria, complete aneurysm occlusion at 12 months was achieved in 89% (58/65). Eclipse sign prior to FD was observed in 42% (27/65) with unchanged appearance in 4.6% (3/65) of the treated patients. None of these three patients achieved complete aneurysm occlusion. Among all analyzed variables, such as aneurysm size, device type used, age, and appearance of the eclipse sign pre- and post-FD, the most reliable predictor of permanent aneurysm occlusion at 12 months was earlier, prolonged, and sustained eclipse sign visibility in more than three angiographic phases in comparison to the baseline (p < 0.001). Elevation in flow velocities within the ipsilateral vascular territory was noted in 70% (9/13), and bilaterally in 54% (7/13) of the treated patients. None of the patients had silent emboli.ConclusionsIntra-aneurysmal and parent vessel hemodynamic changes after FD can be reliably assessed by the cerebral angiography and transcranial doppler with important implications for the prediction of successful treatment