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1.
Nolan S. Hartkamp Jeroen Hendrikse Gert J. de Borst L. Jaap Kappelle Reinoud P.H. Bokkers 《Journal of neuroradiology. Journal de neuroradiologie》2019,46(3):173-178
Background and purpose
Intracerebral steal is a paradoxical vasodilatory response that reduces cerebral blood flow (CBF) in hemodynamically compromised brain tissue when blood is rerouted to more healthy areas. The aim of our study was to investigate the presence and extent of steal in patients with steno-occlusive internal carotid artery (ICA) disease, and to assess its relation with collateral blood flow through the circle of Willis (CoW).Materials and methods
Thirty-eight patients with symptomatic steno-occlusive ICA disease underwent MRI examination with arterial spin labeling (ASL) perfusion imaging before and after a vasodilatory challenge. Intracerebral steal was defined as a decline in CBF after acetazolamide. Collateral flow via the CoW was assessed with time-of-flight and flow direction MR angiography (MRA) through the CoW was assessed with 2D phase-contrast MRA's.Results
Eight of 38 patients (21%) had steal in the hemisphere ipsilateral to the symptomatic ICA (mean tissue volume with steal, 6.9?±?4.1?mL; mean CVR, ?11?±?30%). Cerebrovascular reactivity (CVR) was lower in the middle cerebral artery flow territory of the affected hemisphere in patients with steal compared those without (P?=?0.002). Collateral blood flow was impaired in 4 of the 8 patients with steal. These patients had a larger area of steal (P?=?0.002).Conclusions
Intracerebral steal occurs in patients with obstructive ICA disease and can be assesses at brain tissue level with ASL perfusion MRI. Its presence is related to more severely declined CVR in the surrounding brain tissue area and the volume is associated with impaired primary collateral blood flow through the CoW. 相似文献2.
A.-M. Grapperon M. Berro E. Salort-Campana A. Verschueren E. Delmont S. Attarian 《Revue neurologique》2019,175(1-2):73-80
Introduction
A retrospective analysis was performed to document the clinical and electrophysiological features of Guillain-Barré syndrome (GBS) subtypes using different diagnostic criteria.Methods
One hundred GBS patients were included. Clinical and laboratory features were analyzed, and patients were classified according to four sets of diagnostic criteria. Electrodiagnostic criteria were also analyzed.Results
A total of 69 patients met Asbury and Cornblath's criteria, 96 met Van der Meché’s criteria, 99 met Wakerley's diagnostic classification and 86 met level 1 or 2 of the Brighton criteria. Rates of GBS subtypes were: 69% classic GBS; 8% Miller–Fisher syndrome; 12% paraparetic GBS; 2% pharyngeal–cervical–brachial GBS; and 9% unclassified. Those for electrodiagnostic subtypes were 52% demyelinating and 9% axonal according to Hadden's criteria vs 41% demyelinating and 41% axonal as per Rajabally's criteria.Conclusion
In this study of case distribution within the GBS spectrum of a retrospective cohort of French patients, the application of new diagnostic criteria enabled accurate diagnoses and classifications of the different subtypes, and also increased the recognition of axonal GBS. 相似文献3.
Etienne Santos Sophie Broussy Emilie Lesaine Florence Saillour François Rouanet Patrick Dehail Pierre-Alain Joseph Florence Aly Igor Sibon Bertrand Glize 《Revue neurologique》2019,175(1-2):59-64
Background/Objective
General practitioners (GPs) are pivotal in the organization of the entire post-stroke management system. This study aimed to examine the sequelae of chronic post-stroke patients and to assess whether the medical follow-up organized by GPs is truly in accordance with current recommendations and patients’ clinical needs.Methods
This was an observational study including chronic post-stroke patients after a first stroke. Their post-stroke follow-ups (visits to GPs and specialist doctors) were compared with guidelines and with clinical needs as evaluated through a number of questionnaires.Results
Overall, 53.2% of patients visited a neurologist as recommended and, although 49.4% had neuropsychiatric consequences, only 6.3% visited a psychiatrist. Similarly, while 34.2% had significant post-stroke disability, only 6.3% saw a rehabilitation physician.Conclusion
Taking into account not only cardiovascular prevention, but all post-stroke consequences, medical follow-ups as organized by GPs were not in accordance with recommendations and failed to take advantage of the currently available multidisciplinary resources required to improve patients’ needs. 相似文献4.
Lakshmi Leishangthem Pooja SirDeshpande Dharti Dua Sudhakar R. Satti 《Journal of neuroradiology. Journal de neuroradiologie》2019,46(2):148-154
Background
Dural venous sinus stenting (DVSS) is an accepted treatment option in selected patients with medically refractory idiopathic intracranial hypertension and obstructive venous outflow physiology prior to cerebrospinal flow diversion (CSFD) surgery. There are no randomized controlled studies focusing on outcomes and complication rates for dural venous sinus stenting.Purpose
We present the largest comprehensive meta-analysis on DVSS for idiopathic intracranial hypertension (IIH) focusing on success rates, complications, and re-stenting rates to date. We also present a simplified approach to direct retrograde internal jugular vein (IJ) access for DVSS that allows for expedited procedures.Materials and methods
We performed a retrospective electronic PubMed query of all peer-reviewed articles in the last 15 years between 2003 to 2018. We included all patients who underwent dural venous sinus stenting for a medically refractive IIH and excluded articles without sufficient data on outcomes, complication rates and re-stenting rates. We also evaluated and compared outcomes in patients undergoing direct retrograde IJ access DVSS to traditional transfemoral vein access.Results
A total of 29 papers and 410 patients who underwent DVSS met criteria for inclusion. DVSS was associated with high technical success [99.5%], low rates of repeated procedure [10%], and low major complication rates [1.5%].Conclusion
Our retrospective comprehensive review of DVSS for medically refractory IIH suggests that stenting in appropriately chosen patients is associated with low complication rates, high technical success, and low repeat procedure rates. 相似文献5.
Huipan Wu Xiaojian Yin Xiaojiang Chai Yuqiang Li Guodong Wang Xiaofang Yang Yi Sun Sien Ren Cunjian Bi Ming Li Yuan Liu 《Annales médico-psychologiques》2019,177(4):313-318
Objective
Explore the mental sub-health of Chinese Han adolescents with different nutritional statuses.Method
In all, 8457 Han adolescents were selected by random case method, and were conducted mental sub-health test by Multidimensional Sub-health Questionnaire of Adolescents (MSQA).Result
Detection rates of mental sub-health state among Chinese junior high school students with wasting, normal weight, overweight and obesity were 25.9%, 22.2%, 25.3% and 30.7%, and the detection rates of mental sub-health symptoms were 35.1%, 35.9%, 37.5% and 39.0% respectively. Detection rates of mental sub-health state among senior high school students were 20.5%, 17.7%, 22.8% and 21.8%, and the detection rates of mental sub-health symptoms were 34.7%, 31.4%, 31.1% and 42.3% respectively, and the comparison between different groups has statistical significance.Conclusion
Obesity group has the most obvious mental sub-health, and then the overweight, wasting and normal weight group in sequence. 相似文献6.
Takashi Okazaki Tetsu Niwa Keiji Suzuki Shuhei Shibukawa Yutaka Imai 《Brain & development》2019,41(4):327-333
Purpose
Signals of some brain regions change along with development in T1-weighted imaging (T1WI) in infants. This study aimed to assess the association of the signal intensity of the pituitary stalk on thin-slice T1WI with infant age.Methods
This retrospective study was performed in 89 infants (gestational age [GA], 25–41?weeks; postmenstrual age [PMA], 36–46?weeks; chronological age [CA], 4–141?days) without intracranial abnormalities. The signal ratio of the pituitary stalk/pons on thin-slice T1WI was calculated, and its correlations with GA, PMA, and CA were assessed. Additionally, the signal ratio of the anterior pituitary gland/pons was calculated, and its correlation with that of the pituitary stalk was assessed. The signal intensity and distribution of the pituitary stalk were visually rated, and their correlations with GA, PMA, and CA were assessed.Results
The signal ratio of the pituitary stalk was significantly positively correlated with GA (P?<?0.001) and negatively correlated with CA (P?<?0.001), but was not correlated with PMA. Stepwise multiple regression revealed that CA was independently associated with the signal ratio of the pituitary stalk (P?<?0.001). GA was significantly higher (P?<?0.05) and CA was significantly lower (P?<?0.05) in infants with a high signal intensity and wide distribution of high signal intensity of the pituitary stalk.Conclusions
The signal intensity of the pituitary stalk on T1WI was negatively correlated with CA in infants, which might be related to postnatal changes in the pars tuberalis of the pituitary stalk after birth in infants. 相似文献7.
A. González Gómez A. García-Ben A. Soler García I. García-Basterra F. Padilla Parrado J.M. García-Campos 《Neurología (Barcelona, Spain)》2019,34(4):241-247
Introduction
The contrast sensitivity test determines the quality of visual function in patients with multiple sclerosis (MS). The purpose of this study is to analyse changes in visual function in patients with relapsing-remitting MS with and without a history of optic neuritis (ON).Methods
We conducted a longitudinal study including 61 patients classified into 3 groups as follows: a) disease-free patients (control group); b) patients with MS and no history of ON; and c) patients with MS and a history of unilateral ON. All patients underwent baseline and 6-year follow-up ophthalmologic examinations, which included visual acuity and monocular and binocular Pelli-Robson contrast sensitivity tests.Results
Monocular contrast sensitivity was significantly lower in MS patients with and without a history of ON than in controls both at baseline (P=.00 and P=.01, respectively) and at 6 years (P=.01 and P=.02). Patients with MS and no history of ON remained stable throughout follow-up whereas those with a history of ON displayed a significant loss of contrast sensitivity (P=.01). Visual acuity and binocular contrast sensitivity at baseline and at 6 years was significantly lower in the group of patients with a history of ON than in the control group (P=.003 and P=.002 vs P=.006 and P=.005) and the group with no history of ON (P=.04 and P=.038 vs P=.008 and P=.01). However, no significant differences were found in follow-up results (P=.1 and P=.5).Conclusions
Monocular Pelli-Robson contrast sensitivity test may be used to detect changes in visual function in patients with ON. 相似文献8.
Payam Sajedi Lydia Chelala Joel Nunez-Gonalez Carolyn Cronin Steven Kittner Jiachen Zhuo Yang Zhang Dheeraj Gandhi Prashant Raghavan 《Journal of neuroradiology. Journal de neuroradiologie》2019,46(2):136-140
Background and purpose
Carotid webs are intraluminal filling defects at the carotid bulb which are considered rare, though possibly underappreciated entities with recent studies demonstrating a likely casual association with ischemic stroke. The purpose of the study is to describe our recent experience with clinical and imaging manifestations of carotid webs.Materials and methods
A retrospective review of CTA neck studies in all adult patients presenting to our institution during the 19-month study interval was performed to determine the presence of carotid webs. Subsequent chart review of these patients with webs was performed to assess their clinical history and to obtain demographic detail.Results
A total of 14 patients were identified with carotid webs in the study population. The mean age of patients with webs was 42.1?years (range: 28–54), consisting mostly of African Americans (86%) and females (64%). Ten (71%) of web patients had a history of ischemic stroke, each ipsilateral to the side of web, and at least four of these patients had recurrent ischemic stroke.Conclusion
We provide one of the largest sample sizes of webs gathered in a single study. Given its association with ischemic stroke, carotid webs should be assessed for in all patients presenting with ischemic stroke, especially younger African Americans. 相似文献9.
A. Olascoaga Arrate M.M. Freijo Guerrero C. Fernández Maiztegi I. Azkune Calle R. Silvariño Fernández M. Fernández Rodríguez P. Vazquez Naveira A. Anievas Elena I. Iturraspe González Y. Pérez Díez R. Ruiz Fernández 《Neurología (Barcelona, Spain)》2019,34(2):80-88
Introduction
According to numerous studies, using emergency medical services (EMS) to transport stroke patients to hospitals decreases diagnostic and treatment delays.Objectives
To determine the frequency of use of EMS by stroke patients in Bizkaia (Spain), analyse the factors associated with using EMS, and study the impact of EMS on time to care.Methods
We gathered data from 545 patients hospitalised for acute ischaemic stroke and recruited consecutively. Data were obtained from the patients’ medical histories and interviews with the patients themselves or their companions. We studied the following variables: previous health status, stroke symptoms and severity (NIHSS), type of transport, and time to medical care. Univariate and multivariate analyses were performed to identify factors associated with use of EMS and care delays.Results
Patients transported to hospital by the EMS accounted for 47.2% of the total. Greater stroke severity, arriving at the hospital at night, and poor functional status at baseline were found to be independently associated with use of EMS. Use of EMS was linked to earlier arrival at the hospital. Door-to-imaging times were shorter in the EMS group; however, this association disappeared after adjusting for stroke severity. Revascularisation was more frequent among patients transported by the EMS.Conclusions
EMS transport was associated with shorter prehospital delays. Effective health education programmes should be developed to promote EMS transport for patients with stroke symptoms. In-hospital stroke management should also be improved to reduce time to medical care. 相似文献10.
Sergio Nappini Nicola Limbucci Giuseppe Leone Andrea Rosi Leonardo Renieri Arturo Consoli Antonio Laiso Iacopo Valente Francesco Rosella Riccardo Rosati Salvatore Mangiafico 《Journal of neuroradiology. Journal de neuroradiologie》2019,46(2):141-147
Background
Recent trials established the efficacy of mechanical stent-retriever thrombectomy for treatment of stroke patients with large vessel occlusion (LVO) in the anterior circulation. However, stent-retriever thrombectomy may not accomplish successful recanalization in all patients. The aim of this study is to report the role of bail-out permanent stenting after failure of mechanical thrombectomy.Methods
Among 430 patients included in a prospectively maintained database, we analysed 325 cases of anterior circulation LVO. Mechanical thrombectomy (mTICI 2b-3) was effective in 213/325 (65%) and failed in 112/325 (35%). Bail-out intracranial stenting was performed in 17/325 (5.2%) patients. In all cases a fully retrievable detachable stent was used (Solitaire AB, Medtronic).Results
No intraprocedural technical complications occurred. Successful reperfusion (mTICI 2b/3) was achieved in 12/17 patients (70.6%). Three (17.6%) patients died: one extensive infarction in the internal carotid artery territory, one large intracerebral haemorrhage, and one massive pulmonary embolism. Haemorrhagic conversion, both symptomatic and asymptomatic, occurred in 2/17 (11.7%). Good clinical outcome (mRS 0–2) at 3-months was achieved in 41.2% of patients.Conclusion
Bail-out intracranial stenting after unsuccessful thrombectomy is technically feasible and the associated haemorrhagic risk seems acceptable in selected patients. We suggest that bail-out intracranial stenting, is safe and effective in selected patients with LVO stroke who failed to respond to thrombectomy. 相似文献11.
Background
Spinal dural arteriovenous fistulas (SDAVF) are usually solitary lesions. Synchronous and/or metachronous double SDAVF have rarely been reported in the literature. We report on three patients with double SDAVF and present our single center experience in the diagnostic and treatment management in these patients.Material and methods
We retrospectively revised our medical database for all patients who were diagnosed and treated in our center due to a SDAVF between 1990 and 2017. All data including demographics, clinical presentations, as well as radiological data were re-evaluated for this study.Results
Three (1.4%) of 209 consecutive patients with SDAVF presented double SDAVF with different arterial feeders and venous drainage patterns. All three patients were men. The mean age at time of diagnosis was 67.9?±?10?years (median; 68, range: 53–82). Myelopathic symptoms were reported in all three cases. All three fistulas were located in the thoracolumbar region between T7 and L2. MRI/CE-MRA showed medullar T2-hyperintensity, intramedullary contrast-enhancement and dilatation of perimedullary veins in various extensions.Conclusion
Double SDAVF are extremely rare and were found in 1.4% of patients in our series. The vast majority of the reported double SDAVF in the literature has been detected synchronously within an area of equal or less than three vertebral levels. Thus, whenever the SDAVF is identified, further injections of the fistula-zone neighbored segmental arteries might be recommended. However, due to the extremely low incidence of double SDAVF a complete spinal DSA is not indicated. 相似文献12.
Marinus J. Becks Rashindra Manniesing Jeroen Vister Sjoert A.H. Pegge Stefan C.A. Steens Ewoud J. van Dijk Mathias Prokop Frederick J.A. Meijer 《Journal of neuroradiology. Journal de neuroradiologie》2019,46(2):124-129
Background and purpose
To evaluate whether brain CT perfusion (CTP) aids in the detection of intracranial vessel occlusion on CT angiography (CTA) in acute ischemic stroke.Materials and methods
Medical-ethical committee approval of our hospital was obtained and informed consent was waived. Patients suspected of acute ischemic stroke who underwent non-contrast CT(NCCT), CTA and whole-brain CTP in our center in the year 2015 were included. Three observers with different levels of experience evaluated the imaging data of 110 patients for the presence or absence of intracranial arterial vessel occlusion with two strategies. In the first strategy, only NCCT and CTA were available. In the second strategy, CTP maps were provided in addition to NCCT and CTA. Receiver-operating-characteristic (ROC) analysis was used for the evaluation of diagnostic accuracy.Results
Overall, a brain perfusion deficit was scored present in 87–89% of the patients with an intracranial vessel occlusion, more frequently observed in the anterior than in the posterior circulation. Performance of intracranial vessel occlusion detection on CTA was significantly improved with the availability of CTP maps as compared to the first strategy (P = 0.023), due to improved detection of distal and posterior circulation vessel occlusions (P-values of 0.032 and 0.003 respectively). No added value of CTP was found for intracranial proximal vessel occlusion detection, with already high accuracy based on NCCT and CTA alone.Conclusion
The performance of intracranial vessel occlusion detection on CTA was improved with the availability of brain CT perfusion maps due to the improved detection of distal and posterior circulation vessel occlusions. 相似文献13.
Elif Bulut Abdulsamet Erden Omer Karadag Kader Karli Oguz Seza Ozen 《Journal of neuroradiology. Journal de neuroradiologie》2019,46(3):193-198
Purpose
To increase the knowledge of central nervous system (CNS) imaging features in deficiency of adenosine deaminase 2 (DADA2) by examining magnetic resonance imaging (MRI) studies of a relatively large number of patients.Methods
We retrospectively examined neuroimages of 12 patients (7 male, 5 female) diagnosed with DADA2. The mean age of the patients at the time of initial brain MRI was 16.7 ± 10.2 years. Seven patients (58.3%) fulfilled the classification criteria of polyarteritis nodosa. Brain MRI studies were assessed with respect to findings of ischemia, intracranial hemorrhages, focal parenchymal signal abnormalities, cerebral/cerebellar volume loss, and abnormal contrast enhancement. Angiographic studies of 7 patients were evaluated for the signs of vasculitis.Results
The most frequent finding was acute and/or chronic lacunar ischemic lesions in the brainstem and/or deep gray matter (n = 9, 75%). Six patients (50%) revealed MRI findings compatible with recurrent ischemic attacks. Small nodular contrast enhancement (n = 2, 16.6%), acute putaminal hemorrhage (n = 1, 8.3%) and findings compatible with posterior reversible encephalopathy syndrome (n = 1, 8.3%) were also detected. Slight-to-moderate diffuse cerebral and/or cerebellar volume loss (n = 7, 58.3%), decreased T1 signal of the bone marrow (n = 6, 50%) and optic atrophy (n = 1, 8.3%) were the other findings on brain MRI. The only abnormal angiographic finding was reduced caliber of the right distal posterior cerebral artery in MRA of a patient (14.6%).Conclusion
DADA2 should be included in the differential diagnosis of young patients presenting with ischemic and/or hemorrhagic lesions located in the brainstem and deep gray matter, especially if they have a family history or additional systemic abnormalities. 相似文献14.
M. Mendibe Bilbao S. Boyero Durán J. Bárcena Llona A. Rodriguez-Antigüedad 《Neurología (Barcelona, Spain)》2019,34(4):259-269
Background
The course of multiple sclerosis (MS) is influenced by sex, pregnancy and hormonal factors.Aims
To analyse the influence of the above factors in order to clarify the aetiopathogenic mechanisms involved in the disease.Methods
We conducted a comprehensive review of scientific publications in the PubMed database using a keyword search for ‘multiple sclerosis’, ‘MS’, ‘EAE’, ‘pregnancy’, ‘hormonal factors’, ‘treatment’, and related terms. We reviewed the advances presented at the meeting held by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in March 2013 in London, as well as recommendations by international experts.Results and conclusions
We provide recommendations for counselling and treating women with MS prior to and during pregnancy and after delivery. Current findings on the effects of treatment on the mother, fetus, and newborn are also presented. We issue recommendations for future research in order to address knowledge gaps and clarify any inconsistencies in currently available data. 相似文献15.
M. León Ruiz M.L. Rodríguez Sarasa L. Sanjuán Rodríguez M.T. Pérez Nieves F. Ibáñez Estéllez S. Arce Arce E. García-Albea Ristol J. Benito-León 《Neurología (Barcelona, Spain)》2019,34(3):165-197
Introduction
Very little has been written on seizure management in palliative care (PC). Given this situation, and considering the forthcoming setting up of the Palliative Care Unit at our neurorehabilitation centre, the Clínica San Vicente, we decided to establish a series of guidelines on the use of antiepileptic drugs (AEDs) for handling seizures in PC.Methods
We conducted a literature search in PubMed to identify articles, recent manuals, and clinical practice guidelines on seizure management in PC published by the most relevant scientific societies.Results
Clinical practice guidelines are essential to identify patients eligible for PC, manage seizures adequately, and avoid unnecessary distress to these patients and their families. Given the profile of these patients, we recommend choosing AEDs with a low interaction potential and which can be administered by the parenteral route, preferably intravenously. Diazepam and midazolam appear to be the most suitable AEDs during the acute phase whereas levetiracetam, valproic acid, and lacosamide are recommended for refractory cases and long-term treatment.Conclusions
These guidelines provide general recommendations that must be adapted to each particular clinical case. Nevertheless, we will require further well-designed randomised controlled clinical trials including large samples of patients eligible for PC to draft a consensus document recommending adequate, rational, and effective use of AEDs, based on a high level of evidence, in this highly complex area of medical care. 相似文献16.
R. López Ruiz S. Quintas P. Largo M. de Toledo M.T. Carreras A. Gago-Veiga R. Manzanares J. Vivancos 《Neurología (Barcelona, Spain)》2019,34(2):73-79
Objective
Thirty percent of the patients for whom code stroke is activated have stroke mimics, the most common being epilepsy. Our purpose was to evaluate the usefulness of multiparametric CT for differentiating between seizure-related symptoms and vascular events.Material and methods
We conducted a retrospective observational study; data were gathered prospectively during one year. We studied multiparametric CT images of patients admitted following code stroke activation and finally diagnosed with epilepsy.Results
The study included a total of 11 patients; 36% were men and mean age was 74.5 years. Three patients had right hemisphere syndrome, 4 displayed left hemisphere syndrome, and the remaining 4 had isolated aphasia. Maximum time from symptom onset to multiparametric CT study was 8.16 hours. Perfusion CT results were normal in 2 patients. Nine patients showed longer or shorter times to peak (Tmax); cerebral blood volume (CBV) and cerebral blood flow (CBF) maps varied. EEG was performed a maximum of 47.6 hours after symptom onset. Four patients showed findings compatible with status epilepticus, 2 displayed focal epileptiform activity, and 5 showed post-ictal slowing ipsilateral to perfusion CT abnormalities.Conclusion
The most sensitive parameter for differentiating between stroke and epilepsy in our series was increased time to peak in multilobar cortical locations in the absence of large-vessel occlusion and basal ganglia involvement. Multiparametric CT is a fast, readily available, and useful tool for the differential diagnosis of acute-onset neurological signs of epileptic origin in patients initially attended after code stroke activation. 相似文献17.
R. Carrasco Moro J.A. Gutiérrez Cierco J.S. Martínez San Millán H. Pian M.A. Martínez Rodrigo 《Neurología (Barcelona, Spain)》2019,34(2):98-104
Introduction
We present our experience with the diagnosis and treatment of spinal angiolipomas (SAL).Methods
We used our database of surgical patients to gather epidemiological, clinical, diagnostic, treatment, and follow-up data from confirmed cases of SAL. Patients’ functional status was evaluated using the modified Japanese Orthopaedic Association (mJOA) score for thoracic myelopathy.Results
We included 7 patients with ages ranging between 42 and 63 years; 4 were women. Lesions in all patients were located in the thoracic epidural space; in 2 cases, lesions extended outside the spinal canal. The most frequent form of presentation was pain combined with progressive myelopathy; patients scored 5 to 9 points on the mJOA scale. Radiological findings varied; this variability clearly depended on the proportion of tumour components (cellular variant in one case, predominantly angiomatous in another, and myxoid in yet another case). Four cases displayed radiological signs of bone involvement. Surgery resulted in excellent mJOA scores except in one case (mJOA score of 10); no recurrences were detected during follow-up (periods ranging from 1 to 5 years).Conclusions
Extradural SAL can present with highly variable radiological and clinical features. Surgery must be tailored to each individual situation according to tumour extension; in some cases, it may include spinal reconstruction. Surgery results in excellent outcomes regardless of preoperative functional status and it is associated with low recurrence rates, even in case of incomplete resection. 相似文献18.
Amgad El Mekabaty Monica S. Pearl Bommy Mershon Ivor Berkowitz Philippe Gailloud Thierry A.G.M. Huisman 《Journal of neuroradiology. Journal de neuroradiologie》2019,46(3):214-221
Background and purpose
The vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation with a higher morbidity and mortality, especially in neonates. Ultrasound, CT and MR are usually used in diagnosis and treatment monitoring of these disorders. In this current study, we aim to examine utility of SWI in evaluation of treatment response in infants with VGAM.Materials and methods
We performed a retrospective chart analysis of children with VGAM in our institution between January 2008 and December 2016. Inclusion criteria included; confirmed VGAM on DSA; available SWI sequence at baseline and at follow up after at least a single embolization session; age at initial MR of 18?years or younger. Signal intensity and Angioarchitecture of VGAM and cerebral veins on SWI, as well as hydrocephalus and clinical outcome were evaluated.Results
Of 11 patients identified with VGAM in our institution, 5 children (3 males and 2 females) satisfied the inclusion criteria. The average age at initial MR was 29?days (range 1–120). Fourteen MRI were available for review. All children had VGAM of mural type. Intramedullary veins were dilated and SWI-hypointense in all children, while subependymal and sulcal veins were dilated and SWI-hypointense in 4 patients on initial MRI. On the first available follow up MRI, cerebral veins have mostly normalized in 4 children and remained mostly dilated and SWI-hypointense in 1 child; even after complete treatment of the VGAM.Conclusion
Our preliminary findings show that SWI seems to offer a beneficial non-invasive tool in evaluating passive venous congestion patterns in pediatric patients with VGAM. It remains to be determined in larger studies, the clinical significance of these SWI changes. 相似文献19.
C. Martínez-Ferrández E. Martínez-Salcedo C. Casas-Fernández H. Alarcón-Martínez S. Ibáñez-Micó R. Domingo-Jiménez 《Neurología (Barcelona, Spain)》2019,34(4):224-228
Introduction
Childhood absence epilepsy (CAE) is considered easily manageable with medication provided that a strict patient classification system is employed. It accounts for 10% of all childhood epilepsy cases starting before the age of 15 and it is most frequent in school-aged girls. The aim of this study is to analyse long-term outcomes of patients diagnosed with CAE according to the Loiseau and Panayiotopoulos criteria and treated during childhood.Methods
We conducted a retrospective study including 69 patients with CAE who are currently older than 11; data were gathered from medical histories, EEG records, and telephone questionnaires.Results
52 patients met the Loiseau and Panayiotopoulos criteria. Mean age is now 17.16 years. Female-to-male ratio was 1.65:1; mean age at onset was 6 years and 2 months; mean duration of treatment was 3 years and 9 months. A family history of epilepsy was present in 30.8% of the patients and 7.7% had a personal history of febrile convulsions. Absence seizures were simple in 73.5% of the patients and complex in 26.5%. Response rates to first-line treatment were as follows: valproic acid, 46.3%; and valproic acid plus ethosuximide, 90.9%. The rate of response to second-line therapy (ethosuximide or lamotrigine) was 84.2%; 4% of the patients experienced further seizures after treatment discontinuation, 78.8% achieved seizure remission, and 25% needed psychological and academic support.Conclusions
Our data show that epileptic patients should be classified according to strict diagnostic criteria since patients with true CAE have an excellent prognosis. The relapse rate was very low in our sample. Despite the favourable prognosis, psychological and academic support is usually necessary. 相似文献20.
J. Uthoff F.A. De Stefano K. Panzer B.W. Darbro T.S. Sato R. Khanna D.E. Quelle D.K. Meyerholz J. Weimer J.C. Sieren 《Journal of neuroradiology. Journal de neuroradiologie》2019,46(3):179-185