Malignant middle cerebral artery (MCA) infarction in people over 85 years old – Diagnosis, management and risk factors

Background and Objectives: The aim of this study is to identify risk factors for the development of delayed neurocognitive recovery (dNCR). Materials and Methods: 140 patients underwent neurocognitive evaluations (Adenbrooke, MoCa, trial making, and CAM test) and middle cerebral artery (MCA) blood flow velocity (BFV) measurements, one day before cardiac surgery. BFV was re-evaluated after anesthesia induction, before the beginning, middle, end, and after cardiopulmonary bypass (CPB) and postsurgery. To measure glial fibrillary acidic protein (GFAP) and neurofilament heavy chain (Nf-H), blood samples were collected after anesthesia induction, 24 and 48 h after the surgery. Neurocognitive evaluation was repeated 7–10 days after surgery. According to the results, patients were divided into two groups: with dNCR (dNCR group) and without dNCR (non-dNCR group). Results: 101 patients completed participation in this research. GFAP increased in both the non-dNCR group (p < 0.01) and in the dNCR group (p < 0.01), but there was no difference between the groups (after 24 h, p 0.342; after 48 h, p 0.273). Nf-H increased in both groups (p < 0.01), but there was no difference between them (after 24 h, p = 0.240; after 48 h, p = 0.597). MCA BFV was significantly lower in the dNCR group during the bypass (37.13 cm/s SD 7.70 versus 43.40 cm/s SD 9.56; p = 0.001) and after surgery (40.54 cm/s SD 11.21 versus 47.6 cm/s SD 12.01; p = 0.003). Results of neurocognitive tests correlated with CO2 concentration (Pearson’s r 0.40, p < 0.01), hematocrit (r 0.42, p < 0.01), MCA BFV during bypass (r 0.41, p < 0.01), and age (r −0.533, p < 0.01). The probability of developing dNCR increases 1.21 times with every one year of increased age (p < 0.01). The probability of developing dNCR increases 1.07 times with a decrease of BFV within 1 cm/s during bypass (p = 0.02). Conclusion: Risk factors contributing to dNCR among the tested patients were older age and middle cerebral artery blood flow velocity decrease during bypass.

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Treatment of Unruptured Middle Cerebral Artery Aneurysms: The Risk Factors and Surgical Safety

World Neurosurgery ◽

10.1016/j.wneu.2015.04.006 ◽

2015 ◽

Vol 84 (3) ◽

pp. 618-619

Author(s):

Wei Zhu ◽

Ying Mao

Keyword(s):

Risk Factors ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Surgical Safety ◽

Middle Cerebral Artery Aneurysms

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Anatomic Risk Factors for Middle Cerebral Artery Aneurysm Rupture

Neurosurgery ◽

10.1227/neu.0000000000000116 ◽

2013 ◽

Vol 73 (5) ◽

pp. 825-837 ◽

Cited By ~ 33

Author(s):

Ahmed Elsharkawy ◽

Martin Lehečka ◽

Mika Niemelä ◽

Juri Kivelev ◽

Romain Billon-Grand ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Computed Tomography Angiography ◽

Artery Aneurysm ◽

University Hospital ◽

Width Ratio ◽

Aneurysm Wall ◽

Unruptured Intracranial Aneurysms

Abstract BACKGROUND: The middle cerebral artery (MCA) is the most frequent location for unruptured intracranial aneurysms. Controversy remains as to which unruptured MCA aneurysms should be treated prophylactically. OBJECTIVE: To identify independent topographical and morphological variables that could predict increased rupture risk of MCA aneurysms. METHODS: A retrospective analysis of computed tomography angiography data of 1009 consecutive patients with 1309 MCA aneurysms, referred between 2000 and 2009 to Helsinki University Hospital, was carried out. Morphological and topographical parameters examined for MCA aneurysms comprised aneurysm wall regularity, size, neck width, aspect ratio, bottleneck factor, height-width ratio, location along the MCA, side, distance from the internal carotid artery bifurcation, and dome projection in axial and coronal computed tomography angiography views. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for rupture. RESULTS: Of the 1309 MCA aneurysms, 69% were unruptured and 31% were ruptured. Most unruptured MCA aneurysms were smaller than 7 mm (78%), with a smooth wall (80%) and a height-width ratio of 1 (47%) and were located at the main bifurcation (57%). Ruptured MCA aneurysms, mostly 7 to 14 mm in size (55%), had an irregular wall (78%) and a height-width ratio greater than 1 (72%) and were located at the main bifurcation (77%). Thirty-eight percent of MCA bifurcation aneurysms, 74% of large aneurysms, 64% of aneurysms with an irregular wall, and 49% of aneurysms with a height-width ratio greater than 1 were ruptured. CONCLUSION: Location at the main MCA bifurcation, wall irregularity, and less spherical geometry were independently associated with rupture of MCA aneurysms with a correlation with aneurysm size.

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Outcome for Middle Cerebral Artery Aneurysm Surgery

Neurosurgery ◽

10.1227/01.neu.0000378025.33899.26 ◽

2010 ◽

Vol 67 (3) ◽

pp. 755-761 ◽

Cited By ~ 43

Author(s):

Michael K. Morgan ◽

Wattana Mahattanakul ◽

Andrew Davidson ◽

John Reid

Keyword(s):

Risk Factors ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Surgical Outcome ◽

Artery Aneurysm ◽

Morbidity Rate ◽

Mortality And Morbidity ◽

Logistic Analysis ◽

Middle Cerebral Artery Aneurysms ◽

Cerebral Artery Aneurysm

Abstract OBJECTIVE To assess in depth the variables contributing to adverse surgical outcome for repair of unruptured middle cerebral artery aneurysms. METHODS Prospectively collected data between October 1989 and June 2009 were examined retrospectively. Putative risk factors were investigated with univariate and multivariate logistic regression analyses. RESULTS In this study, 263 patients (339 aneurysms) underwent surgical clipping in 280 operations for unruptured middle cerebral artery aneurysms. The overall surgical mortality and morbidity rate was 5% (95% confidence interval [CI], 2.9–8.3). Multivariate logistic analysis of risk factors revealed that age and aneurysm size were independent predictors of surgical outcome. Patients < 60 years of age with an aneurysm ≤ 12 mm constituted a low-risk group with a procedure-related combined mortality and morbidity of 0.6% (95% CI, 0–3.8). Patients < 60 years of age with an aneurysm > 12 mm had a procedure-related combined mortality and morbidity of 7.4% (95% CI, 1–24.5). Patients ≥ 60 years of age with an aneurysm of ≤ 12 mm had a procedure-related combined mortality and morbidity of 9.3% (95% CI, 4.3–18.3). Patients ≥ 60 years of age with an aneurysm > 12 mm had a procedure-related combined mortality and morbidity of 22.2% (95% CI, 8.5–45.8). CONCLUSION Age and size of aneurysm were the only 2 independent predictors of surgical outcome.

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Risk Factors and Morphological Differences of Ruptured Saccular Aneurysm in Different Sites of Anterior Circulation in Patients Presenting with Subarachnoid Haemorrhage

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v3i1.36268 ◽

2018 ◽

Vol 3 (1) ◽

pp. 21-28

Author(s):

Reaz Mahmud ◽

Mansur Habib ◽

Sharif Uddin Khan ◽

Asma Khan

Keyword(s):

Risk Factors ◽

Subarachnoid Haemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Aneurysm Rupture ◽

Digital Subtraction ◽

Anterior Circulation ◽

College Hospital ◽

Medical College ◽

The Mean

Background: All sites of intracranial aneurysms have always been considered together in most of the studies of risk factors of aneurysm rupture. Therefore, it is not known whether some risk factors predispose to aneurysm rupture at a particular location. Morphologies also vary in accordance to different sites of the aneurysm.Objective: The purpose of the present study was to observe the differences in the risk factors, the size, aspect ratio and size ratio among the anterior circulation aneurysms.Methodology: This hospital based cross-sectional study carried out in the Department of Neurology at Dhaka Medical College Hospital (DMCH), Dhaka during July 2013 to June 2015 for a period of two (02) years. Patients with subarachnoid haemorrhage caused by ruptured anterior circulation saccular aneurysms admitted in the Departments of Neurology, Internal Medicine and Neurosurgery Departments at Dhaka Medical College Hospital (DMCH), Dhaka and the Department of Neurointervention at National Institute of Neurosciences and Hospital, Dhaka were enrolled in this study. Patients’ ≥18 years of age with subarachnoid haemorrhage caused by anterior circulation aneurysm which was confirmed by computed tomogram (CT-scan) and/or CSF study and digital subtraction angiography were included in this study. The risk factors were identified by interviewing the patients and the morphology were measured from the digital subtraction angiogram.Results: A total number of 85 patients with ruptured saccular anterior circulation aneurysm were enrolled in this study. In this study anterior communicating artery aneurysm (ACom) was the most frequent site of aneurysm (42%). The mean age of the patients with ACom aneurysm (51.72 ± 9.26 years) was significantly higher than posterior communicating artery (47.5 ± 8.2 years) aneurysm and middle cerebral artery (MCA) (43.41 ± 8.0 years) aneurysm. Above the age of 50 ACom aneurysm was the most frequent aneurysm (OR 5.5, p<0.05). Among the female Posterior communicating artery (PCom) aneurysm (46.7%) was the most frequent aneurysm and among the male ACom aneurysm (37.5%) was the most frequent aneurysm. Family history was exclusive in MCA aneurysm (3.5%). The mean size of MCA (7.79 ± 0.71 cm) was higher than ACom (6.12 ± 2.7cm) aneurysm and PCom (6.5 ± 2.4 cm) aneurysm and proportion of aneurysm >10 mm was also higher among the middle cerebral artery (35.6%) aneurysms. The size ratio was significantly higher in ACom (3.08±1.23) and MCA (3.04±0.97) aneurysm. ACom (76.4%) and MCA (83.3%) had also more frequent high risk size ratio.Conclusion: In conclusion anterior circulation aneurysms differ in respects of risk factors and morphology.Journal of National Institute of Neurosciences Bangladesh, 2017;3(1): 21-28

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Treatment of Large and Giant Middle Cerebral Artery Aneurysms: Risk Factors for Unfavorable Outcomes

World Neurosurgery ◽

10.1016/j.wneu.2017.03.028 ◽

2017 ◽

Vol 102 ◽

pp. 301-312 ◽

Cited By ~ 4

Author(s):

Wonhyoung Park ◽

Jaewoo Chung ◽

Jae Sung Ahn ◽

Jung Cheol Park ◽

Byung Duk Kwun

Keyword(s):

Risk Factors ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Middle Cerebral Artery Aneurysms

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Low flow velocity in the middle cerebral artery predicting infarction after bypass surgery in adult moyamoya disease

Journal of Neurosurgery ◽

10.3171/2016.3.jns152256 ◽

2017 ◽

Vol 126 (5) ◽

pp. 1573-1577 ◽

Cited By ~ 2

Author(s):

Hoyeon Cho ◽

Kyung Il Jo ◽

Jua Yu ◽

Je Young Yeon ◽

Seung-Chyul Hong ◽

...

Keyword(s):

Risk Factors ◽

Middle Cerebral Artery ◽

Flow Velocity ◽

Moyamoya Disease ◽

Cerebral Artery ◽

Bypass Surgery ◽

Early Stage ◽

Low Flow ◽

Mean Flow ◽

Postoperative Mri

OBJECTIVEDirect and indirect bypass surgeries are recognized as the most effective treatments for preventing further stroke in adults with moyamoya disease (MMD). However, the risk factors for postoperative infarction after bypass surgery for MMD are not well established. Therefore, the objective of this study was to investigate the risk factors for postoperative infarction. In particular, the authors sought to determine whether transcranial Doppler (TCD) ultrasonography measurements of mean flow velocity (MFV) in the middle cerebral artery (MCA) could predict postrevascularization infarction.METHODSThe medical records of patients with MMD who underwent direct bypass surgery at the authors' institution between July 2012 and April 2015 were reviewed. The MFV in the MCA was measured with TCD ultrasonography and categorized as high (> 80 cm/sec), medium (40–80 cm/sec), and low (< 40 cm/sec). Postoperative MRI, including diffusion-weighted imaging, was performed for all patients within a week of their surgery. Angiographic findings were classified according to the Suzuki scale. Postrevascularization infarction was defined as any diffusion restriction on postoperative MRI scans. Postoperative neurological status was assessed through a clinical chart review, and the modified Rankin Scale was used to evaluate clinical outcomes.RESULTSOf 43 hemispheres in which bypass surgery for MMD was performed, 11 showed postrevascularization infarction. Ten of these hemispheres had low MFV and 1 had medium MFV in the ipsilateral MCA. In both univariate and multivariate analyses, a low MFV was associated with postrevascularization infarction (adjusted OR 109.2, 95% CI 1.9–6245.3). A low MFV was also statistically significantly associated with more advanced MMD stage (p = 0.02).CONCLUSIONSA low MFV in the ipsilateral MCA may predict postrevascularization infarction. Bypass surgery for MMD appears to be safe in early-stage MMD. Results of TCD ultrasonography provide clinical data on the hemodynamics in MMD patients before and after revascularization.

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