scholarly journals Relationship between cerebral aneurysms and variations in cerebral basal arterial network: a morphometric cross-sectional study in Computed Tomography Angiograms from a neurointerventional unit

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e051028
Author(s):  
Arjun Burlakoti ◽  
Jaliya Kumaratilake ◽  
Jamie Taylor ◽  
Maciej Henneberg
Keyword(s):  
Cerebral Artery ◽  
Peak Pressure ◽  
Relative Size ◽  
Size Variation ◽  
Cerebral Aneurysms ◽  
Cross Sectional Study ◽  
Anterior Communicating Artery ◽  
Cross Sectional ◽  
Arterial Network ◽  
Cerebral Ct Angiography

ObjectiveSegments of cerebral basal arterial network (CBAN) dampen the peak pressure in blood flowing through these arteries, thus minimising the chances of development of cerebral aneurysms. The objective of this research was to find the relationship of occurrence of intracranial aneurysms to variations of the components of the CBAN.Design and settingThis is an observational, quantitative and retrospective research, which used cerebral CT angiography (CCTA) images.ParticipantsCerebral CTA of 145 adult patients of both sexes were studied.Main outcome measuresDiameters of segments of CBAN were measured in CCTA images and the relative size of each vessel was calculated to standardise for differences in overall arterial sizes among patients. Relationships among sizes of CBAN components were analysed. Presence of aneurysms in different parts of the CBAN was recorded.ResultsForty-six aneurysms in right internal carotid artery (ICA) and middle cerebral artery (MCA) and 32 aneurysms in left ICA and MCA segments were noted in 42 and 30 patients, respectively. Aneurysms in anterior communicating artery complex and vertebral-basilar arterial segments were seen in 27 and 8 patients, respectively, while they were not detected in parts of posterior cerebral artery (PCA). The significant (p<0.001) inverse relationships between sizes of posterior communicating artery and the first segment of PCA on both sides indicated that blood inputs to the second part of PCA were similar. Difference in means of the index of arterial size variation for people with aneurysms (mean 0.96, SD 0.23) and without aneurysms (mean 0.86, SD 0.22) was significant (p=0.015).ConclusionVariation in segments of CBAN was quantified. The peak pressure dampening mechanism in such arterial segments reduces the chances of development of aneurysms.

scholarly journals Risk factors for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 598-604
Author(s):  
Valentina Opancina ◽  
Snezana Lukic ◽  
Slobodan Jankovic ◽  
Radisa Vojinovic ◽  
Milan Mijailovic
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Medical Center ◽  
White Blood Cells ◽  
Cerebral Aneurysms ◽  
International Normalized Ratio ◽  
Cross Sectional Study ◽  
Cross Sectional

AbstractIntroductionAneurysmal subarachnoid hemorrhage is a type of spontaneous hemorrhagic stroke, which is caused by a ruptured cerebral aneurysm. Cerebral vasospasm (CVS) is the most grievous complication of subarachnoid hemorrhage (SAH). The aim of this study was to examine the risk factors that influence the onset of CVS that develops after endovascular coil embolization of a ruptured aneurysm.Materials and methodsThe study was designed as a cross-sectional study. The patients included in the study were 18 or more years of age, admitted within a period of 24 h of symptom onset, diagnosed and treated at a university medical center in Serbia during a 5-year period.ResultsOur study showed that the maximum recorded international normalized ratio (INR) values in patients who were not receiving anticoagulant therapy and the maximum recorded white blood cells (WBCs) were strongly associated with cerebrovascular spasm, increasing its chances 4.4 and 8.4 times with an increase of each integer of the INR value and 1,000 WBCs, respectively.ConclusionsSAH after the rupture of cerebral aneurysms creates an endocranial inflammatory state whose intensity is probably directly related to the occurrence of vasospasm and its adverse consequences.

Hemorrhagic events associated with unfused or twig-like configuration of the Middle cerebral artery: A rare vascular anomaly with clinical relevance

2020 ◽  
pp. 159101992097043
Author(s):  
Rene Viso ◽  
Ivan Lylyk ◽  
Pablo Albiña ◽  
Javier Lundquist ◽  
Esteban Scrivano ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Clinical Relevance ◽  
Intraventricular Hemorrhage ◽  
Vascular Anomaly ◽  
Clinical Findings ◽  
Anterior Communicating Artery ◽  
Arterial Network ◽  
Ruptured Intracranial Aneurysm ◽  
Hemorrhagic Events

Introduction Twig-like middle cerebral artery configuration (Tw-MCA) is a rare and commonly misdiagnosed vascular anomaly characterized by a plexiform arterial network that replaces the normal M1 segment. The prevalence and clinical relevance of this anomaly is not fully established. Material and methods We sought to explore the prevalence of Tw-MCA in patients clinically referred to digital angiography in a single academic comprehensive endovascular center and evaluated the radiological and clinical findings among patients with hemorrhagic events. Results From 2011 to 2020, a total of 10,234 patients underwent a cerebral angiography at our institution. During this period, 9 (0.088%) Tw-MCAs were identified. Out of these, 5 patients (62.5%) were admitted due to an intracranial hemorrhage. Two patients had a ruptured intracranial aneurysm on the anterior communicating artery, one with multiple brain aneurysms; two patients presented an intraparenchymal hematoma (IPH) due to the presence of a periventricular anastomosis and one patient an intraventricular hemorrhage with unclear origin. Conclusion Tw-MCA is a very rare vascular anomaly associated with hemorrhagic events. Adequate identification of this anomaly is essential in order to avoid misdiagnosis as steno-occlusive disorders.

Comparison of Maxillary Central Inclination, Crown Angulation and Tooth Size Variation in Aesthetic and Non-aesthetic Smiles, A Cross Sectional Study

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Tarulatha Revanappa Shyagali ◽  
Rachita Singh ◽  
Anil Tiwari ◽  
Abhishek Gupta
Keyword(s):  
Size Variation ◽  
Cross Sectional Study ◽  
Tooth Size ◽  
Central Incisor ◽  
Cross Sectional ◽  
Maxillary Central Incisor ◽  
Normal Occlusion ◽  
Lateral Cephalograms ◽  
Significant Difference ◽  
The Aesthetic

Background: An attractive smile is often attributed to incisor alignment and proclined or retroclined incisors could contribute to a less aesthetic smile. Objectives: This study was aimed to evaluate the maxillary central incisor crown inclination, crown angulation and tooth size variation in aesthetic and unattractive smiles. Methods: This study was conducted among 100 females (equally divided into aesthetic and unaesthetic smile groups), aged between15 - 25 years, with Angle’s Class I normal occlusion and balanced profiles. Variations in maxillary central incisor crown inclination and angulation were measured on lateral cephalograms, photographs and the study models of the subjects. Variations in tooth morphology were also evaluated by measuring crown height and width in both groups. Mann-Whitney U test was performed to evaluate the difference between the aesthetic and unaesthetic smiles. P < 0.05 was considered as significant. Results: This study showed that incisor angulation was significantly higher in the unaesthetic group compared to the aesthetic group (P < 0.001). However, there was no statistically significant difference for the incisor inclination relative to the Palatal Plane between the aesthetic and unaesthetic smile groups (P = 0.086). In addition, there were significant differences between the aesthetic and the non-aesthetic groups regarding the central incisor height (P < 0.05). Conclusions: The findings of this study indicate that the possible variations in aesthetics are related to the ethnic elements that are associated with differences in crown angulations, as well as tooth size.

scholarly journals Evaluation of caesarean section practices according to Robson's 10-group classification at a level two maternity ward in Conakry, Guinea

2019 ◽  
Vol 8 (11) ◽  
pp. 4468
Author(s):  
Daniel W. A. Leno ◽  
Mamoudou E. Bah ◽  
Jerry C. Moumbagna ◽  
Tamba M. Millimouno ◽  
David Lamah ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Medical Center ◽  
Caesarean Section Rate ◽  
Relative Size ◽  
Newborn Care ◽  
Fetal Distress ◽  
Cross Sectional Study ◽  
Maternity Ward ◽  
Cross Sectional ◽  
Robson Classification

Background: The frequency of caesarean sections (CS) increased dramatically in the world over the last twenty years. The objective of this study was to evaluate caesarean section practices based on Robson classification in an urban referral hospital in Conakry, GuineaMethods: We conducted a cross-sectional study of 2,266 birthing records collected at the maternity ward of the Coronthie Communal Medical Center in Conakry, from January 1st to December 31st 2016. We included in the study all women who had a caesarean section and whose medical records were complete. Robson's classification was used to classify women into 10 groups based on maternal and fetal characteristics. The relative size of each group, its gross caesarean section rate as well as its contribution to overall caesarean section rate and the main caesarean section indications were calculated.Results: In 2016, 769 caesarean sections were performed out of 2,266 deliveries, corresponding to a hospital section rate of 33.9%. Groups 5 (11.0%), 1 (4.8%), and 3 (4.3%) of the Robson classification were the most contributors to registered hospital caesarean section rate. The main indications for caesarean section were uterine scar in group 5 and acute fetal distress in groups 1 and 3.Conclusions: The systematic reference to the Robson classification could help to identify and avoid the relative indications of the caesarean section in urban Guinea. Besides, increasing induction of labor and strengthening providers’ capacities in emergency obstetric and newborn care services could contribute to reduce caesarean section rates in Guinea.

scholarly journals Eustachian Tube Dysfunction and Wideband Absorbance Measurements at Tympanometric Peak Pressure and 0 daPa

2019 ◽  
Vol 30 (09) ◽  
pp. 781-791 ◽  
Author(s):  
Sreedevi Aithal ◽  
Venkatesh Aithal ◽  
Joseph Kei ◽  
Shane Anderson ◽  
Simon Liebenberg
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Repeated Measures ◽  
Peak Pressure ◽  
Cross Sectional Study ◽  
Eustachian Tube Dysfunction ◽  
Control Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Tube Dysfunction

AbstractAlthough wideband absorbance (WBA) provides important information about middle ear function, there is limited research on the use of WBA to evaluate eustachian tube dysfunction (ETD). To date, WBA obtained under pressurized condition has not been used to evaluate ETD.The objective of the study was to compare WBA at 0 daPa and tympanometric peak pressure (TPP) conditions in healthy ears and ears with ETD.A cross-sectional study design was used.A total of 102 healthy ears from 79 participants (mean age = 10.0 yr) and 43 ears from 32 patients with ETD (mean age = 16.0 yr) were included in this cross-sectional study. WBA was measured at 0 daPa (WBA0) and TPP WBA at TPP (WBATPP).WBA results were analyzed using descriptive statistics and t-tests with the Bonferroni correction. An analysis of variance with repeated measures was applied to the data.WBA0 was significantly lower in the ETD group than in the control group. The WBA0 of the control group demonstrated a broad peak between 1.25 and 4 kHz, whereas the WBA0 of the ETD group had a peak between 2.5 and 4 kHz. WBATPP of the ETD group approached values close to that of the control group. In the control group, WBATPP was only 0.06 to 0.09 higher than WBA0, whereas in the ETD group, WBATPP was 0.29 to 0.42 higher than WBA0 between 0.6 and 1.5 kHz. A differential pattern of WBA at TPP relative to 0 daPa was observed between ears with ETD and ears with otitis media with effusion (OME) and negative middle ear pressure (NMEP).Hence, a comparison of WBA0 and WBATPP can provide potentially useful diagnostic information, and hence can be used as an adjunct tool to evaluate ETD. This is important especially in young children or some adults who are unable to perform maneuvers such as Toynbee or Valsalva during ETD assessment. Further research is needed to verify the results using test performance measures to determine whether WBA0 and WBATPP can objectively determine the presence of ETD or OME with NMEP.

scholarly journals Reference Values of Fetal Peak Systolic Velocity in the Middle Cerebral Artery at 19–40 Weeks of Gestation in Nepalese Population

2014 ◽  
Vol 8 (2) ◽  
pp. 42-45 ◽  
Author(s):  
U Shrestha ◽  
I Shrestha ◽  
RK Ghimire ◽  
S Paudel
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Gestational Age ◽  
Adverse Pregnancy Outcome ◽  
Peak Systolic Velocity ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Systolic Volume ◽  
Serial Measurement ◽  
Adverse Pregnancy

Aims: The purpose of this study was to construct new reference range for fetal middle cerebral artery peak systolic velocity (MCA-PSV) in uncomplicated pregnancy at 19-40 weeks of gestation. Methods: This was a prospective cross-sectional study involving 400 singleton pregnancies between 19 and 40 weeks of gestation without any known risk factors of adverse pregnancy outcome who were referred for routine obstetric examination. The protocol included the doppler examination of fetal middle cerebral artery (MCA) within 2 mm after its origin from the internal carotid artery and data were used to construct the normograms and percentile fitted curves of each doppler parameter for different gestational age. Results: Among 400 singleton uncomplicated pregnancies between 19 and 40 weeks of gestation maximum number of pregnancies (10%) was at 19 weeks of gestation and minimum (2.5%) was at 31 weeks. The fetal peak systolic blood flow in the MCA showed significant correlation with period of gestation. Mean MCA-PSV was 22.35 ± 3.05 at 19 weeks of gestation which increased to 67.73 ± 9.92 at 40 weeks. The MCA-PSV showed continuous increment with increasing gestational age.Conclusions: Continuous increment in the peak systolic volume with advancing gestational age was obtained which was consistent with the previous studies done by various authors. The percentile fitted values and normograms will be valuable for the serial measurement of the peak systolic volume of the middle cerebral artery for complicated pregnancies.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 42-45 DOI: http://dx.doi.org/10.3126/njog.v8i2.9769  

scholarly journals The role of anatomical anomalies in anterior communicating artery aneurysm rupture

2013 ◽  
Vol 19 (3) ◽  
pp. 147-153
Author(s):  
Cr.P Dimitriu ◽  
C. Ionescu ◽  
P. Bordei ◽  
I. Bulbuc
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Circle Of Willis ◽  
Control Group ◽  
Anterior Communicating Artery ◽  
Aneurysm Size ◽  
Proper Patient Selection

Abstract Background and purpose:limited data exist to guide proper patient selection for preventive treatment of unruptured cerebral aneurysms. Cerebral aneurysms have been associated with anomalies of arterial segments that are forming the brain arterial circle of Willis but whether this association is also related to aneurysm rupture is not known. The occurrence of cerebral aneurysm rupture when a circle of Willis anomaly was present or absent was compared. Material and methods: we have performed this study on a number of 312 cases, of which 87 were dissections, 22 dissection followed by plastic injection, 135 magnetic resonance angiography (MRA), 75 computer tomography angiography (CTA), 40 digital subtraction angiographies (DSA), 30 in vivo (intraoperatory) observation. Brain vascular imaging was reviewed for aneurysm size, morphology and presence of anterior cerebral artery anomalies. Results: we divided the study group in 2 cohorts, one control group of 272 cases, in which we have study the anatomical variants occurrence and aneurysm occurrence in general population and another included 45 patients admitted thru emergency room for subarachnoid hemorrhage, of those 38 were ruptured aneurysm of anterior communicating artery (ACoA). Mean aneurysm size was 8.9 mm. An anterior cerebral artery anomaly was identified in 31 cases (81.5%). Multivariate analysis revealed a higher risk of aneurysm rupture when an anterior cerebral artery was present. Conclusions: this study shows that anterior cerebral artery anomalies are more commonly found in ruptured as opposed to unruptured ACoA aneurysms. The presence of an ACA anomaly may be an important characteristic for selecting patients for preventive aneurysm treatment.

scholarly journals Anatomical variations of the anterior communicating artery complex: a multidetector CT angiographic study

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Soe Ei Phyu ◽  
Zunariah Buyong ◽  
Radhiana Hassan ◽  
Jamalludin A. Rahman ◽  
Siti Kamariah Che Mohamed
Keyword(s):  
Multidetector Ct ◽  
Anatomical Variations ◽  
Cross Sectional Study ◽  
Common Trunk ◽  
Anterior Communicating Artery ◽  
Typical Pattern ◽  
Cross Sectional ◽  
High Prevalence ◽  
Different Populations ◽  
The Brain

Introduction: The anterior communicating artery (ACoA) complex of the cerebral circulation, an area with great anatomical diversity, forms part of the communicating arterial supply to the brain. As brain tissues are susceptible to ischemic death, knowledge of this variability is important in diagnosis and management of diseases affecting brain circulation. The aim of the study is to measure the prevalence and to describe these variations. Methods: All patients who underwent CT angiography (CTA) scanning in HTAA from January 2009 to August 2015 were selected. A cross-sectional study was done to study these variations in 81 reconstructed CTA images. Results: Eleven types of variations were described (typical pattern; hypoplasia, aplasia, and duplication of ACoA; hypoplasia, and aplasia of A1 segment of the anterior cerebral artery (ACA); hypoplasia, and aplasia of A2 segment of ACA; A2 segments of ACA arising from a common trunk; the third A2 segment; bihemispheric ACA). A1 segment is the part of ACA from the internal carotid artery to ACoA, and A2 segment is the part of ACA from ACoA to the junction between the rostrum and genu of the corpus callosum. The typical pattern was seen in 35.8%, and the cases with other variation types constituted 64.2%, which is higher compared to previous studies. The variations in ACoA alone were 43.2%, and the most common variation was the ACoA aplasia, accounting for 28.4%. Conclusions: This study shows the high prevalence of anatomical variations in the ACoA complex, and the probable difference of this figure in different populations.

scholarly journals Hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms

2015 ◽  
Vol 21 (1) ◽  
pp. 29-39 ◽  
Author(s):  
Erol Akgul ◽  
Tugsan Balli ◽  
Erol H Aksungur
Keyword(s):  
Cerebral Artery ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Stent Migration ◽  
Long Term Results ◽  
Anterior Communicating Artery ◽  
Stent Insertion ◽  
Neurologic Complication ◽  
Closed Cell

In Y-stenting, stabilization of the first stent may be problematic as in some cases it migrates during second stent insertion. This report evaluates the safety and effectiveness of the technique and presents the long-term results of hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms. We retrospectively evaluated the patients treated endovascularly due to cerebral aneurysms. Twenty patients treated with hybrid Y-stent-assisted coil embolization were enrolled in the study. In hybrid stenting, an open-cell intracranial stent (Neuroform) was used as a first stent to prevent stent migration. A closed-cell stent (Enterprise or Acclino) was used as a second stent and the aneurysm was embolized with coils between the stent struts. In all patients, hybrid Y-stenting and coil embolization were accomplished successfully. No stent migration occurred. Clinically, neither symptomatic neurologic complication nor death was seen. Of 20 wide-necked bifurcation aneurysms, nine were at the basilar tip, while seven were at the middle cerebral artery and three at the anterior communicating artery. In one patient, the aneurysm was at the A2-3 junction of the anterior cerebral artery. One of the patients had a subarachnoid hemorrhage. The mean angiographic follow-up was 25.6 months. No in-stent stenosis was seen in any of the patients and recanalization in only one. Hybrid, Y-configured, dual stent-assisted coil embolization is a safe and effective method in the treatment of wide-necked bifurcation aneurysms to prevent stent migration and aneurysm recanalization, and is a viable alternative to microsurgery.

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