Quantifying asymmetry of anterior cerebral arteries as a predictor of anterior communicating artery complex aneurysm

ObjectivesThe aim of this study was to establish an anatomical index for early prediction of the risk of development of aneurysms in anterior communicating arterial complex (AcomAC). The asymmetric diameter of one anterior cerebral artery (ACA) to other could alter haemodynamics and may contribute to formation of aneurysms in AcomAC and be a reliable predictor of the risk of development of aneurysms.Design and settingThis is a retrospective, observational and quantitative study, which used cerebral computed tomography angiography (CCTA) scans in South Australia.ParticipantsCCTA scans of 166 adult patients of both sexes were studied.Main outcome measuresThe internal diameters of the proximal segments of ACAs (A1s) were measured. Position and presence or absence of aneurysms in AcomAC were determined. The ratio of A1 diameters was taken as a measure of A1 asymmetry.ResultsThe ratio of diameters of A1s correlated with the occurrence of AcomAC aneurysms. The risk of development of aneurysms in AcomAC was much greater (80%, OR=47.3) when one A1 segment’s radius was at least 50% larger (ie, 2.25 times cross-sectional area) than the other.ConclusionThe general information on asymmetric A1 has been published previously. The present findings have significant contribution since the A1s asymmetry ratios have been categorised in ascending order and matched with the presence of AcomAC aneurysms. The asymmetry ratio of the A1 is a good predictor for the development of AcomAC aneurysms. Reconstruction of the asymmetric A1 could be done if the technology gets advanced.

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Anatomical variations of circle of Willis - a cadaveric study

International Surgery Journal ◽

10.18203/2349-2902.isj20171016 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1249 ◽

Cited By ~ 1

Author(s):

Ramanuj Singh ◽

Ajay Babu Kannabathula ◽

Himadri Sunam ◽

Debajani Deka

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Anterior Part ◽

Cerebral Arteries ◽

Anatomical Variations ◽

Circle Of Willis ◽

Anterior Communicating Artery ◽

Surgical Interventions ◽

Collateral Channel ◽

The Right

Background: The circle of Willis (CW) is a vascular network formed at the base of skull in the interpeduncular fossa. Its anterior part is formed by the anterior cerebral artery, from either side. Anterior communicating artery connects the right and left anterior cerebral arteries. Posteriorly, the basilar artery divides into right and left posterior cerebral arteries and each join to ipsilateral internal carotid artery through a posterior communicating artery. Anterior communicating artery and posterior communicating arteries are important component of circle of Willis, acts as collateral channel to stabilize blood flow. In the present study, anatomical variations in the circle of Willis were noted.Methods: 75 apparently normal formalin fixed brain specimens were collected from human cadavers. 55 Normal anatomical pattern and 20 variations of circle of Willis were studied. The Circles of Willis arteries were then colored, photographed, numbered and the abnormalities, if any, were noted.Results: Twenty variations were noted. The most common variation observed is in the anterior communicating artery followed by some other variations like the Posterior communicating arteries, Anterior cerebral artery and posterior cerebral artery (PCA) was found in 20 specimens.Conclusions: Knowledge on of variations in the formation of Circle of Willis, all surgical interventions should be preceded by angiography. Awareness of these anatomical variations is important in the neurovascular procedures.

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Surgical anatomy of the proximal anterior cerebral artery

Journal of Neurosurgery ◽

10.3171/jns.1976.44.3.0359 ◽

1976 ◽

Vol 44 (3) ◽

pp. 359-367 ◽

Cited By ~ 119

Author(s):

Ralph O. Dunker ◽

A. Basil Harris

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Anterior Commissure ◽

Cerebral Arteries ◽

Internal Capsule ◽

Carotid Bifurcation ◽

Surgical Anatomy ◽

Anterior Communicating Artery ◽

Content Type ◽

Posterior Limb

✓ The authors present this study of proximal anterior cerebral arteries in the normal human to provide a clearer basis for strategy in aneurysm surgery. They describe patterns of origin of branches, their subarachnoid course, and parenchymal distribution. Branches that originate from the anterior cerebral artery at the internal carotid bifurcation perfuse the genu and contiguous posterior limb of the internal capsule and the rostral thalamus. Proximal 4-mm branches supply the anterior limb of the internal capsule, the neighboring hypothalamus, anteroventral putamen, and pallidum. The remaining anterior cerebral artery proximal to the communicating artery sends branches to the optic chiasm, the adjacent hypothalamus, and the anterior commissure. Heubner's artery arises directly opposite the anterior communicating artery to supply much of the striatum and internal capsule rostral to the anterior commissure. The anterior communicating artery branches supply the fornix, corpus callosum, septal region, and anterior cingulum. The parenchymal distribution of these end arteries may be surmised from the site of origin of named vessels. With this anatomical information one can avoid interruption of blood supply to vital structures when dealing with the anterior cerebral artery and its branches.

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Revascularization of the anterior cerebral artery

Journal of Neurosurgery ◽

10.3171/jns.1985.62.4.0603 ◽

1985 ◽

Vol 62 (4) ◽

pp. 603-606 ◽

Cited By ~ 15

Author(s):

Akira Ikeda ◽

Tomohisa Okada ◽

Masato Shibuya ◽

Satoshi Noda ◽

Masakazu Sugiura ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Cerebral Arteries ◽

The Other ◽

Anterior Communicating Artery ◽

Technical Aspects ◽

Content Type ◽

Good Filling ◽

Fine Print

✓ Intracranial anastomosis between the distal anterior cerebral arteries (ACA's) was performed on two patients. One patient had isolated occlusion of the proximal ACA on one side causing monoparesis in the leg, and the other patient suffered from occlusion of the internal carotid artery and a small anterior communicating artery. The weakness of the legs improved immediately after surgery and cerebral angiography revealed a good filling of the bilateral ACA's. Technical aspects and indications for the procedure are discussed.

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Bilateral Infraoptic Origin of Anterior Cerebral Arteries: A Rare Anomaly and its Embryological and Clinical Significance

Interventional Neuroradiology ◽

10.1177/159101990601200210 ◽

2006 ◽

Vol 12 (2) ◽

pp. 155-159 ◽

Cited By ~ 8

Author(s):

S. Chakraborty ◽

N. F. Fanning ◽

S. K. Lee ◽

K.G. TerBrugge

Keyword(s):

Clinical Significance ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Cerebral Arteries ◽

Anatomical Variations ◽

Anterior Communicating Artery ◽

Aneurysm Formation ◽

Rare Anomaly

We describe a case of bilateral infraoptic origin of the anterior cerebral arteries associated with an anterior communicating artery (ACOM) aneurysm. Anatomical variations of the anterior cerebral artery (ACA) are common; however, bilateral infraoptic course of the anterior cerebral artery is extremely rare. Since an infraoptic course of the ACA is associated with ACOM aneurysm formation, an understanding of the cerebrovascular anatomy and embryology is important for appropriate management of the aneurysm.

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Cerebral Angiographic Study of Anatomical Variations of Anterior Cerebral Artery Complex in Bangladeshi Population

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v32i2.57441 ◽

2016 ◽

Vol 32 (2) ◽

pp. 56-62

Author(s):

Md Amir Hossain ◽

Sharif Uddin Khan ◽

Kazimohibur Rahman ◽

Sirajeeshafiqul Islam ◽

Khairulkabir Patwary ◽

...

Keyword(s):

Cerebral Artery ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Cerebral Arteries ◽

Anatomical Variations ◽

Anterior Communicating Artery ◽

Terminal Branch ◽

Complex Anatomy ◽

Proximal Anterior Cerebral Artery ◽

Bangladeshi Population

Background: Anterior cerebral artery is an important terminal branch of internal carotid artery. It forms the anterior component of circle of Willis along with the anterior communicating artery. It is known for the frequent variations. The knowledge of anatomical variations in anterior cerebral artery is of considerable help to clinicians and interventionists. Method: Morphology and variations of the anterior cerebral arteries and the anterior communicating artery were studied in 90 patients undergone digital subtraction angiography (DSA). Results: Variations were found in 33% (n=30). Variations of the segments in relation with size, course, communications and terminations of the anterior cerebral artery (ACA) were noted. These were divided into different groups like hypoplasia, aplasia, duplication and fenestrations. Hypoplasia/Aplasia of proximal anterior cerebral artery (A1) was 24.5% in right side and 9% in left side. Anterior communicating artery (AComA) was found absent in 9% and fenestration in 9%. Callosomarginal artery was found absent in 2.2% in right side and 4.5% in left side. In right callosomarginal artery 6% had abnormal origin and 3.5% abnormal in left side.Pericallosal artery was present 100% on both sides. Conclusion: Variations of anterior cerebral artery complex anatomy is found common in Bangladeshi population. Bangladesh Journal of Neuroscience 2016; Vol. 32 (2): 56-62

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Mirror Image Distal Anterior Cerebral Artery Aneurysms Treated with Coil Embolization

Interventional Neuroradiology ◽

10.1177/159101991301900107 ◽

2013 ◽

Vol 19 (1) ◽

pp. 49-55 ◽

Cited By ~ 4

Author(s):

E. Enesi ◽

A. Rroji ◽

M. Demneri ◽

G. Vreto ◽

M. Petrela

Keyword(s):

Case Report ◽

Endovascular Treatment ◽

Coil Embolization ◽

Anterior Cerebral Artery ◽

Cerebral Arteries ◽

Mirror Image ◽

Anterior Communicating Artery ◽

First Case ◽

Anatomic Variants ◽

Distal Anterior Cerebral Artery

Mirror image aneurysms of the distal anterior cerebral arteries (DACA) are rare. To the best of our knowledge this is the first case report of two patients with mirror image DACA aneurysms treated successfully with coil embolization. The association of aneurysms with anatomic variants has been extensively reported. We may speculate that the remnants of the failed regression of the supreme anterior communicating artery could lead to an increase in stress across their territorial bifurcation, leading to the development of mirror image DACA aneurysms. We found the endovascular treatment of mirror image DACA aneurysms to be feasible and effective. If possible, we suggest the treatment of both aneurysms in one procedure.

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Patients perspectives on drug shortages in six European hospital settings – a cross sectional study

BMC Health Services Research ◽

10.1186/s12913-021-06721-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Darija Kuruc Poje ◽

Domagoj Kifer ◽

Isabelle Huys ◽

Joao Miranda ◽

Helena Jenzer ◽

...

Keyword(s):

Management Practices ◽

Healthcare Professionals ◽

Demographic Data ◽

General Information ◽

Basic Knowledge ◽

Drug Shortage ◽

Cross Sectional ◽

Drug Shortages ◽

Good Communication ◽

Information Preferences

Abstract Background It is known that drug shortages represent a major challenge for all stakeholders involved in the process, but there is little evidence regarding insights into patients′ awareness and perspectives. This study aimed to investigate the patients-perceived drug shortages experience and their view on outcomes in different European hospital settings. Furthermore, we wanted to explore information preferences on drug shortages. Methods A retrospective, cross sectional, a mixed method study was conducted in six European hospital settings. One hospital (H) from each of this country agreed to participate: Bosnia and Herzegovina (H-BiH), Croatia (H-CR), Germany (H-GE), Greece (H-GR), Serbia (H-SE) and Poland (H-PO). Recruitment and data collection was conducted over 27 months from November 2017 until January 2020. Overall, we surveyed 607 patients which completed paper-based questionnaire. Questions related to: general information (demographic data), basic knowledge on drug shortages, drug shortages experienced during hospitalization and information preferences on drug shortage. Differences between hospital settings were analyzed using Chi-squared test or Fisher’s exact test. For more complex contingency tables, Monte Carlo simulations (N = 2000) were applied for Fisher’s test. Post-hoc hospital-wise analyses were performed using Fisher’s exact tests. False discovery rate was controlled using the Bonferroni method. Analyses were performed using R: a language and environment for statistical computing (v 3.6.3). Results 6 % of patients reported experiences with drug shortages while hospitalized which led to a deterioration of their health. The majority of affected patients were hospitalized at hematology and/or oncology wards in H-BiH, H-PO and H-GE. H-BiH had the highest number of affected patients (18.1 %, N = 19/105, p < 0.001) while the fewest patients were in H-SE (1 %, N = 1/100, p = 0.001). In addition, 82.5 %, (N = 501/607) of respondents wanted to be informed of alternative treatment options if there was a drug shortage without a generic substitute available. Majority of these patients (66.4 %, N = 386/501) prefer to be informed by a healthcare professional. Conclusions Although drug shortages led to serious medical consequences, our findings show that most of the patients did not perceive shortages as a problem. One possible interpretation is that good hospital management practices by healthcare professionals helped to mitigate the perceived impact of shortages. Our study highlights the importance of a good communication especially between patients and healthcare professionals in whom our patients have the greatest trust.

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A Survey on How Ocular Surface Demodex Infestation Interactively Associates with Diabetes Mellitus and Dry Eye Disease

Acta Parasitologica ◽

10.1007/s11686-021-00382-8 ◽

2021 ◽

Author(s):

Chang Huang ◽

Shuze Chen ◽

Sheng Fu ◽

Yingli Li ◽

Zhenhao Li ◽

...

Keyword(s):

Diabetes Mellitus ◽

Dry Eye ◽

Ocular Surface ◽

Cross Sectional Study ◽

General Information ◽

Potential Interaction ◽

Dry Eye Disease ◽

Eye Disease ◽

Cross Sectional ◽

Demodex Infestation

Abstract Purpose Prevention of ocular surface (OS) Demodex infestation plays an important role in OS hygiene and variety of factors may be associated with it, in which diabetes mellitus (DM) or dry eye disease (DED) has caught the attention of most scholars. However, there has been no research on whether there was a potential interaction between DM and DED in the process of OS Demodex infestation. This cross-sectional study was implemented in Zhujiang Hospital of Southern Medical University. Methods Ophthalmologic interviews, questionnaires, and examinations were conducted. Factors including general information, DM status, dry eye condition, etc. were collected to study the correlation of DM and DED on OS Demodex infestation. Results After statistical analysis, we found that both DM (P < 0.001) and DED (P = 0.013 < 0.05) are closely associated with OS Demodex infestation. Compared with DED, DM has higher priority association with OS Demodex infestation, and patients with both diseases have a significant higher risk of OS Demodex infestation (R = 0.197, P < 0.001). Meanwhile, age (R = 0.299, P < 0.001) and hypertension (P < 0.05) were also correlated with OS Demodex infestation. Conclusion This study provides a new evidence-based basis for clinical prevention and management of OS Demodex infestation.

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Knowledge of breast cancer among medical students in Syrian Private University, Syria: a cross-sectional study

BMC Medical Education ◽

10.1186/s12909-021-02673-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hlma Ismail ◽

Mosa Shibani ◽

Hanaa Wael Zahrawi ◽

Ali Fouad Slitin ◽

Mhd Amin Alzabibi ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Medical Students ◽

Clinical Features ◽

Smoking Status ◽

Private University ◽

Cross Sectional Study ◽

General Information ◽

Sectional Study ◽

Cross Sectional

Abstract Background Breast cancer is the most common cancer among women and the second leading cause of cancer death globally. Since early diagnosis is crucial to reducing mortality, high levels of knowledge regarding general information, risk factors, and symptoms are required among healthcare professionals to deliver breast cancer care. This study aimed to determine Syrian medical students’ knowledge about breast cancer in the fields of general knowledge, common clinical features, and risk factors. Methods This cross-sectional study was conducted at the Syrian Private University in October 2019 (Breast Cancer Awareness Month), Damascus, during the Syrian war crisis. Data were collected through self-administered surveys and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., United States). The chi-square test was applied to assess the relationship between the level of knowledge and gender. One way analysis of variance was performed to assess the overall differences in mean knowledge score by study year, GPA, mother’s education, and source of information. Unpaired Student’s T-test was used to analyze the differences in mean knowledge scores (continuous variable) based on smoking status and alcohol consumption. Results Of 320 students, 301 completed the questionnaire (response rate = 94.0%), of which 179(59.5%) were males. The study revealed above-average knowledge scores (total mean = 68.4%) regarding breast cancer, general information (71.9%), common clinical features (71.6%), and risk factors (71.6%). Clinical students (4th, 5th, and 6th years) scored higher compared with pre-clinical students (1st, 2nd, and 3rd years). Conclusion This study showed above-average knowledge scores regarding breast cancer. More efforts to correct misinformation, through reassessing the university curriculum and promoting awareness about breast cancer are required.

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Information Overload, Wellbeing and COVID-19: A Survey in China

Behavioral Sciences ◽

10.3390/bs11050062 ◽

2021 ◽

Vol 11 (5) ◽

pp. 62

Author(s):

Jialin Fan ◽

Andrew P Smith

Keyword(s):

General Public ◽

Online Survey ◽

Information Overload ◽

Age Distribution ◽

General Information ◽

Anxiety And Depression ◽

Specific Information ◽

Cross Sectional ◽

Wide Range ◽

Negative Coping

(1) Psychology must play an important role in the prevention and management of the COVID-19 pandemic. The aim of the present study was to examine associations between the perceptions of information overload and wellbeing in China during the initial phase of COVID-19. (2) Methods: The present research involved a cross-sectional online survey, which controlled for established predictors of wellbeing and the perception of general (not COVID-19-specific) information overload. The setting of the research was China, February 2020. A total of 1349 participants completed an online survey, and the results from 1240 members of the general public who stated that they were uninfected are reported here (55.6% female; 49.4% single; age distribution: 17–25 years: 26%; 26–30 years: 24.3%; 31–40 years: 23.9%; 41–50 years: 16.2%; 51 years+: 9.6%; the most frequent occupations were: 21.5% students; 19.5% teachers; 25.9% office workers; 10.8% managers, plus a few in a wide range of jobs). The outcomes were positive wellbeing (positive affect and life satisfaction) and negative wellbeing (stress, negative affect, anxiety and depression). (3) Results: Regressions were carried out, controlling for established predictors of wellbeing (psychological capital, general information overload, positive and negative coping). Spending time getting information about COVID-19 was associated with more positive wellbeing. In contrast, perceptions of COVID-19 information overload and feeling panic due to COVID-19 were associated with more negative wellbeing. (4) Conclusions: These results have implications for the communication of information about COVID-19 to the general public and form the basis for further research on the topic.

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