Safety of diagnostic spinal angiography in children

2020 ◽  
pp. neurintsurg-2020-015906 ◽  
Author(s):  
Ayushi Gautam ◽  
Mina Motaghi ◽  
Philippe Gailloud
Keyword(s):  
Radiation Exposure ◽  
Imaging Modality ◽  
Neurological Complication ◽  
Neurological Complications ◽  
Diagnostic Group ◽  
Spinal Angiography ◽  
Air Kerma ◽  
Contrast Volume ◽  
The Difference ◽  
Lower Contrast

BackgroundSpinal angiography (SA) is associated with low complications in adults but its safety in children has not been properly analyzed. The goal of our study is to assess the safety of pediatric SA.MethodsThis study is the retrospective analysis of a series of 36 consecutive SA procedures performed in 27 children over a 5-year period. Parameters including neurological complications, non-neurological complications requiring additional management, contrast volume, and radiation exposure were analyzed via univariate and bivariate methods.ResultsOur cohort included 24 diagnostic and 12 combined therapeutic cases in children with an average age of 11.1 years. No neurological or non-neurological complication requiring additional management was recorded. The average volume of contrast administered was 1.6 mL/kg in the diagnostic group and 0.9 mL/kg in the combined group. The average air kerma was 186.9mGy for an average of 36.8 exposures in the diagnostic group, and 264.5mGy for an average of 21 exposures in the combined group. Patients in the combined group had lower contrast load (45% lower on average) and higher air kerma (1.6 times higher on average). The difference in air kerma was due to a higher live fluoroscopy-related exposure.ConclusionsThis study reports the largest pediatric SA cohort analyzed to date and the only one including radiation dose and contrast load. It confirms that pediatric SA is a safe imaging modality with low risk of complications, and demonstrates that SA can be performed in children with low radiation exposure and contrast load.

scholarly journals Treatment of posterior circulation fusiform aneurysms

2020 ◽  
pp. 1-7
Author(s):  
Ephraim W. Church ◽  
Mark G. Bigder ◽  
Eric S. Sussman ◽  
Santosh E. Gummidipundi ◽  
Summer S. Han ◽  
...  
Keyword(s):  
Neurological Complication ◽  
Posterior Inferior Cerebellar Artery ◽  
Retrospective Chart Review ◽  
Neurological Complications ◽  
Posterior Circulation ◽  
Flow Diversion ◽  
Interdisciplinary Treatment ◽  
Complication Rates ◽  
The Difference

OBJECTIVEPerforator arteries, the absence of an aneurysm discrete neck, and the often-extensive nature of posterior circulation fusiform aneurysms present treatment challenges. There have been advances in microsurgical and endovascular approaches, including flow diversion, and the authors sought to review these treatments in a long-term series at their neurovascular referral center.METHODSThe authors performed a retrospective chart review from 1990 to 2018. Primary outcomes were modified Rankin Scale (mRS) scores and Glasgow Outcome Scale (GOS) scores at follow-up. The authors also examined neurological complication rates. Using regression techniques, they reviewed independent and dependent variables, including presenting features, aneurysm location and size, surgical approach, and pretreatment and posttreatment thrombosis.RESULTSEighty-four patients met the inclusion criteria. Their mean age was 53 years, and 49 (58%) were female. Forty-one (49%) patients presented with subarachnoid hemorrhage. Aneurysms were located on the vertebral artery (VA) or posterior inferior cerebellar artery (PICA) in 50 (60%) patients, basilar artery (BA) or vertebrobasilar junction (VBJ) in 22 (26%), and posterior cerebral artery (PCA) in 12 (14%). Thirty-one (37%) patients were treated with microsurgical and 53 (63%) with endovascular approaches. Six aneurysms were treated with endovascular flow diversion. The authors found moderate disability or better (mRS score ≤ 3) in 85% of the patients at a mean 14-month follow-up. The GOS score was ≥ 4 in 82% of the patients. The overall neurological complication rate was 12%. In the regression analysis, patients with VA or PICA aneurysms had better functional outcomes than the other groups (p < 0.001). Endovascular strategies were associated with better outcomes for BA-VBJ aneurysms (p < 0.01), but microsurgery was associated with better outcomes for VA-PICA and PCA aneurysms (p < 0.05). There were no other significant associations between patient, aneurysm characteristics, or treatment features and neurological complications (p > 0.05). Patients treated with flow diversion had more complications than those who underwent other endovascular and microsurgical strategies, but the difference was not significant in regression models.CONCLUSIONSPosterior circulation fusiform aneurysms remain a challenging aneurysm subtype, but an interdisciplinary treatment approach can result in good outcomes. While flow diversion is a useful addition to the armamentarium, traditional endovascular and microsurgical techniques continue to offer effective options.

scholarly journals Safety of Diagnostic Cerebral and Spinal Digital Subtraction Angiography in a Developing Country: A Single-Center Experience

2017 ◽  
Vol 7 (1-2) ◽  
pp. 99-109 ◽  
Author(s):  
Qasim Bashir ◽  
Asim Ishfaq ◽  
Ammad Anwar Baig
Keyword(s):  
Digital Subtraction Angiography ◽  
Developing Country ◽  
Imaging Modality ◽  
Cerebrovascular Disorders ◽  
Developed Countries ◽  
Neurological Complications ◽  
Complication Rates ◽  
Spinal Angiography ◽  
Digital Subtraction ◽  
Entire Cohort

Background: Digital subtraction angiography (DSA) remains the gold standard imaging modality for cerebrovascular disorders. In contrast to developed countries, the safety of the procedure is not extensively reported from the developing countries. Herein, we present a retrospective analysis of the basic technique, indications, and outcomes in 286 patients undergoing diagnostic cerebral and spinal angiography in a developing country, Pakistan. Methods: A retrospective review of patient demographics, procedural technique and complication rates of 286 consecutive patients undergoing the diagnostic cerebral/spinal angiography procedure at one institution from May 2013 to December 2015 was performed. Neurological, systemic, or local complications occurring within and after 24 h of the procedure were recorded. Results: Mean age reported for all patients was 49.7 years. Of all the 286 cases, 175 were male (61.2%) and the rest female (111, 38.8%). Cerebral DSA was performed in 279 cases (97.6%), with 7 cases of spinal DSA (2.4%). Subarachnoid hemorrhage was the most common indication for DSA accounting for 88 cases (30.8%), closely followed by stroke (26.6%) and arteriosclerotic vascular disease (23.1%). No intra- or post-procedural neurological complications of any severity were seen in any of the 286 cases. One case of asymptomatic aortic dissection was reported (0.3%) in the entire cohort of patient population. Conclusion: Diagnostic cerebral/spinal digital subtraction angiography was found to be safe in Pakistan, with complication rates at par with and comparable to those reported in the developed world.

RADIATION EXPOSURE TO THE BACK WITH DIFFERENT TYPES OF APRONS

2021 ◽  
Author(s):  
Seung Wan Hong ◽  
Tae Won Kim ◽  
Jae Hun Kim
Keyword(s):  
Radiation Exposure ◽  
Effective Dose ◽  
Exposure Time ◽  
The Other ◽  
Lead Apron ◽  
Type Group ◽  
Air Kerma ◽  
Different Types ◽  
The Relationship

Abstract Physicians and nurses stand with their back towards the C-arm fluoroscope when using the computer, taking things out of closets and preparing drugs for injection or instruments for intervention. This study was conducted to investigate the relationship between the type of lead apron and radiation exposure to the backs of physicians and nurses while using C-arm fluoroscopy. We compared radiation exposure to the back in the three groups: no lead apron (group C), front coverage type (group F) and wrap-around type (group W). The other wrap-around type apron was put on the bed instead of on a patient. We ran C-arm fluoroscopy 40 times for each measurement. We collected the air kerma (AK), exposure time (ET) and effective dose (ED) of the bedside table, upper part and lower part of apron. We measured these variables 30 times for each location. In group F, ED of the upper part was the highest (p &lt; 0.001). ED of the lower part in group C and F was higher than that in group W (p = 0.012). The radiation exposure with a front coverage type apron is higher than that of the wrap-around type and even no apron at the neck or thyroid. For reducing radiation exposure to the back of physician or nurse, the wrap-around type apron is recommended. This type of apron can reduce radiation to the back when the physician turns away from the patient or C-arm fluoroscopy.

scholarly journals Epileptic seizures in patients with COVID-19: A systematic review of early evidences

2021 ◽  
Vol 8 (1) ◽  
pp. 33-44
Author(s):  
B Roy ◽  
I Banerjee
Keyword(s):  
Systematic Review ◽  
Epileptic Seizure ◽  
Case Reports ◽  
Neurological Complication ◽  
Epileptic Seizures ◽  
Neurological Complications ◽  
Cross Sectional Study ◽  
Cerebrovascular Diseases ◽  
Cross Sectional ◽  
Demyelinating Lesions

Background: Global emergence of SARS-CoV-2 surfaced neurological complications amongst the patients. COVID-19 resembles with other coronavirus strains follows a trend of neurological complication, damage and encephalopathy, which entails considerable risks, requires attention for the neurologists. This is, to our knowledge, the first systematic review of the literature to investigate solely to elucidate the seizure spectrum by unfolding epileptogenicity of the SARS CoV-2 and potential pathways of neuroinvasion. Methods: A systematic literature search was performed in PubMed and Embase database following standard guidelines, using specific keywords based on epileptic seizure onset described from December 01, 2019, to July 17, 2020 Results: A total of 17 studies were included ranging from case reports, series of cases, multicentre cross-sectional study with the first-time onset of seizure associated with an epileptic origin. We excavated causes of complex COVID-19 related neurological manifestations, e.g., cerebrovascular diseases, encephalitis, demyelinating lesions, cytokine storm and proposed routes of SARS-CoV-2 entry into the nervous system to understand the mechanism of an epileptic seizure. Conclusion: COVID-19 is a potent neuropathogen which causes the new onset of epileptic seizures should get diagnostic recognition to evade possible deterioration of neurological conditions. However, more shreds of evidence from the future will further elucidate the epileptogenic potential of the pandemic.

scholarly journals Imaging findings of neurologic complications in lung transplantation: Review of a 9-year cohort

2021 ◽  
Vol 10 (8) ◽  
pp. 205846012110387
Author(s):  
Elena Marín-Díez ◽  
Marta Drake-Pérez ◽  
Natalia Valle-San Román ◽  
Víctor Manuel Mora Cuesta ◽  
Miguel Ángel Hernández-Hernández ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Therapeutic Option ◽  
Neurological Complication ◽  
Underlying Disease ◽  
Neurological Complications ◽  
Critical Illness Polyneuropathy ◽  
Imaging Findings ◽  
Post Transplant ◽  
Elevated Rate ◽  
Lung Transplant Recipients

Background Lung transplantation (LT) requires complex multidisciplinary organization and constitutes a therapeutic option and a life-saving procedure. Although the number of lung recipients continues to increase, neurological complications and death rates following lung transplantation are still higher than desirable. Purpose This study aims to analyse the neuroimaging findings in a cohort of adult patients with LT. Material and Methods A retrospective cohort study of all lung transplant recipients (344 patients: 205 men and 139 women) at a single institution from January 2011 to January 2020. The collected data included demographic features, clinical data and evaluation of the imaging findings. We also recorded the date of neurological complication(s) and the underlying disease motivating lung transplantation. Results We found an elevated rate of neuroimaging findings in patients following LT with 32.6% of positive studies. In our cohort, the average time after LT to a neurological complication was 4.9 months post-transplant. Encephalopathy, critical illness polyneuropathy and stroke, in that order, were the most frequent neurological complications. Structural abnormalities in brain imaging were more often detected using MRI than CT for indications of encephalopathy and seizures. Conclusions LT recipients constitute an especially vulnerable group that needs close surveillance, mainly during the early post-transplant period.

Abstract WP72: Low kV Computed Tomography Cerebral Angiogram Using Third-Generation Reconstruction Algorithm Provides Significantly Improved Image Quality With Lower Contrast and Radiation Exposure

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Girish Bathla ◽  
Sarv Priya ◽  
Neetu Soni ◽  
Colin Derdeyn
Keyword(s):  
Image Quality ◽  
Radiation Exposure ◽  
Basilar Artery ◽  
Reconstruction Algorithm ◽  
Third Generation ◽  
Cerebral Angiogram ◽  
Subjective Image Quality ◽  
Contrast Dose ◽  
Significant Difference ◽  
Lower Contrast

Introduction/Aim: We aimed to determine if CTA imaging using third generation reconstruction algorithm and lower contrast dose-low kVp technique (LD-CTA) was comparable to regular contrast dose CTA at 120 kVp using a sinogram affirmed iterative reconstruction algorithm (ND-CTA). Methods: Retrospective imaging review of 100 consecutive patients (50 each in LD- and ND-CTA groups). Two readers independently assessed the subjective image quality across multiple vascular segments on a Likert-like scale. Contrast- and signal-to-noise ratios (CNR/ SNR) were compared for the mid-M1-MCA vessels bilaterally and the mid-basilar artery. Fisher’s exact test was used to compare subjective image quality. Interclass correlation coefficient (ICC) was calculated for the SNR/CNR values. Finally differences in contrast dose, CT-dose index (CTDI) and dose length product (DLP) were compared using Mann-Whitney U test. Results: Both observers showed excellent correlation in subjective image quality (mean percentage agreement of 95.2% (84-100%) for group-1 versus 89.2% (82%-98%) for group-2). The subjective scores were not statistically different in the anterior circulation but showed significantly better image quality for the basilar artery. LD-CTA group showed significantly better SNR and CNR (p < 0.0001) for both MCA vessels and the basilar artery. ICC showed moderate correlation (0.51-0.63) between the observers. Student paired t-test did not show any significant difference between the observers. LD-CTA group also used lower contrast (49 cc versus 103 cc in ND-CTA) and had lower radiation exposure (DLP/ CTDI for both groups 268.3/12.42 vs 519.5/ 25.15, both < 0.0001). Conclusion: Next-generation reconstruction algorithm and low-Kv scanning significantly improved image quality on cerebral CTA images despite lower contrast dose, and in addition, have lower radiation exposure.

scholarly journals Not All Embolizations Are Created Equally in the Management of Posterior Epistaxis: Discussion of Safety Measures Avoiding Neurological Complications

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Mareike Franke ◽  
Jasper Franke ◽  
Christian Saager ◽  
Sven Barthel ◽  
Randolf Riemann ◽  
...  
Keyword(s):  
Neurological Complication ◽  
Neurological Complications ◽  
Surgical Approaches ◽  
Success Rates ◽  
Artery Ligation ◽  
Retrospective Data Analysis ◽  
First Choice ◽  
Surgical Methods ◽  
Choice Of Treatment ◽  
Meta Analyses

Today, there are still no uniform guidelines for the treatment of epistaxis. Furthermore, it is widely debated whether embolization or surgical approaches should be the first choice of treatment for intractable posterior epistaxis after conservative measures have failed. In several meta-analyses, it is reported that endoscopic sphenopalatine artery ligation and embolization have similar success rates, but embolization was associated with more severe neurological complications. Regarding existing literature, there are many comparative analyses of surgical methods but none for embolization protocols. Against this backdrop of a lack of uniform standards in embolization techniques, we present a retrospective evaluation of what has emerged to be best procedural practice for endovascular treatment of epistaxis in our department using microsphere particles and microcoils, in particular regarding precaution measures to avoid neurological complications. In our retrospective data analysis of 141 procedures in 123 patients, performed between 2008 and 2019, we find success rates very similar to those reported in other studies (95.1% immediate-stop-of-bleeding success and 90.2% overall embolization success) but did not encounter any major neurological complication opposed to other reports. We suggest some aspects of our protocol as precaution measure to avoid neurological complications. More generally and perhaps even more importantly, we make a strong case for standardization for embolization techniques to the level of details in surgical procedure standardization to enable an apples to apples comparison of embolization techniques to each other and of intervention vs. surgery.

scholarly journals Insights on Embolic Protection, Repositioning, and Stroke: A Subanalysis of the RESPOND Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Julia Seeger ◽  
Volkmar Falk ◽  
David Hildick-Smith ◽  
Sabine Bleiziffer ◽  
Daniel J. Blackman ◽  
...  
Keyword(s):  
Stroke Risk ◽  
Relative Risk Reduction ◽  
Neurological Complications ◽  
Embolic Protection ◽  
Transcatheter Aortic Valve ◽  
Sts Score ◽  
The Difference ◽  
Ischemic Attack ◽  
The Impact

RESPOND is a prospective, single-arm study enrolling 1014 transcatheter aortic valve replacement (TAVR) patients. The objective of this analysis is to assess the impact of cerebral embolic protection (CEP) devices and prosthetic valve repositioning on the risk of neurologic complications in patients treated with the fully repositionable Lotus Valve in the RESPOND postmarket study. Valve repositioning and CEP use were at the operators’ discretion. Stroke events were adjudicated by an independent medical reviewer. This analysis assessed the baseline differences among patients according to CEP use and valve repositioning and evaluated the neurological complications at 72 hours after TAVR, hospital discharge, and 30-day follow-up. A multivariate analysis was performed to identify the potential predictors of stroke. Of the 996 patients implanted with the Lotus Valve (mean age: 80.8 years, 50.8% female, STS score 6.0 ± 6.9), 92 cases (9.2%) used CEP. The overall rate of acute stroke/transient ischemic attack (TIA) was 3.0% at 72 hours after TAVR. The 72-hour stroke/TIA rate was 1.1% in patients who had CEP and 3.2% in those who did not. Use of CEP was associated with a 2.1% absolute reduction in the risk of acute neurological events (relative risk reduction: 65.6%), although the difference was not statistically significant (p=0.51). Repositioning of the Lotus Valve occurred in 313/996 procedures (31.4%). The 72-hour rate of stroke/TIA was similar in patients who had valve repositioning (2.9%) compared with those who did not (3.1%; p=0.86). The selective use of a CEP device in the RESPOND study was associated with a nonsignificantly lower risk for stroke within 72 hours. The use of the repositioning feature of the Lotus Valve did not increase the stroke risk.

scholarly journals Neurological complications and pathogenetic therapy for chronic nitrous oxide intoxication (“laughing gas”) in nightclub visitors

2020 ◽  
Vol 10 (3) ◽  
pp. 49-62
Author(s):  
N. А. Suponeva ◽  
D. А. Grishina ◽  
D. А. Grozova ◽  
N. V. Belova ◽  
М. А. Ginzberg ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Neurological Complication ◽  
Neurological Complications ◽  
Vitamin B ◽  
Aged People ◽  
Laughing Gas ◽  
Pathogenetic Therapy ◽  
Vitamin Level ◽  
Sensory Polyneuropathy

Background. Nitrous oxide abuse (“laughing gas”, N2O) is common among young people attending nightclubs. Contrary to popular belief about the safety of N2O, in some cases neurological complications develop due to a deficiency of vitamin B12, the activity of which is blocked by N2O. Purpose of the study – to determine the typology and course of neurological disorders in a group of patients who regularly use “laughing gas”. To note the key diagnostic markers that allow verification of vitamin B12 deficiency induced by nitrous oxide consumption. To describe pathogenetic therapy features and follow-up. Materials and methods. The study included 12 patients (10 men and 2 women) aged 18 to 45 years (average age 29 years) with a diagnosis of B12-deficient myelopolyneuropathy induced by regular use of nitrous oxide. Results. The most common neurological complication of nitrous oxide abuse for more than 1 month was a generalized lesion of the peripheral nerves with acute or subacute distal symmetric sensory or sensorimotor axonal polyneuropathy. In the clinical picture, sensory complaints and disorders prevailed. Paresis developed in half of the cases. A typical neuroimaging symptom characteristic of funicular myelosis was rarely detected (16.7 %). A decrease in B12 vitamin level could most reliably be diagnosed only indirectly, by the presence of hyperhomocysteinemia (91.7 % of cases). In all cases that were followed-up, prolonged therapy with cyanocobalamin led to partial (n = 5; 62.5 %) or complete (n = 3; 37.5 %) regression of neurological symptoms. Conclusion. Caution regarding the use of nitrous oxide should be in all cases of predominantly sensory polyneuropathy with acute or subacute development in young and middle-aged people. A thorough history taking (targeted survey on the fact of nitrous oxide consumption) and diagnostics (testing the level of homocysteine, if possible methylmalonic acid) allow you to not miss a deficiency of vitamin B12, the treatment of the consequences of which with timely verification and adequate correction is quite effective. It is recommended that the level of homocysteine in the blood to be regularly monitored during the treatment (in order to achieve its normalization).

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