scholarly journals The Deception of Mass Effect: Subacute Posterior Cerebral Artery Infarction Presenting as a Mimic of Acute Middle Cerebral Artery Syndrome

2021 ◽  
pp. 251660852110467
Author(s):  
R. Scalabrino ◽  
G Ngo ◽  
Alessandro Iliceto ◽  
M. Bramwit ◽  
Raymond Mirasol ◽  
...  
Keyword(s):  
Primary Care ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Expert Witness ◽  
Posterior Cerebral Artery ◽  
Multimodality Imaging ◽  
Mass Effect ◽  
Care Physician ◽  
Cerebrovascular Event ◽  
Patient’S Outcome

Clinical data from 3 related cases sheds light on the complex presentation of subacute posterior cerebral artery strokes mimicking acute middle cerebral artery (MCA) syndrome. An expert witness in the field of interventional and diagnostic radiology defended a primary care physician against litigation for an alleged missed diagnosis using multimodality imaging to age a cerebrovascular event. The use of basic computerized tomography and magnetic resonance imaging physics principles are applied to determine whether a patient is outside the treatment window for thrombolytic administration or endovascular intervention. In the defended case, earlier stroke recognition would not have changed the patient’s outcome under question as he was deemed to have a completed infarct prior to presenting to the primary care physician’s (PCP’s) office, making the patient ineligible from acute stroke thrombolytic or endovascular treatment.

scholarly journals Malignant middle cerebral artery infarction following subacute subdural hematoma: A case report and literature review

2021 ◽  
Vol 12 ◽  
pp. 105
Author(s):  
Saad Moughal ◽  
Micaela Uberti ◽  
Alaa Al-Mousa ◽  
Salem Al-Dwairy ◽  
Anan Shtaya ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Mass Effect ◽  
Case Description ◽  
Middle Cerebral Artery Infarction ◽  
Ct Head ◽  
Malignant Mca Infarction ◽  
Significant Mass Effect ◽  
Significant Mass

Background: Subacute subdural hematomas (ASDH) are only treated surgically when they cause mass effect significant enough to give symptoms. Rarely, sub-ASDH may cause enough pressure to result in a malignant middle cerebral artery (MCA) territory infarction. Decompressive craniectomy (DC) is the last resort to reduce intracranial pressure following malignant MCA infarction. Herein, we review the literature and describe a case of MCA/posterior cerebral artery (PCA) territories infarction following drainage of a sub-ASDH that was treated with DC with good outcome. Case Description: We report a case of malignant right-sided MCA/PCA infarction in a 62-year-old man who presented with progressive headache following a cycling incident leading to a head injury. Initial CT head demonstrated a small right ASDH. He had no neurological deficit, headache settled on analgesia, and there was no expansion of the SDH on the repeat CT; therefore, he was managed conservatively. He was admitted 6-days later with worsening headaches and hyponatremia. Repeat CT revealed an increase in size of the hematoma and mass effect leading to a mini-craniotomy and evacuation of hematoma. He developed left-sided hemiplegia, slurred speech and hyponatremia, and CT head demonstrated a right-sided MCA/PCA infarction with significant mass effect. He underwent emergent DC and subsequent cranioplasty and ultimately recovered to mRS of 2. Conclusion: SDH are frequent neurosurgical entities. Malignant MCA/PCA strokes following mini-craniotomies are rare but need to be considered especially during the consent process.

scholarly journals Adverse Outcome of Early Recurrent Ischemic Stroke Secondary to Atrial Fibrillation after Repeated Systemic Thrombolysis

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Luciano A. Sposato ◽  
Valeria Salutto ◽  
Diego E. Beratti ◽  
Paula Monti ◽  
Patricia M. Riccio ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Neurological Outcome ◽  
Left Middle Cerebral Artery ◽  
Cerebrovascular Event ◽  
Middle Cerebral Artery Infarction ◽  
Systemic Thrombolysis ◽  
Left Middle

Background. Recurrent ischemic stroke is associated with adverse neurological outcome in patients with atrial fibrillation. There is very scarce information regarding the neurological outcome of atrial fibrillation patients undergoing repeated systemic thrombolysis after early recurrent ischemic stroke.Clinical Case and Discussion. We describe a case of a 76-year-old woman with known paroxysmal atrial fibrillation who was admitted because of an acute right middle cerebral artery ischemic stroke and who underwent repeated systemic thrombolysis within 110 hours. The patient underwent systemic thrombolysis after the first ischemic stroke with almost complete neurological recovery. On the fourth day after treatment, an acute left middle cerebral artery ischemic stroke was diagnosed and she was treated with full-dose intravenous recombinant tissue plasminogen activator. A hemorrhagic transformation of the left middle cerebral artery infarction was noted on follow-up cranial computed tomographic scans. The patient did not recover from the second cerebrovascular event and died 25 days after admission.Conclusion. To the best of our knowledge, this is the second case reporting the adverse neurological outcome of a patient with diagnosis of atrial fibrillation undergoing repeated systemic thrombolysis after early recurrent ischemic stroke. Our report represents a contribution to the scarce available evidence suggesting that repeated systemic thrombolysis for recurrent ischemic stroke should be avoided.

scholarly journals 5-French SOFIA: Safe Access and Support in the Anterior Cerebral Artery, Posterior Cerebral Artery, and Insular Middle Cerebral Artery

2018 ◽  
Vol 7 (6) ◽  
pp. 308-314 ◽  
Author(s):  
Bradley A. Gross ◽  
William J. Ares ◽  
Cynthia L. Kenmuir ◽  
Ashutosh P. Jadhav ◽  
Tudor G. Jovin ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Cerebral Arteries ◽  
Artery Aneurysm ◽  
Arteriovenous Shunt ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Case Type ◽  
Inner Diameter

Introduction: Distal access catheters are an infrequent focus of technical notes in neurointervention. The 5-French SOFIA’s unique design allows for compatibility with 6-French guide catheters, while its supple construction allows for remarkably distal access for a catheter with a 0.055-inch inner diameter. Methods: The authors reviewed a prospectively maintained endovascular database for cases utilizing the 5-French SOFIA from February 2017 through November 2017. Case type, SOFIA location, microcatheter used, and catheter-related complications were noted. Results: Over the evaluated period, the 5-French SOFIA was utilized in 33 cases, including 13 aneurysm treatments, 10 arteriovenous shunt embolizations, 5 stroke thrombectomies, and 5 other cases. Of 5 flow diversion cases, 1 was for a symptomatic cavernous internal carotid artery aneurysm necessitating transradial access, another for a ruptured A3 aneurysm, and another for a middle cerebral artery (M2) aneurysm; 2 were more proximal aneurysms. Thrombectomies were for M2 (n = 3) or A2 (n = 2) occlusions. In all cases, the 5-French SOFIA reached its anticipated distal target without complication or the need to utilize a smaller/alternative catheter. Of these 33 cases, there were 10 cases of distal SOFIA target locations: 6 M2/M3, 3 anterior cerebral arteries (ACA), and 1 posterior cerebral artery (PCA). M2/M3 and PCA catheterization was achieved over 2.1-Fr microcatheters; ACA catheterization employed a 2.9-Fr microcatheter for pipeline embolization and a deployed stentriever in the setting of two thrombectomies. Conclusion: The 5-French SOFIA can be safely utilized for distal, superselective catheterization in the context of complex neurointervention, including aneurysm and arteriovenous shunt embolization and distal thrombectomy.

Bypass of the maxillary to proximal middle cerebral artery or proximal posterior cerebral artery with radial artery graft

2011 ◽  
Vol 153 (8) ◽  
pp. 1649-1655 ◽  
Author(s):  
Xiang’en Shi ◽  
Hai Qian ◽  
K I Singh K.C. ◽  
Yongli Zhang ◽  
Zhongqing Zhou ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Radial Artery ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Radial Artery Graft ◽  
Artery Graft ◽  
Proximal Middle Cerebral Artery

Congenital Intracerebral Pial Arteriovenous Fistula: A Case Report

2017 ◽  
Vol 79 (02) ◽  
pp. 173-176 ◽  
Author(s):  
Shun-Bao Xin ◽  
Guang-Bin Wang ◽  
Wen-Juan Liu ◽  
Qiang Liu
Keyword(s):  
Magnetic Resonance ◽  
Middle Cerebral Artery ◽  
Arteriovenous Fistula ◽  
Cerebral Artery ◽  
Mass Effect ◽  
Vascular Lesion ◽  
Left Middle Cerebral Artery ◽  
Ethylene Vinyl Alcohol ◽  
Sagittal Sinus ◽  
Pial Arteriovenous Fistula

AbstractPial arteriovenous fistula (AVF) is an extremely rare intracranial vascular lesion. The pediatric type of AVF has a high percentage of varix, leading to mass effect with symptoms. We report a 12-year-old boy who was admitted due to sudden confusion and urinary incontinence. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography (MRA) confirmed the diagnosis of congenital pial AVF. Digital subtraction angiography (DSA) revealed the lesion originating from the left middle cerebral artery and draining into the superior sagittal sinus. The AVF was successfully obliterated with six microcoils and 2.5-mL ethylene vinyl alcohol copolymer using a middle cerebral artery approach. This patient was discharged without neurologic deficits. The AVF became smaller and ultimately disappeared on the DSA and MRA at follow-up.

scholarly journals Hemispatial neglect in cerebrovascular disease involving the territory of the middle cerebral artery and posterior cerebral artery.

Nosotchu ◽  
1994 ◽  
Vol 16 (5) ◽  
pp. 348-353
Author(s):  
Kenichi Iijima ◽  
Shotai Kobayashi ◽  
Nobuo Suyama ◽  
Kazuya Yamashita ◽  
Shuhei Yamaguchi
Keyword(s):  
Cerebrovascular Disease ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Hemispatial Neglect

scholarly journals Remote results of endovascular treatment of middle cerebral artery aneurysms

2015 ◽  
Vol 17 (2) ◽  
pp. 28
Author(s):  
D. V. Shcheglov
Keyword(s):  
Postoperative Complications ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Considerable Increase ◽  
Mass Effect ◽  
Endovascular Occlusion ◽  
Middle Cerebral Artery Aneurysms

Our objective was to study the dynamics of remote results of MCA SA endovascular occlusion. 149 patients with MCA SA were examined and operated, 127 patients were selected for 36 months follow-up, 112 patients in 1 year follow-up, 52 patients were to be examined in 23 years, 17 in 45 years and 14 patients in more than 5 years. Endovascular occlusion was carried out by means of different coils during reconstructive 138 (92.6%) and unplanned deconstructive occlusions 8 (5.4%). For planned deconstructions detachable balloons were used 3 (2%). 17 (11.4%) recurrences were diagnosed and 12 (8%) repeated operations were performed. 19 (12.8%) intra-and postoperative complications/ predictors and 18 (12.1%) complications unrelated to surgery were observed in the first 30 days and only 1 (1.1%) mass effect was identified in 36 months. After our research we were ableto trackthe dynamicsof thepatientslife quality according totheRankinscale; tomonitorthe changes in SA occlusion degree; to define the frequency of recurrences and complications/predictors of complications and to determine the amount of reoperations. We noted a considerable increase in the quantity of total occlusions after reoperations, which resulted in much better filling of the CA cavity, because the prophylaxis of the repeated hemorrhages is the main goal of SA endovascular treatment.

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