scholarly journals Endovascular intervention for cerebral watershed infarction due to severe stenosis of the middle cerebral artery is safe and effective: A Retrospective Study

2019 ◽  
Author(s):  
Huifang Xie ◽  
Zhenxing Yan ◽  
Siqin Liu ◽  
Xiongjun He ◽  
Liang Zhang ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Blood Lipid ◽  
Endovascular Intervention ◽  
Severe Stenosis ◽  
Standard Drug ◽  
Drinking History ◽  
Time Of Admission ◽  
Watershed Infarction

Abstract Introduction The aim of this study was to compare the clinical outcomes of standard drug therapy and endovascular intervention for cerebral watershed infarction (WSI) due to severe stenosis of the middle cerebral artery.Methods 86 patients with WSI due to severe stenosis of middle cerebral artery were included 46 endovascular intervention patients and 40 standard drug patients. Clinical data were collected at the time of admission, discharge, and the 90-day return to the hospital for review.Results At the time of admission, there were no significant differences in the baseline data of age, gender, blood pressure, blood glucose, blood lipid, NIHSS, MOCA, or lifestyle characteristics such as smoking and drinking history(P>0.05).At 90 days after discharge, there were statistically significant differences in NHISS score(3.20 ± 1.65and4.35 ± 2.63,P=0.028), mRS score(0.69 ± 0.81and1.20 ± 0.96,P=0.01) and MOCA score(21.24 ± 3.72and19.02 ± 3.48,P=0.006) between the two groups.Conclusion The endovascular intervention for WSI due to severe stenosis of the middle cerebral artery has similar periprocedural complications and better outcomes compared to standard drug therapy.

Tension-type headache in patients with concomitant musculoskeletal disorders

2020 ◽  
pp. 72-79
Author(s):  
Yu. O. Novikov ◽  
I. E. Salakhov
Keyword(s):  
Cervical Spine ◽  
Drug Therapy ◽  
Drug Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Tension Type Headache ◽  
World Health ◽  
Standard Drug ◽  
Rehabilitation Treatment ◽  
Type Headache

Introduction. According to the defi nition of the World Health Organization (WHO), tension-type headache (TTH) is the most common type of primary headache. Rehabilitation of patients with chronic tension-type headache continues to be an important socio-medical problem. Its main goal is the most complete restoration of the functions of the musculoskeletal system of the neck, the correction of vascular and psychoemotional problems, and the patient′s return to his everyday life and work. As a rule, the main emphasis in the treatment of such patients is placed primarily on drug therapy. At the same time, practitioners are faced with a number of problems — the low effectiveness of the treatment, the nonpersistency of the results, allergic reactions, polypharmacy and others. All this suggests that there is a need for differentiated rehabilitation treatment of patients with tension-type headache with the use of various non-pharaceutical methods. The goal of research — to evaluate the clinical effi cacy of complex non-drug therapy in patients with tension-type headache.Materials and methods. The prospective controlled randomized study, which was conducted from October 2017 to March 2019 at the Department of Medical Rehabilitation of the Bashkir State Medical University, included 110 patients with TTH from the age of 20 to 45 years. All patients, depending on the treatment methodology used, were randomly divided into two groups of 55 people. Patients of the main group received complex rehabilitation treatment with the use of non-drug methods: osteopathic correction, acupuncture and exercise therapy. Patients in the control group received treatment in accordance with the standard of medical care for TTH (analgesics, non-steroidal antiinfl ammatory drugs, antidepressants, vasoactive and nootropic drugs). The study of the clinical effectiveness of the therapy included: an assessment of the severity of pain with the use of a visual analogue scale and a tensoalgimeter, a goniometric study with an assessment of the volume of active movements in the cervical spine, transcranial ultrasound dopplerography with an assessment of quantitative indicators in the system of the middle cerebral artery.Results. The use of complex non-drug therapy in patients with TTH compared with standard drug therapy leads to a signifi cantly more important decrease in the severity of pain, an increase in pain threshold, an increase in the volume of active movements in the cervical spine. The effect of non-drug treatment methods on blood fl ow in the system of the middle cerebral artery is comparable in its effectiveness with the use of pharmaceutical drugs.Conclusion. The proposed complex rehabilitation treatment of patients with TTH with the use of non-drug methods has shown clinical effi cacy which is comparable, and in a number of indicators, superior to the effectiveness of conventional medical treatment. All this determines the necessity of wider implementation of multidisciplinary non-drug treatment of patients with this pathology.

scholarly journals Angiographic Morphological Characteristics of Middle Cerebral Artery aneurysms

2018 ◽  
Vol 24 (3) ◽  
pp. 208-211
Author(s):  
Antônio Santos de Araújo Junior ◽  
Paulo Henrique Pires De Aguiar ◽  
Daniel De Carvalho Kirchhoff ◽  
Apio Cláudio Antunes ◽  
Marco Antonio Stefani ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Morphological Characteristics ◽  
Aneurysm Rupture ◽  
The Other ◽  
Single Institution ◽  
Unruptured Aneurysms ◽  
Middle Cerebral Artery Aneurysms ◽  
Vascular Neurosurgery ◽  
Time Of Admission

Background: The treatment of Middle Cerebral Artery Aneurysms (MCAA) and the relation of their morphology to the chance of  rupture are an important topic in vascular neurosurgery. Objective: To assess the correlation between MCAA morphology and 1) the chance of aneurysm rupture and 2) its morbimortality. Methods: Twenty-nine patients with MCAA at the M1 segment (4 patients had multiple aneurysms), were followed/ treated by our crew at a single institution over the last 5 years; 14 aneurysms were ruptured at the time of admission and 15 were diagnosed incidentally. Aneurysms were classified by shape and their geometries were correlated with rupture rate and their morbimortality. Results: Aneurysms measured between 7 and 10 mm in diameter (90% of the aneurysms), and there was no difference in size between the ruptured and unruptured aneurysms. Patients whose MCAAs were ruptured at admission were 3 times as likely than patients with unruptured aneurysms to have a transverse elliptic or inverted-pear-shaped aneurysm (21% vs 9%, p<0.05). On the other hand, patients with unruptured MCAAs were 6 times more likely than patients with ruptured MCAAs to have a pear-shaped aneurysm (36.3% vs 5.2%, p<0.001). Round-shaped aneurysms were more frequent overall, but they were not significantly more prone to rupture. Conclusion: Although this was a small group of patients, we conclude that transverse elliptic and inverted-pear-shaped aneurysms were more associated with rupture than round/ pear-shaped aneurysms.

Superficial temporal artery to middle cerebral artery anastomosis

1979 ◽  
Vol 50 (5) ◽  
pp. 560-569 ◽  
Author(s):  
John R. Little ◽  
Y. Lucas Yamamoto ◽  
William Feindel ◽  
Ernst Meyer ◽  
Charles P. Hodge
Keyword(s):  
Middle Cerebral Artery ◽  
Fluorescein Angiography ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Anastomotic Site ◽  
Regional Cerebral Blood ◽  
Severe Stenosis ◽  
Content Type ◽  
Clearance Studies

✓ Fluorescein angiography and xenon-133 (133Xe) clearance studies were performed during surgery on 15 patients who were undergoing superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis. Fourteen patients had occlusive disease of the internal carotid artery (ICA), and one patient had severe stenosis of the MCA. Before anastomosis, fluorescein angiography showed slow filling of the MCA branches through collateral channels. Focal areas of impaired microcirculatory filling and washout were seen in the territory of severely sclerotic cortical arteries. The findings of preanastomotic 133Xe clearance studies were variable and a uniform pattern of regional cerebral blood flow (rCBF) changes was not defined. In 55% of the patients, rCBF was reduced to 25 ml/100 gm/min or less at one or more detector sites. Fluorescein angiography provided an immediate assessment of anastomotic patency and clearly displayed the distribution of blood entering the epicerebral circulation through the STA. In 67% of patients, multiple MCA cortical branches filled with fluorescein, whereas in 33% filling was restricted to the receptor artery territory. An immediate, substantial (≥ 15 ml/100 gm/min) increase in rCBF was demonstrated in 73% of patients after anastomosis. The rCBF changes were consistently better in patients with donor and receptor arteries greater than 1 mm in diameter. Redistribution of collateral input acted to increase rCBF in areas distant from the anastomotic site. Some improvement in fluorescein circulation and rCBF also was seen in cortex supplied by sclerotic MCA branches.

scholarly journals Evaluating the Velocity and Extent of Cortical Venous Filling in Patients With Severe Middle Cerebral Artery Stenosis or Occlusion

2021 ◽  
Vol 12 ◽  
Author(s):  
Jia'Xing Lin ◽  
Zhong'Yuan Cheng ◽  
Ying'Ying Shi ◽  
Xiang'Ran Cai ◽  
Li'An Huang
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Clinical Manifestations ◽  
Clinical Value ◽  
Severe Stenosis ◽  
Future Studies ◽  
Sagittal Sinus ◽  
Venous Filling ◽  
Antegrade Flow ◽  
Middle Cerebral Artery Stenosis

Objective: To investigate the velocity and extent of cortical venous filling (CVF) and its association with clinical manifestations in patients with severe stenosis or occlusion of the middle cerebral artery (MCA) using dynamic computed tomography angiography (CTA).Methods: Fifty-eight patients (36 symptomatic and 22 asymptomatic) with severe unilateral stenosis (≥70%) or occlusion of the MCA M1 segment who underwent dynamic CTA were included. Collateral status, antegrade flow, and CVF of each patient were observed using dynamic CTA. Three types of cortical veins were selected to observe the extent of CVF, and the absence of CVF (CVF-) was recorded. Based on the appearance of CVF in the superior sagittal sinus, instances of CVF, including early (CVF1), peak (CVF2), and late (CVF3) venous phases, were recorded. The differences in CVF times between the affected and contralateral hemispheres were represented as rCVFs, and CVF velocity was defined compared to the median time of each rCVF.Results: All CVF times in the affected hemisphere were longer than those in the contralateral hemisphere (p &lt; 0.05). Patients with symptomatic MCA stenosis had more ipsilateral CVF- (p = 0.02) and more delayed CVF at rCVF2 and rCVF21 (rCVF2-rCVF1) (p = 0.03 and 0.001, respectively) compared to those with asymptomatic MCA stenosis. For symptomatic patients, fast CVF at rCVF21 was associated with poor collateral status (odds ratio [OR] 6.42, 95% confidence interval [CI] 1.37–30.05, p = 0.02), and ipsilateral CVF- in two cortical veins was associated with poor 3-month outcomes (adjusted OR 0.025, 95% CI 0.002–0.33, p = 0.005).Conclusions: Complete and fast CVF is essential for patients with symptomatic MCA stenosis or occlusion. The clinical value of additional CVF assessment should be explored in future studies to identify patients with severe MCA stenosis or occlusion at a higher risk of stroke occurrence and poor recovery.

scholarly journals Contrast extravasation after angioplasty for symptomatic stenosis of the middle cerebral artery: A case report

2019 ◽  
Vol 25 (6) ◽  
pp. 710-713
Author(s):  
Xiaohui Wang ◽  
Bin Yang ◽  
Haojing Zhu ◽  
Liqun Jiao
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Neurological Deficits ◽  
Severe Stenosis ◽  
Contrast Extravasation ◽  
Intracranial Artery Stenosis ◽  
The Brain ◽  
Symptomatic Stenosis ◽  
Tomography Scan

Contrast extravasation is a common phenomenon in acute ischaemic stroke patients who are treated with endovascular therapy, but it is rarely reported in selective angioplasty of intracranial artery stenosis. In this case we present the treatment and follow-up studies of a patient with severe stenosis in the M1 segment of the middle cerebral artery. We observed extravasation of contrast medium in the brain tissue around the stent after the operation by a computed tomography scan taken immediately, but the patient did not experience any neurological deficits during the operation and the 4-year follow-up. Also the contrast extravasation did not transform into haemorrhage or hyperperfusion.

Abstract T P39: Leptomeningeal Collaterals in Patients with Proximal Middle Cerebral Artery Occlusion are Associated with Milder Stroke and Better Functional Outcome after Fibrinolysis

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Charlotte R Trampedach ◽  
Christian Ovesen ◽  
Anders F Christensen ◽  
Hanne K Christensen
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Acute Ischemia ◽  
Stroke Severity ◽  
Severe Stroke ◽  
Proximal Middle Cerebral Artery ◽  
Time Of Admission ◽  
Cerebral Artery Occlusion

Background: Proximal middle cerebral artery occlusions (M1 occlusion) are often but not always associated with severe stroke and poor outcome. The presence of leptomeningeal collaterals can potentially reduce the acute ischemia and thus reduce stroke severity. Occlusions and collaterals can be assessed using computed tomography angiography (CTA). Collaterals were scored according to the amount of collateral supply filling the occluded middle cerebral artery territory. We assessed the hypothesis that leptomeningeal collaterals covariates with National Institutes of Health Stroke Scale (NIHSS) at time of admission and with three month outcome after acute ischaemic stroke. Method: Fifty-eight patients - subsequently diagnosed with a M1 occlusion on CTA - were admitted within 4.5 hours after symptom onset between May 2009 and December 2011. All patients were scored according to NIHSS at time of admittance by a stroke-neurologist. Occlusions and leptomeningeal collaterals were evaluated on the nonenhanced CT and CTA. All patients received fibrinolysis. Outcome was assessed by modified Rankin Scale (mRS) at 3 months. Results: Fifty-eight patients with a M1 occlusion were included into the analysis (57% female, 43% male, mean age 70 years, range 42-93 years). There was no correlation between age and collateral score. Median NIHSS at time of admittance was 15 (range 3-25), which correlated to the collateral score (r= -0.422, p=0.001). Median mRS at 3 months was 3 (range 0-6) and a correlation with the collateral score was present (r=-0.361, p=0.007). Conclusion: Leptomeningeal collaterals on CT angiography in patients with a proximal middle cerebral artery occlusion relate to lower NIHSS on admission as well as less handicap three months after fibrinolysis treatment.

scholarly journals Low Bifurcation of The Left Common Carotid Artery Associated With Klippel–Feil Syndrome And Severe Stenosis of The Bilateral Proximal Middle Cerebral Artery

2021 ◽  
Author(s):  
Yan Li ◽  
Minli Lv ◽  
Jianquan Zhong
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Common Carotid Artery ◽  
Spinous Process ◽  
Left Common Carotid Artery ◽  
Posterior Arch ◽  
Severe Stenosis ◽  
Proximal Middle Cerebral Artery ◽  
Neck Vessels

Abstract BackgroundThe bifurcate position of the common carotid artery is protean. It is most often locating between the C3 and C5 vertebral levels.Intrathoracic bifurcation of common carotid artery is a rare anatomic finding,and an association with bilateral segmental severe stenosis of middle cerebral artery has not been reported in the past literature .we report a case of low bifurcation of the left common carotid artery associated with Klippel–Feil syndrome and severe stenosis of the bilateral proximal middle cerebral artery.Case PresentationA 47-years old woman presented with dizziness and sleep disturbance,whose computed tomography angiography image incidentally revealed an intrathoracic bifurcation of the left common carotid artery associated with bilateral segmental severe narrowing of middle cerebral artery（MCA）.The left transverse process and spinous process of C3-4 fused and posterior arch of atlas did not fuse on Volume rendered（VR） imaging. ConclusionWe should not only pay attention to the variation of the neck vessels, but also to the serious secondary changes of intracranial vessels caused by neck vessels variation. Low carotid bifurcation may cause chronic progressive stenosis /occlusion of the proximal MCA or severe ischemic stroke events .

scholarly journals Higher Serum Melatonin Levels during the First Week of Malignant Middle Cerebral Artery Infarction in Non-Surviving Patients

2019 ◽  
Vol 9 (12) ◽  
pp. 346 ◽  
Author(s):  
Leonardo Lorente ◽  
María M. Martín ◽  
Pedro Abreu-González ◽  
Rafael Sabatel ◽  
Luis Ramos ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Area Under The Curve ◽  
Secondary Brain Injury ◽  
The Novel ◽  
Middle Cerebral Artery Infarction ◽  
Acute Infarction ◽  
Prediction Of Mortality ◽  
Study Results ◽  
Time Of Admission

Objective: The activation of different physiopathological pathways (neuroinflammation, apoptosis, and oxidation) can lead to secondary brain injury in ischemic stroke, and in animal models the administration of melatonin has reduced that secondary injury. Lower levels of serum melatonin were found at the time of admission of cerebral infarction in surviving patients than in non-surviving patients. Thus, we carried out this prospective and observational study with the aim of exploring serum melatonin levels in the first week of a malignant middle cerebral artery infarction (MMCAI) in surviving and non-surviving patients, and to explore the capacity of those levels to predict mortality. Methods: Patients with severe MMCAI, defined as computed tomography showing acute infarction in more than 50% of the territory and Glasgow Coma Scale (GCS) lower than 9, were included in the study. We measured serum melatonin concentrations at days 1, 4, and 8 of MMCAI. Mortality at 30 days was the endpoint of our study. Results: Non-surviving patients (n = 34) compared to surviving patients (n = 34) showed higher serum melatonin levels at days 1 (p < 0.001), 4 (p < 0.001), and 8 (p = 0.001) of MMCAI. Serum melatonin concentrations at days 1, 4, and 8 of MMCAI had an area under the curve (AUC) (95% confidence interval (CI)) in the prediction of mortality of 0.89 (0.80–0.96; p < 0.001), 0.81 (0.68–0.91; p < 0.001), and 0.82 (0.68–0.92; p < 0.001), respectively. Conclusions: The novel findings of our study were that serum melatonin levels in the first week of MMCAI were higher in non-surviving patients, and were able to predict mortality.

Cheiro-oral syndrome due to severe stenosis of the middle cerebral artery

1996 ◽  
Vol 243 (6) ◽  
pp. 483-484 ◽  
Author(s):  
D. G. Nabavi ◽  
P. Zunker ◽  
T. Mumme ◽  
D. Georgiadis
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Severe Stenosis
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