scholarly journals MASSIVE MURAL AORTIC ARCH THROMBUS.

2021 ◽  
Author(s):  
Ali Ayaon Albarrán ◽  
Jose Ignacio Juarez Del Rio ◽  
María Mercedes Campos Sanz ◽  
Cristina Rodríguez Alcalá
Keyword(s):  
Ct Angiography ◽  
Axillary Artery ◽  
Filling Defect ◽  
Aortic Disease ◽  
Ascending Aorta ◽  
Left Middle Cerebral Artery ◽  
Aortic Thrombus ◽  
Left Middle ◽  
Hypothermic Arrest ◽  
Treatment Surgery

Mural aortic thrombus is a rare pathology that is more frequently seen in severe atherosclerotic aortic walls, in aneurysms and acute aortic syndrome(1). However this can be found in patients without aortic disease, and be responsible for systemic or cerebral emboli. A 54-year-old male was admitted to our institution for syncope and aphasia, he was found in the street with ethylic intoxication. After neurological examination mixed type aphasia was observed, cerebral and supra aortic arteries CT angiography were performed. Cerebral CT showed focal filling defect of left middle cerebral artery. Supra aortic arteries CT angiography was completed with toracoabdominal CT because massive ascending and arch thrombus was found. The thrombus measured 130 x 33 x 15 mm (Figures 1A and 1B and 1C), and covered from mid ascending aorta to 40 mm distal to the ostium of left subclavian artery. The patient was referred to our unit for urgent surgical treatment. Surgery was performed throw median sterntomy, cardiopulmonary bypass with moderate hypothermic arrest and anterograde cerebral perfusion via right axillary artery. Longitudinal aortotomy was made and 140 x 30 x 15 mm thrombus (Figure 2), attached to posterior mid ascending aorta, was found and resected, the aortic wall did not show any abnormality. The patient had an eventful recovery and was discharged 9 days later with oral anticoagulation and aspirin.

scholarly journals A giant floating thrombus in the ascending aorta: a case report

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Peng Yang ◽  
Ya Li ◽  
Yao Huang ◽  
Chen Lu ◽  
Weitao Liang ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Thrombus Formation ◽  
Attachment Site ◽  
Filling Defect ◽  
Ascending Aorta ◽  
Floating Thrombus ◽  
Contrast Enhanced ◽  
Aortic Thrombus ◽  
Therapeutic Recommendations ◽  
Enhanced Computed Tomography

Abstract Background A floating thrombus in an ascending aorta with normal morphology is very rare, but when it does occur, it may induce a systemic embolism or fatal stroke. The pathophysiological mechanisms of aortic mural thrombi remain unclear, and there is no consensus regarding therapeutic recommendations. Case presentation We report a 49-year-old male who presented with chest discomfort for 5 days and was admitted to our emergency unit. A contrast-enhanced computed tomography angiography (CTA) surprisingly demonstrated a large filling defect suggestive of a thrombus in his otherwise healthy distal ascending aorta. Surgical resection of the mass and attachment site was performed. Histological examination confirmed that the mass was a thrombus, but the cause of the thrombus formation was unknown. Conclusions floating aortic thrombi are rare, and they are prone to break off, thus carrying a potential risk for embolic events with catastrophic consequences. Surgical resection, both of the aortic thrombus and attachment site, as well as postoperative anticoagulant administration, are standard treatments.

Diagnosing coronary thrombosis using multiphase post-mortem CT angiography (MPMCTA): A case study

2021 ◽  
Vol 61 (1_suppl) ◽  
pp. 77-81
Author(s):  
Camatti Jessika ◽  
Santunione Anna Laura ◽  
Draisci Stefano ◽  
Gangi Bruno Giuliano ◽  
Bisceglia Marco ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Coronary Thrombosis ◽  
Filling Defect ◽  
Forensic Radiology ◽  
Criminal Court ◽  
Post Mortem ◽  
Reference Standard ◽  
Solid Foundation ◽  
Court Proceedings

While post-mortem angiography (PMA) is gradually establishing its role in Forensic Radiology, the available literature in Italy lacks a solid foundation, particularly regarding its use in criminal court proceedings. An illustrative example of multiphase post-mortem CT angiography (MPMCTA) is presented here to encourage the systematic implementation of PMA methods. To demonstrate concordance between MPMCTA and the reference standard (autopsy and histology) in a case of acute coronary thrombosis, we report a case where MPMCTA, autopsy, histological and toxicological analyses were performed on a previously healthy 51-year-old man. MPMCTA detected a right coronary artery filling defect that could be ascribed to coronary thrombosis, which was later confirmed by autopsy and histological examinations.

Neuroimaging of Children With Takayasu Arteritis

2021 ◽  
pp. 088307382199128
Author(s):  
Hafize Emine Sönmez ◽  
Ferhat Demir ◽  
Semanur Özdel ◽  
Şerife Gül Karadağ ◽  
Esra Bağlan ◽  
...  
Keyword(s):  
Takayasu Arteritis ◽  
Internal Carotid ◽  
Laboratory Data ◽  
Left Middle Cerebral Artery ◽  
Mri Findings ◽  
Cranial Mri ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
And Diffusion ◽  
Left Middle

Objective: Takayasu arteritis is a rare granulomatous chronic vasculitis that affects the aorta and its main branches. Neurologic manifestations can accompany the disease; however, there is no study on neuroimaging in children with Takayasu arteritis. Therefore, we aimed to evaluate cranial magnetic resonance imaging (MRI) in pediatric Takayasu arteritis patients. Materials and Methods: Demographic, clinical, and laboratory data were obtained retrospectively. Results: The study included 15 pediatric Takayasu arteritis patients. All patients presented with constitutional symptoms. Additionally, 6 patients suffered from headache, 2 had syncope, 1 had loss of consciousness, and 1 had convulsion. All patients underwent cranial and diffusion MRI a median 12 months after diagnosis. Cranial MRI findings were normal in 12 patients, whereas 3 patients had abnormal findings, as follows: stenosis in the M1 and M2 segments of the left middle cerebral artery (n = 1); diffuse thinning of the right internal carotid, middle cerebral, and right vertebral and basilar artery (n = 1); as a sequela, areas of focal gliosis in both the lateral ventricular and posterior periventricular regions (n = 1). Among these 3 patients, 1 had no neurologic complaints. Conclusion: Abnormal MRI findings can be observed in pediatric Takayasu arteritis patients, even those that are asymptomatic; therefore, clinicians should carefully evaluate neurologic involvement in all pediatric Takayasu arteritis patients.

scholarly journals Post-stroke cognitive impairment on the Mini-Mental State Examination primarily relates to left middle cerebral artery infarcts

2021 ◽  
pp. 174749302098455
Author(s):  
Nick A Weaver ◽  
Angelina K Kancheva ◽  
Jae-Sung Lim ◽  
J Matthijs Biesbroek ◽  
Irene MC Huenges Wajer ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cognitive Deficits ◽  
Mini Mental State Examination ◽  
Left Middle Cerebral Artery ◽  
Post Stroke ◽  
Lesion Symptom Mapping ◽  
State Examination ◽  
Left Middle

Background Post-stroke cognitive impairment can occur after damage to various brain regions, and cognitive deficits depend on infarct location. The Mini-Mental State Examination (MMSE) is still widely used to assess post-stroke cognition, but it has been criticized for capturing only certain cognitive deficits. Along these lines, it might be hypothesized that cognitive deficits as measured with the MMSE primarily involve certain infarct locations. Aims This comprehensive lesion-symptom mapping study aimed to determine which acute infarct locations are associated with post-stroke cognitive impairment on the MMSE. Methods We examined associations between impairment on the MMSE (<5th percentile; normative data) and infarct location in 1198 patients (age 67 ± 12 years, 43% female) with acute ischemic stroke using voxel-based lesion-symptom mapping. As a frame of reference, infarct patterns associated with impairments in individual cognitive domains were determined, based on a more detailed neuropsychological assessment. Results Impairment on the MMSE was present in 420 patients (35%). Large voxel clusters in the left middle cerebral artery territory and thalamus were significantly (p < 0.01) associated with cognitive impairment on the MMSE, with highest odds ratios (>15) in the thalamus and superior temporal gyrus. In comparison, domain-specific impairments were related to various infarct patterns across both hemispheres including the left medial temporal lobe (verbal memory) and right parietal lobe (visuospatial functioning). Conclusions Our findings indicate that post-stroke cognitive impairment on the MMSE primarily relates to infarct locations in the left middle cerebral artery territory. The MMSE is apparently less sensitive to cognitive deficits that specifically relate to other locations.

scholarly journals Radial self-navigated native magnetic resonance angiography in comparison to navigator-gated contrast-enhanced MRA of the entire thoracic aorta in an aortic patient collective

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Martina Correa Londono ◽  
Nino Trussardi ◽  
Verena C. Obmann ◽  
Davide Piccini ◽  
Michael Ith ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Image Quality ◽  
Magnetic Resonance Angiography ◽  
Thoracic Aorta ◽  
Aortic Root ◽  
Aortic Disease ◽  
Ascending Aorta ◽  
Scan Time ◽  
Contrast Enhanced

Abstract Background The native balanced steady state with free precession (bSSFP) magnetic resonance angiography (MRA) technique has been shown to provide high diagnostic image quality for thoracic aortic disease. This study compares a 3D radial respiratory self-navigated native MRA (native-SN-MRA) based on a bSSFP sequence with conventional Cartesian, 3D, contrast-enhanced MRA (CE-MRA) with navigator-gated respiration control for image quality of the entire thoracic aorta. Methods Thirty-one aortic native-SN-MRA were compared retrospectively (63.9 ± 10.3 years) to 61 CE-MRA (63.1 ± 11.7 years) serving as a reference standard. Image quality was evaluated at the aortic root/ascending aorta, aortic arch and descending aorta. Scan time was recorded. In 10 patients with both MRA sequences, aortic pathologies were evaluated and normal and pathologic aortic diameters were measured. The influence of artifacts on image quality was analyzed. Results Compared to the overall image quality of CE-MRA, the overall image quality of native-SN-MRA was superior for all segments analyzed (aortic root/ascending, p < 0.001; arch, p < 0.001, and descending, p = 0.005). Regarding artifacts, the image quality of native-SN-MRA remained superior at the aortic root/ascending aorta and aortic arch before and after correction for confounders of surgical material (i.e., susceptibility-related artifacts) (p = 0.008 both) suggesting a benefit in terms of motion artifacts. Native-SN-MRA showed a trend towards superior intraindividual image quality, but without statistical significance. Intraindividually, the sensitivity and specificity for the detection of aortic disease were 100% for native-SN-MRA. Aortic diameters did not show a significant difference (p = 0.899). The scan time of the native-SN-MRA was significantly reduced, with a mean of 05:56 ± 01:32 min vs. 08:51 ± 02:57 min in the CE-MRA (p < 0.001). Conclusions Superior image quality of the entire thoracic aorta, also regarding artifacts, can be achieved with native-SN-MRA, especially in motion prone segments, in addition to a shorter acquisition time.

Bivalirudin for Endovascular Intervention in Acute Ischemic Stroke: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 54 (1) ◽  
pp. 218-223 ◽  
Author(s):  
Mark R. Harrigan ◽  
Elad I. Levy ◽  
Bernard R. Bendok ◽  
L. Nelson Hopkins
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Intracranial Hemorrhage ◽  
National Institutes Of Health ◽  
Left Middle Cerebral Artery ◽  
Computed Tomographic ◽  
Left Middle ◽  
Arterial Thrombolysis

Abstract OBJECTIVE AND IMPORTANCE Intra-arterial thrombolysis has been demonstrated to improve recanalization and outcomes among patients with acute ischemic stroke. However, thrombolytic agents have limited effectiveness and are associated with a significant risk of bleeding. Bivalirudin is a direct thrombin inhibitor that has been demonstrated in the cardiology literature to have a more favorable efficacy and bleeding profile than other antithrombotic medications. We report the use of bivalirudin during endovascular treatment of acute stroke, when hemorrhagic complications are not uncommon. CLINICAL PRESENTATION A 71-year-old woman with atrial fibrillation presented with right hemiparesis and aphasia and was found to have a National Institutes of Health Stroke Scale score of 10. Computed tomographic scans revealed no evidence of intracranial hemorrhage, aneurysm, or ischemic stroke. Cerebral angiography revealed thromboembolic occlusion of the superior division of the left middle cerebral artery. INTERVENTION For anticoagulation, a loading dose of bivalirudin was intravenously administered before the interventional procedure, followed by continuous infusion. Attempts to remove the clot with an endovascular snare failed to induce recanalization of the vessel. Bivalirudin was then administered intra-arterially. Immediate postprocedural angiography demonstrated restoration of flow in the left middle cerebral artery. Repeat computed tomographic scans demonstrated no intracranial hemorrhage. The patient's hemiparesis and aphasia were nearly resolved and her National Institutes of Health Stroke Scale score was 2 at the time of her discharge 5 days later. CONCLUSION To our knowledge, this is the first report of the use of bivalirudin for treatment of acute ischemic stroke. Bivalirudin may be a useful agent for intravenous anticoagulation and intra-arterial thrombolysis in this setting.

Multiple middle cerebral artery aneurysms in an infant

1990 ◽  
Vol 72 (5) ◽  
pp. 806-809 ◽  
Author(s):  
Cornelia Cedzich ◽  
J. Schramm ◽  
G. Röckelein
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Systemic Disease ◽  
Intracerebral Hematoma ◽  
Left Middle Cerebral Artery ◽  
Content Type ◽  
Middle Cerebral Artery Aneurysms ◽  
Subarachnoid Blood ◽  
Left Middle ◽  
Control Angiography

✓ An 11-month-old boy was admitted for evaluation of drowsiness, vomiting, and convulsions. Computerized tomography showed subarachnoid blood in the left sylvian fissure and a small intracerebral hematoma in the temporal lobe. Angiography revealed several aneurysms of the left middle cerebral artery (MCA). During surgery, 13 aneurysms were found arising from one main branch of the left MCA, and this segment of the MCA was trapped. Somatosensory evoked potentials did not show any change during surgery. The diseased arterial segment was examined histologically and the pathogenetic aspects of the case are discussed. Control angiography 6 months later excluded systemic disease or other aneurysms. The rarity of such lesions in childhood and their successful surgical treatment are discussed briefly.

ISCHEMIC STROKE IN COVID-19 PATIENT: A RARE CASE REPORT.

2021 ◽  
pp. 72-73
Author(s):  
Atul Kaushik ◽  
Showkat Nazir Wani ◽  
Anish Garg ◽  
Dev Kumar
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Rare Case ◽  
Cardiovascular Complications ◽  
Left Middle Cerebral Artery ◽  
Early Evaluation ◽  
Rare Case Report ◽  
Ct Head ◽  
Left Middle ◽  
Middle Cerebral Artery Infarct

Background: COVID-19 is shown to be associated with hypercoagulable state which may cause neurological and cardiovascular complications. COVID-19 has been represented as an independent risk factor for acute ischemic stroke. Objective:We report a case of acute ischemic stroke as a COVID-19 complication. Material and methods: A 62-year-old known hypertensive male was diagnosed with COVID-19. He developed neurological symptoms 10 days after being tested positive. On doing an NC-CT head, a large acute ischemic stroke involving left Middle Cerebral Artery infarct was detected. Result and Conclusion: Our case represents the development of acute ischemic stroke as a neurological manifestation in patient with COVID-19. Early evaluation for acute neurological changes and timely management may reduce morbidity and mortality in such cases.

Epiaortic Ultrasound-Guided True Lumen Cannulation of Ascending Aorta in Acute Aortic Dissection Type A

2021 ◽  
Vol 104 (4) ◽  
pp. 604-609
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Axillary Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Ultrasound Guided ◽  
True Lumen ◽  
Artery Cannulation ◽  
Aortic Cannulation ◽  
Aortic Dissection Type A

Background: The choice of arterial inflow for acute Stanford type A aortic dissection repair remains controversial. The axillary artery should be considered as first choice for cannulation, but this technique is time-consuming. The ascending aortic cannulation provides antegrade perfusion and can be performed rapidly but there are several concerns such as aortic rupture, extension of dissection, and false lumen cannulation. Objective: To compare the establishment time of cardiopulmonary bypass (CPB) and postoperative outcomes of the two cannulation techniques that provide antegrade perfusion, which was direct true lumen cannulation on the dissected ascending aorta using epiaortic ultrasound-guided and axillary artery cannulation in Siriraj Hospital. Materials and Methods: The authors retrospectively reviewed all the 30 cases of acute aortic dissection type A using two different cannulation methods performed between February 2011 and May 2017. Direct true lumen ascending aortic cannulation was performed using the epiaortic ultrasound-guide with Seldinger technique in 12 patients, and axillary artery cannulation was performed in 18 patients. Results: The direct true lumen ascending aortic cannulation was safely performed in all patients. None of them had aortic rupture. Skin incision to CPB time was significantly faster in the epiaortic ultrasound-guided ascending aortic cannulation group at 29±8 versus 49±14 minutes (p<0.001). The 30-day mortality and postoperative adverse events, such as ischemic stroke, acute kidney injury, visceral organ and limb malperfusion showed no statistically significant difference from the axillary artery cannulation method. Conclusion: Epiaortic ultrasound-guided true lumen cannulation of ascending aorta in the treatment of acute aortic dissection type A is safe and feasible. Skin incision to CPB time can be performed faster and provided good outcome compared to the axillary artery cannulation technique. Keywords: Acute aortic dissection, Ascending cannulation, Epiaortic ultrasound

Giant Intracranial Aneurysms Presenting with Massive Cerebral Edema

Neurosurgery ◽  
1984 ◽  
Vol 15 (4) ◽  
pp. 572-577 ◽  
Author(s):  
Roberto C. Heros ◽  
Sastry Kolluri
Keyword(s):  
Cerebral Hemisphere ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Brain Swelling ◽  
Middle Cerebral Artery Aneurysm ◽  
Computed Tomographic ◽  
Computed Tomographic Scan ◽  
Cerebral Artery Aneurysm ◽  
Left Middle

Abstract Two cases of giant left middle cerebral artery aneurysm presenting with rapidly progressing hemiparesis and aphasia are presented. In both, the computed tomographic scan showed recent intraaneurysmal thrombosis and massive edema and swelling of the cerebral hemisphere. There was no evidence of recent hemorrhage in either case. In both patients, surgical resection of the aneurysm was accomplished, but the outcome was disastrous. The literature is reviewed and the possible mechanisms responsible for brain swelling in these cases are discussed.

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