scholarly journals Acute isolated anterior cerebral artery infarcts: A clinical – radiological study

2021 ◽  
Vol 26 (3) ◽  
pp. 459-464
Author(s):  
Sanjith Aaron ◽  
Divyan Pancharatnam ◽  
Amal Al Hashmi
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anatomical Variations ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Limb Weakness ◽  
Ct Angiogram ◽  
The Mean ◽  
Toast Classification ◽  
Stroke Centre

Background: The anterior cerebral artery (ACA) supplies many eloquent areas and can have anatomical variations making ACA strokes clinically and radiologically challenging. This study looks at the clinical and radiological features of isolated acute ACA strokes from a stroke centre in Oman. Methods: A retrospective study conducted over a 2 year period on ACA strokes presenting within 12 hours of symptom onset. TOAST classification was used for aetiology. National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were used to assess stroke severity. Fischer’s classification was used for assessing the arterial segments with CT angiogram. Heidelberg Bleeding Classification was used for haemorrhagic conversion. Results: Isolated ACA strokes constituted 25/1180 (2.1 %) of ischemic strokes. Males 15/25 (60%) Mean age was 68.4 years (Range 42 -97 years). Twenty eight percent of patients had earlier strokes. Hemiparesis (68%) was the commonest clinical presentation. Twenty percent had only lower limb weakness. Hypertension 22/25 (88%) followed by diabetes mellitus 12/25 (48%) was the commonest risk factor. The mean NIHSS was 9 (range 3 to 13). In 36% of patients there was progression of stroke. Plain CT Picked the infarct only in 6/24 (25%). Left side involvement in 18/25 (72%) Artery of Hubner was involved in 6/25 (24%); 44% had an embolic aetiology. There was no mortality and at discharge, 11/25 (44%) had mRS3 or less. Conclusions: In acute ACA infarcts a CT scan can miss the diagnosis in 74%. An embolic aetiology has to be considered in any Isolated ACA stroke and the outcome appears to be good.

scholarly journals Prehospital Unassisted Assessment of Stroke Severity Using Telemedicine

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2907-2909 ◽  
Author(s):  
Robbert-Jan Van Hooff ◽  
Melissa Cambron ◽  
Rita Van Dyck ◽  
Ann De Smedt ◽  
Maarten Moens ◽  
...  
Keyword(s):  
Concurrent Validity ◽  
Mobile Network ◽  
National Institutes Of Health ◽  
Fourth Generation ◽  
Stroke Severity ◽  
Examination Time ◽  
Excellent Internal Consistency ◽  
Remote Assessment ◽  
Interrater Variability ◽  
The Mean

Background and Purpose— We evaluated the feasibility and the reliability of remote stroke severity quantification in the prehospital setting using the Unassisted TeleStroke Scale (UTSS) via a telestroke ambulance system and a fourth-generation mobile network. Methods— The technical feasibility and the reliability of the UTSS were studied in healthy volunteers mimicking 41 stroke syndromes during ambulance transportation. Results— Except for 1 issue, high-quality telestroke assessment was feasible in all scenarios. The mean examination time for the UTSS was 3.1 minutes (SD, 0.4). The UTSS showed excellent intrarater and interrater variability (ρ=0.98 and 0.97; P <0.001), as well as excellent internal consistency and rater agreement. Adequate concurrent validity can be derived from the strong correlation between the UTSS and the National Institutes of Health Stroke Scale (ρ=0.90; P <0.001). Conclusions— Remote assessment of stroke severity in fast-moving ambulances using a system dedicated to prehospital telemedicine, 4G technology, and the UTSS is feasible and reliable.

Human fetal medial striate artery or artery of Heubner

2009 ◽  
Vol 3 (4) ◽  
pp. 296-301 ◽  
Author(s):  
Ljiljana Vasović ◽  
Sladjana Ugrenović ◽  
Ivan Jovanović
Keyword(s):  
Middle Cerebral Artery ◽  
Diagnostic Test ◽  
Cerebral Artery ◽  
Cerebral Circulation ◽  
Anterior Cerebral Artery ◽  
Anatomical Variations ◽  
Test Results ◽  
Terminal Part ◽  
The Brain

Object The authors describe some of the features of the medial striate branch or recurrent artery of Heubner (RAH). This structure has indisputable functional, neurological, and neurosurgical significance, and originates from the A1 and/or A2 segments of the anterior cerebral artery. Methods Microdissection of 94 human fetal specimens was performed. The RAH was observed in 97.3% (single in 71.6%, double in 25.1%, and triple in 3.3%) of the cases. Its origin was from A2 in 42.3% of specimens, from the A1–A2 junction in 25.7%, and from A1 in 20%. Results Five types and 14 subtypes of the RAH were identified, determined based on vessel origin and number. In its course, the RAH gave 1–12 branches, and the terminal part most frequently penetrated into the brain through the anterior perforated substance at the level of the sphenoid segment of the middle cerebral artery. The specimens with a single RAH fenestration, abnormal double RAH anastomosis, and unusual RAH origin and relationship to the surrounding vessels represented new data. Conclusions The authors' observations of common anatomical variations in the number and origin of the RAH, as well as its abnormalities, may assist neuroradiologists in the interpretation of diagnostic test results and neurosurgeons in performing procedures in the anterior cerebral circulation.

scholarly journals Anatomical variations of circle of Willis - a cadaveric study

2017 ◽  
Vol 4 (4) ◽  
pp. 1249 ◽  
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.

Partial Gyrus Rectus Resection as a Technique to Improve the Exposure to the Anterior Communicating Artery Complex through the Junctional Triangle: A Quantitative Study

2020 ◽  
Author(s):  
Daniel Valli ◽  
Xiaochun Zhao ◽  
Evgenii Belykh ◽  
Qing Sun ◽  
Michael T. Lawton ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Outcome Measures ◽  
Quantitative Study ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Pterional Approach ◽  
Before And After ◽  
The Mean ◽  
Gyrus Rectus

Abstract Objective The junctional triangle, formed by the distal A1 anterior cerebral artery (ACA) segment, the proximal A2 ACA segment, and the medial surface of gyrus rectus (GR), is a corridor of access to superiorly and posteriorly projecting anterior communicating artery (AComA) aneurysms that is widened by GR retraction or resection. Exposure of the AComA complex through the junctional triangle after GR resection has not been previously quantitatively evaluated. Design GR resection extent and increase in artery exposure through the junctional triangle were assessed in this study. Setting This study was conducted in the laboratory with a pterional approach, exposing the AComA complex. Participants Ten sides of five cadaveric heads were considered. Main Outcome Measures Exposure extent of ipsilateral and contralateral A1, A2, and AComA and accessibility of branches coming off the AComA complex were measured before and after GR resection. The GR was resected until sufficient bilateral A2 and contralateral A1 exposures were achieved. GR resection span was measured. Results The mean (standard deviation) resected span of GR was 7 ± 3.9 mm. After GR resection, the exposed span of the ipsilateral A2 increased from 2 ± 0.7 mm to 4 ± 1.1 mm (p = 0.001); contralateral A2 exposure increased from 3 ± 1.5 mm to 4 ± 1.1 mm (p = 0.03). Contralateral recurrent artery of Heubner (RAH) and orbitofrontal artery were accessible in five and eight specimens, respectively, before GR resection and in all 10 after resection. Conclusion GR resection improves exposure of bilateral A2 segments through the junctional triangle. Exposure improvement is greater for the ipsilateral A2 than contralateral A2. The junctional triangle concept is enhanced by partial GR resection during surgery for superior and posterior AComA aneurysms.

Abstract W P367: Anterior Cerebral Artery Diameter Predicts Anterior Cerebral Artery Territorial Stroke.

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ashkan Shoamanesh ◽  
Hesham Masoud ◽  
Katrina Weed ◽  
Kaylyn Duerfeldt ◽  
Helena Lau ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Medical Center ◽  
Low Frequency ◽  
Demographic Variables ◽  
Patient Demographics ◽  
Stroke Etiology ◽  
Artery Embolism ◽  
Ct Angiogram ◽  
Arterial Anatomy

Background: Anterior cerebral artery strokes (ACAS) account for only 1-2% of cerebral infarctions, and typically result from embolism in western populations. The cause of the low frequency of ACAS in relation to MCA strokes (MCAS) is uncertain, but differences in arterial anatomy may affect flow-directed embolism rates. We aimed to determine whether variability in ACA A1 diameters (A1D) and A1D/MCA M1 diameter (M1D) ratios predict ACAS Methods: Consecutive patients admitted to Boston Medical Center with a diagnosis of ACAS between 01/2008-10/2012 were reviewed. Patients with an interpretable CT angiogram (CTA) or magnetic resonance angiogram (MRA) of the cerebral vasculature were eligible. Excluded were patients with ACAS ipsilateral (ipsi) to an aplastic ACA, concomitant ipsi MCAS, and those with lacunar, watershed, aneurysm clipping or local intracranial atherosclerosis as stroke etiology. Patient demographics were compiled. Ipsilateral and contralateral (contra) A1D, M1D, as well as ICA-ACA and ICA-MCA angles were measured from CTA and MRA images. Consecutive MCAS admitted between 01/2011-10/2012 served as controls. Results: The study comprised 55 individuals (27 ACA, 28 MCA) with mean age of 69 years. Stroke etiology was cardioembolism in 56%, internal carotid artery embolism in 16% and idiopathic in 27%. Patients with ACAS had larger mean ipsi A1D (2.47 vs. 2.05 mm,p<0.01), ipsi A1D/M1D ratios (0.95 vs. 0.73,p<0.001) and were more likely to have a contra aplastic/hypoplastic ACA (41 vs. 4%,<0.001). Ipsi A1D (OR per 1 mm increment: 8.52 [95% CI 1.36, 53.26]) and ipsi A1D/M1D ratio (OR per 10% increment: 1.83 [95% CI 1.15, 2.91]) remained significant following multivariate analysis. Ipsilateral M1D was protective for ACAS (OR per 1 mm increment: 0.17 [95% CI 0.03, 0.90]) after adjusting for ipsi A1D. There were no significant differences in demographic variables, stroke etiologies, terminal ICA-ACA or ICA-MCA angles between ACAS and MCAS. Conclusions: Larger ipsilateral A1D and A1D/M1D ratio are independent predictors of ACAS. These findings concur with the notion that A1D and M1D are important in determining the path of emboli that reach the terminal ICA.

A neurosurgical view of anatomical variations of the distal anterior cerebral artery: an anatomical study

2006 ◽  
Vol 104 (2) ◽  
pp. 278-284 ◽  
Author(s):  
Hasan Caglar Ugur ◽  
Gokmen Kahilogullari ◽  
Ali Firat Esmer ◽  
Ayhan Comert ◽  
Aysun B. Odabasi ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Cerebral Arteries ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Main Trunk ◽  
Surgical Interventions ◽  
Parietal Lobes ◽  
Distal Anterior Cerebral Artery ◽  
Human Brains

Object The vascularization pattern of the anatomy of the distal anterior cerebral artery (ACA) remains a subject of debate. The authors provide detailed information about the distal ACA and shed light on issues concerning it that have not previously been adequately discussed. Methods Fifty adult human brains (100 hemispheres) were obtained during routine autopsies. Cerebral arteries were separately cannulated and injected with latex. The vascularization patterns of the cortical branches and the variations of the arteries were investigated. The authors found that the distal ACA supplied all the inner surfaces of the frontal and parietal lobes and a median of one third of the outer surfaces. The origin of the arteries from the main trunk and their exit angles affected the vascularization patterns of the hemispheres. The authors redefine controversial terminology regarding the callosomarginal artery. Conclusions In each hemisphere, the vascularization pattern of the distal ACA is different to a greater or lesser extent. An awareness of this fact will contribute significantly to surgical interventions.

Resistive Index in Late-Onset Neonatal Sepsis

2018 ◽  
Vol 32 (4) ◽  
pp. 93-97
Author(s):  
Rameshwor Yengkhom ◽  
Pradeep Suryawanshi ◽  
Snehal Ingale ◽  
Bhvya Gupta ◽  
Sujata Deshpande
Keyword(s):  
Cerebral Artery ◽  
Neonatal Sepsis ◽  
Anterior Cerebral Artery ◽  
Late Onset ◽  
Perinatal Asphyxia ◽  
Newborn Infants ◽  
Resistive Index ◽  
Genetic Syndromes ◽  
Hemodynamic State ◽  
The Mean

Background and Objectives: Hemodynamics in neonatal sepsis is complex and poorly understood. Several studies have reported conflicting findings on cerebral blood flow (CBF) in sepsis from severely increased flow to severely decreased flow. The objective of our study was to study CBF by measuring the resistive index (RI) of the anterior cerebral artery in late-onset neonatal sepsis (LONS). Methods: All newborn infants admitted in our neonatal intensive care unit with suspected LONS during the period from January 2017 to December 2017 underwent point-of-care transcranial Doppler ultrasonography to measure the RI of the anterior cerebral artery within 24 h of clinical presentation before starting inotropes if at all required. Infants with congenital heart disease, perinatal asphyxia, major congenital malformations, and genetic syndromes were excluded. Neonates with positive culture were included in the final analysis. Results: Of 89 suspected LONS, 33 were culture positive and were analyzed. The mean admission weight was 2.33 ± 0.76 kg. The mean gestational age was 33.5 ± 3.4 wk. Most common organism isolated was Klebsiella pneumoniae (82%). The RI was high in 54.5% (17 of 33) and normal in 45.5% (15 of 33) cases. Conclusions: LONS is a unique and complex hemodynamic state and we found it associated with the high RI indicating decreased CBF. A larger study may help in more understanding of this unique hemodynamic association.

Management of Proximal Anterior Cerebral Artery Aneurysms: Anatomical Variations and Technical Nuances

2016 ◽  
Vol 85 ◽  
pp. 85-95 ◽  
Author(s):  
Tanmoy Kumar Maiti ◽  
Shyamal Bir ◽  
Subhas Konar ◽  
Papireddy Bollam ◽  
Hugo H. Cuellar-Saenz ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anatomical Variations ◽  
Proximal Anterior Cerebral Artery

scholarly journals Anterior communicating artery duplication associated with a triplication of anterior cerebral artery – A rare anatomical variation

2020 ◽  
Vol 11 ◽  
pp. 36
Author(s):  
Francisco Matos Ureña ◽  
Jose Gregorio Matos Ureña ◽  
Saul Almeida ◽  
Nícollas Nunes Rabelo ◽  
Mauricio Mandel ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Neurological Deficits ◽  
Systemic Hypertension ◽  
Prior History ◽  
Anterior Communicating Artery ◽  
Fisher Grade ◽  
Angio Ct

Background: The anterior communicating artery complex may presente several anatomical variations, and many abnormalities have been reported in radiologiacal and cadaveric studies. Case Description: The authors present a case of a 44-year-old Caucasian female, with a prior history of smoking and arterial systemic hypertension, admitted in the emergency department complaining of a sudden headache, nausea, and vomiting followed by tonic-clonic seizures. Computerized tomography (CT) and angiography (angio- CT) were carried out and showed Fisher Grade IV subarachnoid hemorrhage. Angio-CT revealed an anterior communicating artery (AComA) aneurysm. Minimally invasive craniotomy and microsurgical clipping were performed uneventfully. An unusual anatomical variation of the AComA complex characterized by duplication of the AComA associated with a triplication of anterior cerebral artery (ACA) was observed. The patient was discharged with no neurological deficits. Concluision: This unique anatomical variation of the AComA-ACA complex constitute risck factors for development and rupture of aneurysms.

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