Brain Infarcts
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Shyam Prabhakaran ◽  
David S. Liebeskind ◽  
George Cotsonis ◽  
Azhar Nizam ◽  
Edward Feldmann ◽  

2021 ◽  
Vol 23 (3) ◽  
pp. 449-452
Philipp Krisai ◽  
Ceylan Eken ◽  
Stefanie Aeschbacher ◽  
Michael Coslovsky ◽  
Vinzent Rolny ◽  

Chon Sum Ong ◽  
Nur Amalina Binti Che Din ◽  
Celine Mien Er Fong ◽  
Amira Nabiha Binti Jamalludin

An accident with a tamping iron made Phineas Gage a historically famous brain-injury survivor. (1) Each year, approximately 1.6 million people sustain traumatic brain injury, leading to 52,000 deaths annually. (2) However, there is limited literature regarding traumatic brain penetration injury that could be found. A 42-year-old male with psychosis forcefully inserted a butter knife through nostril, traversed via sella turcica into posterior corpus callosum in a mental health facility. He was intubated in his local hospital and transferred over to a tertiary hospital for neurosurgical intervention. Radiological imaging showed impingement of knife against the posterior cerebral artery (PCA), multiple brain infarcts, intraventricular, and subarachnoid haemorrhage. The knife was removed after securing the PCA with the collaboration between neurosurgery and interventional radiology team. Sinus repair was immediately performed by the otorhinolaryngologists. External ventricular drain was inserted due to hydrocephalus secondary to brain haemorrhage. He eventually developed ventriculitis leading to sepsis and was treated with multiple antibiotics. The traumatic brain injury led to anterior hypopituitarism and diabetes insipidus which was treated using hormone therapy. He not only survived the fatal brain injury but also regained his Glasgow Coma Scale (GCS) score. This case demonstrates the potential of a multi-disciplinary and specialty approach to achieve outcomes a single specialty team could not. The outcome of a case which was deemed to be a non-survivable brain injury was made different due to the bold decision making, experience and innovative surgical strategy. Future research is needed to better understand and manage brain penetration injury.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S27

Stroke ◽  
2021 ◽  
Mukul Sharma ◽  
Eric E. Smith ◽  
Lesly A. Pearce ◽  
Ashkan Shoamanesh ◽  
Kanjana S. Perera ◽  

Background and Purpose: The spectrum of brain infarction in patients with embolic stroke of undetermined source (ESUS) has not been well characterized. Our objective was to define the frequency and pattern of brain infarcts detected by magnetic resonance imaging (MRI) among patients with recent ESUS participating in a clinical trial. Methods: In the NAVIGATE ESUS trial (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source), an MRI substudy was carried out at 87 sites in 15 countries. Participants underwent an MRI using a specified protocol near randomization. Images were interpreted centrally by those unaware of clinical characteristics. Results: Among the 918 substudy cohort participants, the mean age was 67 years and 60% were men with a median (interquartile range) of 64 (26–115) days between the qualifying ischemic stroke and MRI. On MRI, 855 (93%) had recent or chronic brain infarcts that were multiple in 646 (70%) and involved multiple arterial territories in 62% (401/646). Multiple brain infarcts were present in 68% (510/755) of those without a history of stroke or transient ischemic attack before the qualifying ESUS. Prior stroke/transient ischemic attack ( P <0.001), modified Rankin Scale score >0 ( P <0.001), and current tobacco use ( P =0.01) were associated with multiple infarcts. Topographically, large and/or cortical infarcts were present in 89% (757/855) of patients with infarcts, while in 11% (98/855) infarcts were exclusively small and subcortical. Among those with multiple large and/or cortical infarcts, 57% (251/437) had one or more involving a different vascular territory from the qualifying ESUS. Conclusions: Most patients with ESUS, including those without prior clinical stroke or transient ischemic attack, had multiple large and/or cortical brain infarcts detected by MRI, reflecting a substantial burden of clinical stroke and covert brain infarction. Infarcts most frequently involved multiple vascular territories. REGISTRATION: URL: ; Unique identifier: NCT02313909.

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012675
Lina Rydén ◽  
Simona Sacuiu ◽  
Hanna Wetterberg ◽  
Jenna Najar ◽  
Xinxin Guo ◽  

Background and Objectives:Atrial fibrillation (AF) has been associated with cognitive decline and dementia. However, the mechanisms behind these associations are not clear. Examination of cerebrovascular pathology on MRI may shed light on how AF affects the brain. This study aimed to determine whether AF is associated with a broad range of cerebrovascular diseases, beyond the well-known association with symptomatic stroke, including silent infarcts and markers of small vessel disease, e.g. cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and lacunes, in a population-based sample of 70-year-olds.Methods:Data were obtained from the Gothenburg H70 Birth Cohort Studies, where individuals are invited based on birth-date. This study has a cross-sectional design and includes individuals born 1944 who underwent structural brain MRI in 2014-17. AF diagnoses were based on self-report, EKG, and register data. Symptomatic stroke was based on self-report, proxy-interviews, and register data. Brain infarcts and CMBs were assessed by a radiologist. WMH volumes were measured on FLAIR images using the Lesion Segmentation Tool. Multivariate logistic regression was used to study the association between AF and infarcts/CMBs, and multivariate linear regression was used to study the association between AF and WMHs.Results:A total of 776 individuals were included and 65 (8.4%) had AF. AF was associated with symptomatic stroke (OR 4.5, 95% CI 2.1-9.5), and MRI findings of large infarcts (OR 5.0, 95% CI 1.5-15.9), lacunes (OR 2.7, 95% CI 1.2-5.6), and silent brain infarcts (OR 3.5; 95% CI 1.6-7.4). Among those with symptomatic stroke, individuals with AF had larger WMH volumes (0.0137 ml/total intracranial volume (TIV), 95% CI 0.0074-0.0252) compared to those without AF (0.0043 ml/TIV, 95% CI 0.0029-0.0064). There was no association between AF and WMH volumes among those without symptomatic stroke. In addition, AF was associated to CMBs in the frontal lobe.Discussion:AF was associated with broad range of cerebrovascular pathologies. Further research is needed to establish whether cerebrovascular MRI markers can be added to current treatment guidelines to further personalise anticoagulant treatment in AF patients and to further characterize the pathogenetic processes underlying the associations between AF and cerebrovascular diseases, as well as dementia.

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012765
Romella Durrani ◽  
Matthias G. Friedrich ◽  
Karleen M. Schulze ◽  
Philip Awadalla ◽  
Kumar Balasubramanian ◽  

Objective:To determine whether cognitive reserve attenuates the association of vascular brain injury with cognition.Methods:Cross-sectional data were analyzed from two harmonized studies: the Canadian Alliance for Healthy Hearts and Healthy Minds (CAHHM) and the Prospective Urban and Rural Epidemiology (PURE) study. Markers of cognitive reserve were education, involvement in social activities, marital status, height, and leisure physical activity, which were combined into a composite score. Vascular brain injury was defined asnon-lacunar brain infarcts or high white matter hyperintensity (WMH) burden on MRI. Cognition was assessed using the Montreal Cognitive Assessment Tool (MoCA) and the Digit Symbol Substitution Test (DSST).Results:There were 10,450 participants age 35-81. Mean age was 58.8 years (range 35 to 81) and 55.8% were female. Education, moderate leisure physical activity, being in a marital partnership, being taller, and participating in social groups were each independently associated with higher cognition, as was the composite cognitive reserve score. Vascular brain injury was associated with lower cognition (beta-0.35 [95% CI -0.53 to -0.17] for MoCA and beta -2.19 [95% CI-3.22 to -1.15] for DSST)-but the association was not modified by the composite cognitive reserve variable (interaction p=0.59 for MoCA and p=0.72 for DSST).Conclusions:Both vascular brain injury and markers of cognitive reserve are associated with cognition. However, the effects were independent such that the adverse effects of covert vascular brain injury were not attenuated by higher cognitive reserve. To improve cognitive brain health, interventions to both prevent cerebrovascular disease and promote positive lifestyles are needed.

Cureus ◽  
2021 ◽  
Om Parkash ◽  
Grace W Ying ◽  
Aatma Ram ◽  
Lalitha Padmanabha Vemireddy ◽  
Farah Zahra

2021 ◽  
Vol 84/117 (4) ◽  
Ertan Karacay ◽  
Utku Cenikli ◽  
Ahmet Özsimsek ◽  
Irem Atalay Karacay ◽  
Yavuz Yüksel ◽  

Cureus ◽  
2021 ◽  
Fabricio Sevilla-Acosta ◽  
Angela Ballestero-Pernudi ◽  
Elisandro Jiménez-Cruz ◽  
Hazel Álvarez-Cabalceta ◽  
Gabriela Naranjo-Zuñiga

2021 ◽  
Vol 11 (2) ◽  
pp. 309-314
Nilanjan Mukherjee ◽  
Kamal Kumar Sen ◽  
Manoranjan Mohapatra ◽  
Monoj Kumar G ◽  
B Arun Kumar

Cerebrovascular adverse events are one of the most common causes for morbidity and mortality worldwide. Thromboembolism being the culprit behind a significant number of such events. An attempt has been made to ascertain the association of carotid plaque morphology in the occurrence of ischemic stroke. Heterogeneous plaques (Type 2 & 3) weremostly observed to be ipsilateral to the side of brain infarct, as compared to the contralateral side. Detection of heterogeneous plaques and plaque ulceration in patients may indicate future development of stroke. This study included 75 consecutive patients having anterior circulation infarct in MRI of the brain and atherosclerotic changes in extra cranial carotid system on Carotid Duplex scan. Plaque morphology ipsilateral to the brain infarct was compared to that on the contralateral side. Significantly higher number of heterogeneous plaques (Type 2 & 3) were present ipsilateral to the side of brain infarct, as compared to the contralateral side (p-value 0.004). Plaque ulceration was also observed to be present more frequently on the side of infarct (22.6% on the ipsilateral side and 5.4% on the contralateral side). Moreover, Diabetes mellitus and dyslipidemia were the most prevalent risk factors (78.2% and 65.2%, respectively) in patients with these types of plaques. Detection of heterogeneous plaques and plaque ulceration in patients may indicate future development of stroke, necessitating prompt and appropriate management protocols.Periodic screening of such patients with Carotid Duplex Ultrasonography is expected to be very helpful.

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