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Childs Nerv Syst 2021 Jun 14. Epub 2021 Jun 14.

Department of Neuroradiology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, 600116, India.

Dissecting aneurysms of posterior inferior cerebellar artery (PICA) are usually extensions of vertebral artery dissection. Isolated dissecting aneurysms of PICA are extremely rare. A 5-month-old female child presented with history of fall from a height of around 2 ft. Read More

Ther Adv Neurol Disord 2021 2;14:17562864211021182. Epub 2021 Jun 2.

Second Department of Neurology, National & Kapodistrian, University of Athens, School of Medicine, "Attikon" University Hospital, Iras 39, Gerakas Attikis, Athens, 15344, Greece.

Recent randomized controlled clinical trials (RCTs) have revolutionized acute ischemic stroke care by extending the use of intravenous thrombolysis and endovascular reperfusion therapies in time windows that have been originally considered futile or even unsafe. Both systemic and endovascular reperfusion therapies have been shown to improve outcome in patients with wake-up strokes or symptom onset beyond 4.5 h for intravenous thrombolysis and beyond 6 h for endovascular treatment; however, they require advanced neuroimaging to select stroke patients safely. Read More

Insights Imaging 2021 Jun 10;12(1):76. Epub 2021 Jun 10.

IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.

Newer biologic drugs and immunomodulatory agents, as well as more tolerated and effective radiation therapy schemes, have reduced treatment toxicity in oncology patients. However, although imaging assessment of tumor response is adapting to atypical responses like tumor flare, expected changes and complications of chemo/radiotherapy are still routinely encountered in post-treatment imaging examinations. Radiologists must be aware of old and newer therapeutic options and related side effects or complications to avoid a misinterpretation of imaging findings. Read More

BMJ Open 2021 06 9;11(6):e047305. Epub 2021 Jun 9.

Department of Radiology, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada

Introduction: Severe traumatic brain injury (TBI) is a catastrophic neurological condition with significant economic burden. Early in-hospital mortality (<48 hours) with severe TBI is estimated at 50%. Several clinical examinations exist to determine brain death; however, most are difficult to elicit in the acute setting in patients with severe TBI. Read More

J Med Imaging Radiat Oncol 2021 Jun 8. Epub 2021 Jun 8.

Interventional Neuroradiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia.

Introduction: The global demand for endovascular clot retrieval (ECR) has grown rapidly in recent years creating challenges to healthcare system planning and resource allocation. This study aims to apply our established computational model to predict and optimise the performance and resource allocation of ECR services within regional Australia, and applying data from the state of South Australia as a modelling exercise.

Method: Local geographic information obtained using the Google Maps application program interface and real-world data was input into the discrete event simulation model we previously developed. Read More

BMC Infect Dis 2021 Jun 7;21(1):537. Epub 2021 Jun 7.

Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.

Background: Invasive aspergillosis of the central nervous system is a rare but increasingly prevalent disease. We present the unusual case of an immunosuppressed patient suffering from unexpected superinfected invasive aspergillosis with cerebral, pulmonal, and adrenal manifestations, mimicking a metastasized bronchial carcinoma. This report reveals the importance of including aspergillosis in the differential diagnosis of a cerebral mass lesion in the light of unspecific clinical findings. Read More

Clin Neurol Neurosurg 2021 May 8;207:106671. Epub 2021 May 8.

Pediatric Neurosurgery Santobono-Pausilipon Children's Hospital, Naples, Italy.

Background: Symptomatic cysts of the septum pellucidum (CSP) are extremely rare in children and surgical indications are not well defined. A very careful clinical and neuroradiologic evaluation is necessary to consider a patient for surgical indication.

Methods: We present a surgical series of 7 pediatric patients. Read More

Am J Case Rep 2021 Jun 6;22:e931372. Epub 2021 Jun 6.

Department of Emergency Surgery, Policlinico Tor Vergata, Rome, Italy.

BACKGROUND Jejunoileal neuroendocrine tumors (JI-NETs) are rare tumors that can be associated with mesenteric fibrosis. This case report is of an incidental finding of a JI-NET in a patient who was previously misdiagnosed with sclerosing mesenteritis. CASE REPORT A 42-year-old man was admitted to our institution with diffuse abdominal pain and clinical and radiographic signs of bowel obstruction. Read More

Surg Neurol Int 2021 3;12:204. Epub 2021 May 3.

Superior Medical Experts, Saint Paul, Minnesota, United States.

Background: We present a rare case of a ruptured neoplastic aneurysms (NCA) caused by metastatic spread of triple-negative breast cancer (TNBC) in a female patient in her 60s. The patient had a medical history of TNBC and presented to the emergency department after experiencing 3 days of persistent headache.

Case Description: Head computed tomography (CT) revealed a small volume subarachnoid hemorrhage and digital subtraction angiography revealed a 3. Read More

Surg Neurol Int 2021 26;12:181. Epub 2021 Apr 26.

Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy.

Background: The treatment of spontaneous spinal epidural hematomas (SSEHs), depending on the lesion size and myeloradicular involvement, can be surgical or conservative. Here, we present a 55-year-old patient who sustained a SSEH several months following a systemic SARS-CoV-2 infection.

Case Description: A 55-year-old immunocompromised female (i. Read More

BMC Med Imaging 2021 Jun 3;21(1):94. Epub 2021 Jun 3.

Department of Neurosurgery, Julius Maximilians University, Josef-Schneider Str. 11, 97080, Würzburg, Germany.

Background: Mobile 3-dimensional fluoroscopes are an integral part of modern neurosurgical operating theatres and can also be used in combination with free available image post processing to depict cerebral vessels. In preparation of stereotactic surgery, preoperative Computed Tomography (CT) may be required for image fusion. Contrast CT may be of further advantage for image fusion as it regards the vessel anatomy in trajectory planning. Read More

Nat Commun 2021 06 2;12(1):3289. Epub 2021 Jun 2.

Department of Neurology, Washington University School of Medicine & Barnes-Jewish Hospital, St Louis, MO, USA.

Acute ischemic stroke affects men and women differently. In particular, women are often reported to experience higher acute stroke severity than men. We derived a low-dimensional representation of anatomical stroke lesions and designed a Bayesian hierarchical modeling framework tailored to estimate possible sex differences in lesion patterns linked to acute stroke severity (National Institute of Health Stroke Scale). Read More

J Clin Med 2021 May 25;10(11). Epub 2021 May 25.

Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France.

We performed a systematic review and meta-analysis of published studies to assess the efficacy, safety, and outcomes of N-butyl cyanoacrylate (NBCA) injection for the treatment of variceal gastrointestinal bleeding (GIB). The MEDLINE/PubMed, EMBASE, and SCOPUS databases were searched for English-language studies published from January 1980 to December 2019 and including patients who had injection of NBCA for variceal GIB. Two independent reviewers extracted and evaluated the data from eligible studies. Read More

Neurol Res Pract 2021 Jun 1;3(1):31. Epub 2021 Jun 1.

Department of Neuroradiology, Saarland University Medical Center, Homburg, Germany.

Background: The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy.

Methods: Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Read More

Case Rep Pediatr 2021 15;2021:5587050. Epub 2021 May 15.

Center for HUS Prevention,Control and Management, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

We report on the case of a 7-year-old boy with Shiga toxin-producing -related hemolytic uremic syndrome (STEC-HUS), initially presenting with abdominal pain as the only clinical feature and thus requiring differential diagnosis with a surgical emergency. Diagnosis of STEC-HUS was made with the appearance of bloody diarrhea and renal function impairment, and the clinical picture rapidly progressed to multiorgan failure. Relatively late and severe central nervous system (CNS) involvement was present, characterized by subacute encephalitis progressing to coma, which became apparent when the acute phase of thrombotic microangiopathy was resolving. Read More

Case Rep Neurol Med 2021 12;2021:5517934. Epub 2021 May 12.

Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany.

Thunderclap headache is frequently associated with serious intracranial vascular disorders and a usual reason for emergency department admissions. Association of thunderclap headaches with autoimmune disorders, such as steroid-responsive encephalopathy with autoimmune thyroiditis (SREAT), is highly unusual. Here, we report a patient who presented with high-intensity headache of abrupt onset. Read More

Pract Lab Med 2021 Aug 12;26:e00236. Epub 2021 May 12.

Department of Neuroradiology, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.

Background: Serum biomarker S100B has been explored for its potential benefit to improve clinical decision-making in the management of patients suffering from traumatic brain injury (TBI), especially as a pre-head computed-tomography screening test for patients with mild TBI. Although being already included into some guidelines, its implementation into standard care is still lacking. This might be explained by a turnaround time (TAT) too long for serum S100B to be used in clinical decision-making in emergency settings. Read More

J Int Med Res 2021 May;49(5):3000605211013179

Medical College of Soochow University, Suzhou, China.

Objective: To investigate the relationship between asymmetric prominent hypointense vessels (prominent vessel sign, PVS) on susceptibility-weighted imaging (SWI) and leptomeningeal collateralization in patients with acute ischemic stroke due to large vessel occlusion.

Methods: We retrospectively enrolled patients with M1 segment occlusion of the middle cerebral artery who underwent emergency magnetic resonance imaging and digital subtraction angiography within 24 hours from stroke onset. The extent of PVS on SWI was assessed using the Alberta Stroke Program Early CT Score (ASPECTS). Read More

Emerg Radiol 2021 May 26. Epub 2021 May 26.

Neuroradiology Section, Department of Radiology, University of Colorado Anschutz Medical Campus, Leprino Building, 12401 East 17th Avenue, Aurora, CO, 80045, USA.

COVID-19 was initially described as a pulmonary disease. Increasing attention is now directed to extrapulmonary disease manifestations mediated by viral tropism to the vascular endothelium. Here, we report a case of an adult patient with COVID-19 who presented to the emergency department with neurological signs disproportionate to pulmonary symptoms and was found to have a subacute ischemic stroke. Read More

J Neurol 2021 May 24. Epub 2021 May 24.

Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantova, Italy.

Objective: To characterize patients with acute ischemic stroke related to SARS-CoV-2 infection and assess the classification performance of clinical and laboratory parameters in predicting in-hospital outcome of these patients.

Methods: In the setting of the STROKOVID study including patients with acute ischemic stroke consecutively admitted to the ten hub hospitals in Lombardy, Italy, between March 8 and April 30, 2020, we compared clinical features of patients with confirmed infection and non-infected patients by logistic regression models and survival analysis. Then, we trained and tested a random forest (RF) binary classifier for the prediction of in-hospital death among patients with COVID-19. Read More

Oper Neurosurg (Hagerstown) 2021 May 22. Epub 2021 May 22.

Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

Surgical treatment of lesions involving the postero-medial occipito-temporal region is challenging because of high risk of morbidity due to damage or excessive retraction of critical neuro-vascular structures, especially within the dominant hemisphere.1-3  Here, we describe the case of a 17-yr-old patient who underwent resection of an epileptogenic low-grade tumor located within the left-dominant lingual gyrus. Seizures were characterized, as a first symptom, by right-sided simple visual hallucination that pointed to the left pericalcarine region, corresponding to the lesion location. Read More

Eur J Intern Med 2021 May 18. Epub 2021 May 18.

"Frugoni" Internal Medicine Unit, Centre for Rare Diseases, Interdepartmental Centre for Hereditary Haemorrhagic Telangiectasia, Interdisciplinary Department of Medicine (D.I.M.), VascERN HHT Reference Centre, University of Bari Aldo Moro, Policlinico University Hospital, Bari, Italy.

Background: Portosystemic shunts in Hereditary Haemorrhagic Telangiectasia (HHT) are often overlooked by conventional imaging although they could reduce hepatic clearance of gut-derived toxins.

Aims: To evaluate, the presence of subclinical neurological alterations (SNAs), that we named "minimal portosystemic encephalopathy" (mPSE) in HHT patients without advanced liver disease (ALD).

Methods: In this cross sectional study, consecutive HHT outpatients were firstly screened by critical flicker frequency (CFF) test (abnormal ≤39Hz), and the simplified animal naming test (S-ANT) (abnormal <15) was used to confirm the diagnosis of mPSE. Read More

Stroke 2021 May 20:STROKEAHA120033377. Epub 2021 May 20.

Department of Neurology, UCLA, Los Angeles, CA. (D.L., M.N., L.S., N.R., J.H., S.S., J.L.S.).

Background And Purpose: Clot fragmentation and distal embolization during endovascular thrombectomy for acute ischemic stroke may produce emboli downstream of the target occlusion or in previously uninvolved territories. Susceptibility-weighted magnetic resonance imaging can identify both emboli to distal territories (EDT) and new territories (ENT) as new susceptibility vessel signs (SVS). Diffusion-weighted imaging (DWI) can identify infarcts in new territories (INT). Read More

Pharmacogenet Genomics 2021 May 14. Epub 2021 May 14.

Institute of Pharmacogenetics Department of Nephrology Institute of Diagnostic and Interventional Radiology and Neuroradiology Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen Center for Translational Medicine, Ruhr University Bochum, Herne Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Aachen RWTH Centralized Biomaterial Bank (RWTH cBMB), Medical Faculty Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, RWTH Aachen University, Aachen, Center of Emergency Medicine Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Essen Department of Nephrology, Ruhr University Bochum, Herne Center of Nephrology Mettmann, Mettmann Department of Pulmonary Medicine, Ruhrlandklinik, University Hospital Essen Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.

Objectives: The RNA virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for coronavirus disease 2019 (COVID-19). Cell entry is mediated by the human angiotensin-converting enzyme II (ACE2). ACE2 and its close homolog angiotensin-converting enzyme I (ACE) are currently discussed candidate genes, in which single-nucleotide polymorphisms (SNPs) could alter binding or entry of SARS-CoV-2 and enhance tissue damage in the lung or other organs. Read More

Neurol Res Pract 2021 May 17;3(1):27. Epub 2021 May 17.

Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, Germany.

Background: Emergency intubation is an inherent risk of procedural sedation regimens for endovascular treatment (EVT) of acute ischemic stroke. We aimed to characterize the subgroup of patients, who had to be emergently intubated, to identify predictors of the need for intubation and assess their outcomes.

Methods: This is a retrospective analysis of the single-center study KEEP SIMPLEST, which evaluated a new in-house SOP for EVT under primary procedural sedation. Read More

Clin Imaging 2021 May 6;77:219-223. Epub 2021 May 6.

UCLA Department of Radiology, Neuroradiology Section, Los Angeles, CA, United States of America.

Background: The radiology trainee on-call experience has undergone many changes in the past decade. The development of numerous online information sources has changed the landscape of opportunities for trainees seeking information while on-call. In this study, we sought to understand the current on-call information seeking behaviors of radiology trainees. Read More

Neurology 2021 May 13. Epub 2021 May 13.

Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.

ObjectiveFailure of fixation suppression of spontaneous nystagmus is sometimes seen in patients with vestibular strokes involving the cerebellum or brainstem, however, the accuracy of this test for the discrimination between peripheral and central causes in patients with an acute vestibular syndrome (AVS) is unknown.MethodsPatients with AVS were screened and recruited (convenience sample) as part of a prospective cross-sectional study in the Emergency Department between 2015-2020. All patients received neuroimaging which served as a reference standard. Read More

BMJ Open 2021 05 13;11(5):e046460. Epub 2021 May 13.

Curtin Health Innovation Research Institute, Curtin University Faculty of Health Sciences, Bentley, Western Australia, Australia

Introduction: Mild traumatic brain injury (mTBI) is a complex injury with heterogeneous physical, cognitive, emotional and functional outcomes. Many who sustain mTBI recover within 2 weeks of injury; however, approximately 10%-20% of individuals experience mTBI symptoms beyond this 'typical' recovery timeframe, known as persistent post-concussion symptoms (PPCS). Despite increasing interest in PPCS, uncertainty remains regarding its prevalence in community-based populations and the extent to which poor recovery may be identified using early predictive markers. Read More

Abdom Radiol (NY) 2021 May 12. Epub 2021 May 12.

Department of Radiology, Wisconsin Institutes of Medical Research, University of Wisconsin, Room 2478, 1111 Highland Avenue, Madison, WI, 53705, USA.

Objectives: To evaluate the reproducibility of liver R2* measurements between a 2D cardiac ECG-gated and a 3D breath-hold liver CSE-MRI acquisition for liver iron quantification.

Methods: A total of 54 1.5 T MRI exams from 51 subjects (18 women, 36 men, age 35. Read More

Neurology 2021 May 12. Epub 2021 May 12.

Neuroradiology Unit, ASST Spedali Civili, Brescia, Italy.