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Neurosurgery 2021 Jun 10. Epub 2021 Jun 10.

Department of Neurosurgery, Guro Hospital, Korea University, College of Medicine, Seoul, Republic of Korea.

Background: Many physicians consider aneurysmal wall enhancement (AWE) on high resolution-vessel wall imaging (HR-VWI) as an imaging biomarker of unstable unruptured intracranial aneurysms (UIAs).

Objective: To evaluate the clinical value of different AWE signal intensities (SIs) by assessing the correlation between the AWE SIs and surgical findings and rupture risk assessment tools.

Methods: Twenty-six patients with 34 aneurysms who underwent surgical clipping were included. Read More

Front Surg 2021 25;8:669433. Epub 2021 May 25.

Department of Neurosurgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China.

Anterior inferior cerebellar artery (AICA) aneurysms are relatively rare in clinical practice, accounting for <1% of all intracranial arteries. After the diagnosis and location are confirmed by angiography, magnetic resonance, and other imaging examinations, interventional, or surgical treatment is often used, but some complex aneurysms require reconstructive surgery. An 8-year-old male child was admitted to the hospital due to sudden disturbance of consciousness for 2 weeks. Read More

Front Neurol 2021 25;12:663058. Epub 2021 May 25.

Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada.

The indications for mechanical thrombectomy in acute ischemic stroke continue to broaden, leading neurointerventionalists to treat vessel occlusions at increasingly distal locations farther in time from stroke onset. Accessing these smaller vessels raises the concern of iatrogenic subarachnoid hemorrhage (SAH) owing to increasing complexity in device navigation and retrieval. This study aims to determine the prevalence of SAH following mechanical thrombectomy, associated predictors, and resulting functional outcomes using a multicenter registry and compare this with a systematic review and meta-analysis of the literature. Read More

J Cereb Blood Flow Metab 2021 Jun 10:271678X211020865. Epub 2021 Jun 10.

The Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.

Aneurysmal subarachnoid hemorrhage (aSAH) patients develop delayed cerebral ischemia and delayed deficits (DCI) within 2 weeks of aneurysm rupture at a rate of approximately 30%. DCI is a major contributor to morbidity and mortality after SAH. The cause of DCI is multi-factorial with contributions from microthrombi, blood vessel constriction, inflammation, and cortical spreading depolarizations. Read More

J Neurol Sci 2021 Jun 5;427:117533. Epub 2021 Jun 5.

Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany. Electronic address:

Objectives: Adrenomedullin (ADM) has been identified as a promising biomarker of mortality and outcome in sepsis, heart failure and after major surgery. A recently developed assay specific for bioactive adrenomedullin (bio-ADM) has not yet been assessed in aneurysmal subarachnoid hemorrhage (aSAH). The objective of this prospective trial was to assess the time course of bio-ADM after aSAH in relation to the development of delayed cerebral ischemia (DCI) and its association with clinical outcome. Read More

Neurocrit Care 2021 Jun 10. Epub 2021 Jun 10.

Department of Neurosurgery, Kaiser Permanente, Sacramento, CA, USA.

Research into the glymphatic system reached an inflection point with steep trajectory in 2012 when it was formally recognized and named, but the historical roots for it are solid and deep, dating back to pioneers such as Cushing, Weed, and Dandy. We provide an overview of key discoveries of the glymphatic system, which promotes bulk flow of fluid and solutes throughout the brain parenchyma. We also discuss the lymphatic drainage of the central nervous system. Read More

Neurocrit Care 2021 Jun 9. Epub 2021 Jun 9.

Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.

Background: Subarachnoid hemorrhage (SAH) is characterized by the worst headache of life and associated with long-term opioid use. Discrete pain trajectories predict chronic opioid use following other etiologies of acute pain, but it is unknown whether they exist following SAH. If discrete pain trajectories following SAH exist, it is uncertain whether they predict long-term opioid use. Read More

J Cerebrovasc Endovasc Neurosurg 2021 Jun 10. Epub 2021 Jun 10.

Department of Neurosurgery, Uijeongbu Eulji Medical Center, Eulji University College of Medicine, Uijeongbu, Korea.

Dissecting aneurysm involving the posterior inferior cerebellar artery (PICA) are challenging because of its nature and anatomic relationship to medulla and lower cranial nerve. We introduce a case of ruptured dissecting aneurysm located at the proximal PICA treated with telescoping stents for flow diversion and dissection healing. A 49 years old female visited to the emergency room for ruptured dissecting aneurysm at right proximal PICA. Read More

Medicine (Baltimore) 2021 May;100(19):e25815

Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.

Abstract: There are many grading scales that attempt to predict outcome following aneurysmal subarachnoid hemorrhage (aSAH). Most scales used to assess outcome are based on the neurological status of the patient. Here, we propose a new scale for aSAH patients that combines the Glasgow Coma Scale (GCS) and the modified Fisher scale (mFS). Read More

Medicine (Baltimore) 2021 May;100(19):e25783

Department of Neurosurgery, Stroke and Neurological Disorders Centre, Kyung Hee University Hospital at Gangdong.

Rationale: Among the possible complications during endovascular embolization of intracranial aneurysms, coil protrusion into the parent artery is associated with parent artery occlusion or thromboembolic of the distal arteries. There is no clearly established management strategy for coil protrusion. This report demonstrates our experience with balloon-assisted remodeling to reposition a protruded coil loop. Read More

Rev Med Chil 2021 Jan;149(1):76-87

Departamento de Neurología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Amyloid angiopathy (AA) is a selective deposition of amyloid in the walls of the brain vessels. It is a form of sporadic and localized amyloidosis, constituted by the Aβ4 protein, the same of Alzheimer's disease senile plaques. The most consistent clinical effect of AA is spontaneous brain hemorrhage (BH). Read More

J Thromb Thrombolysis 2021 Jun 8. Epub 2021 Jun 8.

Department of Neurology and Stroke Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.

To report our experience in treating one patient with nontraumatic subarachnoid hemorrhage (SAH) and concurrent acute ischemic stroke (AIS) due to large vessels occlusion (LVO). A man in his 50 s presented with acute right hemiparesis and aphasia. Brain CT showed a SAH in the left central sulcus; CT-angiography revealed a tandem occlusion of the left internal carotid artery and homolateral middle cerebral artery. Read More

J Med Life 2021 Mar-Apr;14(2):216-224

Neurology Department, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania.

With the exponential growth of COVID-19 cases, the neurological complications reported during or after the infection became more common. There is limited knowledge regarding the pathophysiological mechanisms that are responsible for these complications. Recent data provides compelling evidence for the neurotropic nature of SARS-CoV-2, based on neurological manifestations reported during the current pandemic, as well as on previous experience with other coronaviruses. Read More

Curr Med Imaging 2021 Jun 8. Epub 2021 Jun 8.

Department of Neurology, China-Japan Union Hospital of Jilin University, China.

Introduction: At present, the mechanism of telangiectasia is unknown, but some evidence suggests that it may be related to genetic abnormalities. Telangiectasia may lead to bleeding of multiple sites. CT-negative subarachnoid hemorrhage is rare, which is mostly related to hemorrhage with a little amount of bleeding. Read More

J Cereb Blood Flow Metab 2021 Jun 8:271678X211020629. Epub 2021 Jun 8.

Division of Internal Medicine, Universitätsspital and University of Zurich; Zurich, Switzerland.

Secondary brain injury after aneurysmal subarachnoid hemorrhage (SAH-SBI) contributes to poor outcomes in patients after rupture of an intracranial aneurysm. The lack of diagnostic biomarkers and novel drug targets represent an unmet need. The aim of this study was to investigate the clinical and pathophysiological association between cerebrospinal fluid hemoglobin (CSF-Hb) and SAH-SBI. Read More

Geriatr Gerontol Int 2021 Jun 8. Epub 2021 Jun 8.

Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan.

Aim: Intensive rehabilitation effectively improves physical functions in patients with acute stroke, but the frequency of intervention and its cost-effectiveness are poorly studied. This study aimed to examine the effect of early high-frequency rehabilitation intervention on inpatient outcomes and medical expenses of patients with stroke.

Methods: The study retrospectively included 1759 patients with acute stroke admitted to the Kobe City Medical Center General Hospital between 2013 and 2016. Read More

J Korean Med Sci 2021 Jun 7;36(22):e146. Epub 2021 Jun 7.

Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea.

Background: Subarachnoid hemorrhage is a potentially devastating cerebrovascular attack with a high proportion of poor outcomes and mortality. Recent studies have reported decreased mortality with the improvement in devices and techniques for treating ruptured aneurysms and neurocritical care. This study investigated the relationship between hospital volume and short- and long-term mortality in patients treated with subarachnoid hemorrhage. Read More

J Neurol Surg A Cent Eur Neurosurg 2021 Jun 7. Epub 2021 Jun 7.

Department of Neurosurgery, Universitätsklinikum Aachen, RWTH Aachen University, Aachen, Germany.

Background And Importance:  Traumatic avulsion of the ophthalmic artery is a rare cause of subarachnoid hemorrhage (SAH). In this case, a relative minor fall with isolated ocular trauma caused bulbar dislocation and rupture of the ophthalmic artery in its intracranial segment resulting in subarachnoid bleeding.

Clinical Presentation:  In a female patient in her 70s, a direct penetrating trauma to the orbit by a door handle resulted in basal SAH with blood dispersion into both Sylvian fissures. Read More

Oper Neurosurg (Hagerstown) 2021 Jun 7. Epub 2021 Jun 7.

Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Background: Blister aneurysms are rare, technically challenging lesions that are typically ill defined and arise at nonbranch points of arteries.

Objective: To describe the microsurgical treatment of a ruptured blister aneurysm at the internal carotid artery (ICA) terminus using the reverse picket fence clipping technique.

Methods: The patient was a 60-yr-old male. Read More

Neurosurgery 2021 Jun 7. Epub 2021 Jun 7.

Department of Interventional Neuroradiology and Neurosurgery, Instituto Médico ENERI-Clínica La Sagrada Familia, Buenos Aires, Argentina.

Background: Prospective studies have established the safety and efficacy of the PipelineTM Embolization Device (PED; Medtronic) for treatment of intracranial aneurysms (IA).

Objective: To investigate long-term outcomes from the Pipeline Embolization Devices for the Treatment of Intracranial Aneurysms (PEDESTRIAN) Registry.

Methods: The PEDESTRIAN Registry data were retrospectively reviewed, which included patients (March 2006 to July 2019) with complex IAs treated with PED. Read More

Oper Neurosurg (Hagerstown) 2021 Jun 7. Epub 2021 Jun 7.

Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.

Dorsal internal carotid artery (ICA) blister aneurysms are an uncommon aneurysm variant constituting 0.3% to 1% of intracranial aneurysms and can be due to ulceration, atherosclerosis, or dissection.1-3 Despite its rarity, it carries a high risk of rupture with an estimation of 0. Read More

Br J Neurosurg 2021 Jun 7:1-6. Epub 2021 Jun 7.

Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.

Objective: Patient safety indicators (PSI) are a set of potentially preventable events related to patient safety and opportunities for improvement. Eight pertinent PSI have been identified in patients with aneurysmal subarachnoid haemorrhage (ASAH), such as decubitus ulcer, and central line-related bacteraemia. Our aim was to evaluate the efficacy of a health care quality protocol to prevent the appearance of PSI in ASAH patients. Read More

Front Neurol 2021 20;12:590751. Epub 2021 May 20.

Department of Neurosurgery, Radiology and Neurology, University of Minnesota, Minneapolis, MN, United States.

Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality. Prophylactic treatment of the unruptured intracranial aneurysm (UIA) is considered in a select group of patients thought to be at high for aneurysmal rupture. Hospital readmission rates can serve as a surrogate marker for the safety and cost-effectiveness of treatment options for UIAs; we present an analysis of the 30-day rehospitalization rates and predictors of readmission following UIA treatment with surgical and endovascular approaches. Read More

Front Neurol 2021 20;12:547655. Epub 2021 May 20.

Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, TX, United States.

Blast traumatic brain injury is ubiquitous in modern military conflict with significant morbidity and mortality. Yet the mechanism by which blast overpressure waves cause specific intracranial injury in humans remains unclear. Reviewing of both the clinical experience of neurointensivists and neurosurgeons who treated service members exposed to blast have revealed a pattern of injury to cerebral blood vessels, manifested as subarachnoid hemorrhage, pseudoaneurysm, and early diffuse cerebral edema. Read More

Front Physiol 2021 21;12:689239. Epub 2021 May 21.

Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.

Lactate is an intriguing molecule with emerging physiological roles in the brain. It has beneficial effects in animal models of acute brain injuries and traumatic brain injury or subarachnoid hemorrhage patients. However, the mechanism by which lactate provides protection is unclear. Read More

BMC Nephrol 2021 Jun 5;22(1):213. Epub 2021 Jun 5.

Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Linkou Branch, 5, Fu Hsing Street, 333, Taoyuan, Taiwan.

Background: The incidence of cerebral stroke, including ischemic infarction and intracranial hemorrhage (ICH), increases in patients with nephrotic syndrome (NS). However, the clinical characteristics of patients with NS and stroke remain elusive. We aimed to investigate the clinical presentation and prognosis among patients with NS and ischemic stroke (IS) or ICH. Read More

Cell Mol Neurobiol 2021 Jun 5. Epub 2021 Jun 5.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St., Beijing, 100053, China.

Early brain injury (EBI) is the early phase of secondary complications arising from subarachnoid hemorrhage (SAH). G protein-coupled receptor 18 (GPR18) can exert neuroprotective effects during ischemia. In this study, we investigated the roles of GPR18 in different brain regions during EBI using a GPR18 agonist, resolvin D2 (RvD2). Read More

J Emerg Med 2021 Jun 1. Epub 2021 Jun 1.

Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York.

Medicine (Baltimore) 2021 Jun;100(22):e25960

Eye Center of the second hospital, Jilin University, ChangChun, Jilin Province, China.

Introduction: Terson's syndrome with inner limiting membrane (ILM) peeled off spontaneously is rarely seen, and the mechanism of it is not clear. Here we report a case of Terson Syndrome with a rare finding: the ILM peeled off spontaneously associated with macular hole (MH).

Patient Concerns: A 36-year-old female patient was admitted to our hospital with decreased visual acuity in the right eye lasting for 1 month. Read More

J Neurosurg 2021 Jun 4:1-10. Epub 2021 Jun 4.

1Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, Atlanta, Georgia.

Objective: Cerebral vasospasm and delayed cerebral ischemia (DCI) contribute to poor outcome following subarachnoid hemorrhage (SAH). With the paucity of effective treatments, the authors describe their experience with intrathecal (IT) nicardipine for this indication.

Methods: Patients admitted to the Emory University Hospital neuroscience ICU between 2012 and 2017 with nontraumatic SAH, either aneurysmal or idiopathic, were included in the analysis. Read More