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J Neurol 2022 Jun 22. Epub 2022 Jun 22.

Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.

Background: Acute vertebrobasilar artery occlusion (VBAO) is a devastating disease in stroke patients. This study was aimed to identify the initial symptoms of patients with acute VBAO receiving endovascular treatment and determine its associations with clinical outcomes.

Methods: Patients with VBAO receiving endovascular treatment at 21 stroke centres in China were recruited for this derivation cohort A data-driven approach of latent class analysis was applied to identify distinct symptom typologies of VBAO patients. Read More

Ann Indian Acad Neurol 2022 Mar-Apr;25(2):256-260. Epub 2022 Mar 25.

Department of Neurology, Comprehensive Stroke Care Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Background: Timely and effective recanalization to salvage the penumbra is the main determinant of outcome in acute ischemic strokes. Randomized controlled trials on late window mechanical thrombectomy (MT) have proved its safety and efficacy upto 24 h after stroke onset. We looked at the impact of time to reperfusion on vessel recanalization rates and short-term outcome in patients undergoing MT for large vessel occlusion. Read More

Cureus 2022 May 5;14(5):e24751. Epub 2022 May 5.

Internal Medicine/Cardiology, Weill Cornell Medicine, New York, USA.

Vertebrobasilar angioplasty and stenting or mechanical thrombectomy (MT) using a stent retriever or suction thrombectomy are effective interventions in managing acute ischemic stroke caused by vertebrobasilar artery occlusion (VBAO). This study aims to investigate the safety and efficacy of self-expanding stents and balloon angioplasty in managing ischemic stroke. We reviewed the literature for relevant clinical trials and included those reporting the following primary outcomes: successful recanalization, favorable clinical outcome, and stenosis degree change. Read More

Cureus 2022 May 6;14(5):e24792. Epub 2022 May 6.

Neurology, Cheikh Khalifa University Hospital, Mohamed VI University of Health Sciences, Faculty, Casablanca, MAR.

An ischemic stroke is characterized by the brutal installation of a focal functional deficit. Myxomas are the most common primitive cardiac tumors. Neurological manifestations of myxomas are mostly related to cardioembolic events, either caused by a migrating fragment of the tumor or by an attached clot that got detached from the tumor This article describes the case of a 55-year-old male who presented with an ischemic stroke of the vertebrobasilar territory. Read More

J Stroke 2022 May 31;24(2):207-223. Epub 2022 May 31.

Department of Neurology, Ajou University School of Medicine, Suwon, Korea.

The efficacy of endovascular treatment (EVT) in patients with posterior circulation stroke has not been proven. Two recent randomized controlled trials failed to show improved functional outcomes after EVT for posterior circulation stroke (PC-EVT). However, promising results for two additional randomized controlled trials have also been presented at a recent conference. Read More

Front Neurol 2022 23;13:812458. Epub 2022 May 23.

Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China.

Stent retriever thrombectomy (SRT) is one of the most effective methods for the recanalization of acute basilar artery occlusion (ABAO). The proatlantal intersegmental artery (PIA) is a rare carotid-vertebrobasilar anastomosis. Recognition of this rare form of anastomosis is particularly important for the rapid establishment of positive blood flow in patients with ABAO. Read More

Transl Stroke Res 2022 Jun 7. Epub 2022 Jun 7.

Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Feodor-Lynen-Straße 17, 81377, Munich, Germany.

Whether endovascular thrombectomy (EVT) improves functional outcome in patients with large-vessel occlusion (LVO) stroke that do not comply with inclusion criteria of randomized controlled trials (RCTs) but that are considered for EVT in clinical practice is uncertain. We aimed to systematically identify patients with LVO stroke underrepresented in RCTs who might benefit from EVT. Following the premises that (i) patients without reperfusion after EVT represent a non-treated control group and (ii) the level of reperfusion affects outcome in patients with benefit from EVT but not in patients without treatment benefit, we systematically assessed the importance of reperfusion level on functional outcome prediction using machine learning in patients with LVO stroke treated with EVT in clinical practice (N = 5235, German-Stroke-Registry) and in patients treated with EVT or best medical management from RCTs (N = 1488, Virtual-International-Stroke-Trials-Archive). Read More

BMC Neurol 2022 Jun 6;22(1):208. Epub 2022 Jun 6.

Department of Neurosurgery, Japanese Red Cross Nagahama Hospital, Miyamae-cho 14-7, Nagahama, Shiga, Japan.

Background: Persistent primitive trigeminal artery (PPTA) is a remnant of the carotid-vertebrobasilar anastomoses in the embryo. Although PPTAs are discovered incidentally in most cases, altered hemodynamics may lead to increased risk of stroke. To the best of our knowledge, no reports of PPTA associated with superior cerebellar artery (SCA) dissecting aneurysms have been published in the English language. Read More

World J Clin Cases 2022 May;10(14):4494-4501

Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia 42123, Italy.

Background: Bow hunter's syndrome (BHS) is a rare but surgically treatable cause of vertebrobasilar insufficiency due to dynamic rotational occlusion of the vertebral artery. Typically, patients present with posterior circulation transient ischaemic symptoms such as presyncope, syncope, vertigo, diplopia, and horizontal nystagmus, but irreversible deficits, including medullary and cerebellar infarctions, have also been described.

Case Summary: A 70-year-old patient presented an acute onset of vertigo and gait instability triggered by right head rotation. Read More

Int J Stroke 2022 Jun 6:17474930221107500. Epub 2022 Jun 6.

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

One fifth of strokes occur in the territory of the posterior circulation but their management, particularly acute reperfusion therapy and neurointervention procedures for secondary prevention, have received much less attention than similar interventions for the anterior circulation. In this review we overview treatment of posterior circulation stroke, including both interventions in the acute setting and, secondary prevention. We focus on areas in which management of posterior circulation stroke differs from that of stroke in general, and highlight recent advances. Read More

Front Surg 2022 16;9:901759. Epub 2022 May 16.

Department of General Chemistry, Bashkir State Medical University, Ufa, Russian Federation.

Vertebrobasilar insufficiency (VBI) is one of the most common forms of cerebrovascular pathology. The progression of the VBI, especially in the context of inadequate therapy, often leads to the formation of a persistent neurological deficits within the framework of dyscirculatory encephalopathy and the consequences of a stroke in the vertebrobasilar system. This study demonstrate the importance of objective methods of patient investigation to optimize the choice of the most effective methods of surgical treatment for VBI in cases of ineffective medical treatment. Read More

Stroke 2022 May 27:101161STROKEAHA122038527. Epub 2022 May 27.

Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.S.W.P., V.Y., N.Y., B.C.V.C.).

Contrast Media Mol Imaging 2022 26;2022:8952355. Epub 2022 Apr 26.

Department of Neurology, Baoji City People's Hospital, Baoji 721000, Shaanxi, China.

This research aimed to discuss the characteristics of benign paroxysmal positional vertigo (BPPV) and the correlation with cerebrovascular disease. An artificial intelligence algorithm under a parallel dual-domain concatenated convolutional neural network (PDDC-CNN) was proposed to process the images of magnetic resonance imaging (MRI). MRI, magnetic resonance angiography (MRA), and susceptibility weighted imaging (SWI) were performed on all 60 research objects with a 3. Read More

Cochrane Database Syst Rev 2022 05 17;5:CD013692. Epub 2022 May 17.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Background: Vertebral artery stenosis (narrowing of the vertebral artery) is an important cause of posterior circulation ischaemic stroke. Medical treatment (MT) e.g. Read More

Cureus 2022 Apr 13;14(4):e24102. Epub 2022 Apr 13.

Neurology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND.

Intracranial aneurysms are typically asymptomatic. They are usually incidentally detected or detected only after rupture. Ischemic stroke or transient ischemic attack (TIA) due to unruptured intracranial aneurysms (UIAs) is rare. Read More

Intern Med 2022 May 14. Epub 2022 May 14.

Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Japan.

Bow hunter's stroke is a rare cause of vertebrobasilar infarction. There is no consensus regarding the optimal treatment. We herein report a case of bow hunter's stroke successfully treated by endovascular treatment. Read More

Neuroradiology 2022 May 12. Epub 2022 May 12.

Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.

Introduction: The study aims to assess the correlation and association between calcium burden and luminal stenosis in the vertebrobasilar circulation.

Methods: We evaluated 166 patients [mean age, 79.8 ± 8. Read More

Surg Neurol Int 2022 22;13:166. Epub 2022 Apr 22.

Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.

Background: Vertebrobasilar dolichoectasia (VBD) is a vasculopathy characterized by the elongation, widening, and tortuosity of a cerebral artery. Rarely, hydrocephalus results when the extended basilar artery impairs communication of the cerebral ventricle and cerebrospinal fluid dynamics. We experienced such a case when a patient underwent endoscopic third ventriculostomy (ETV) for noncommunicating hydrocephalus with VBD. Read More

BMJ Open 2022 04 28;12(4):e059616. Epub 2022 Apr 28.

Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China

Introduction: Vertebrobasilar dissecting aneurysms (VBDAs) are associated with serious complications and a poor prognosis. It is believed that inflammation of the aneurysm wall may be the main cause of rupture or deterioration. Atorvastatin has been shown to inhibit inflammation and may be a suitable drug candidate. Read More

Diagnostics (Basel) 2022 Mar 15;12(4). Epub 2022 Mar 15.

Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.

Intracranial vertebrobasilar atherosclerosis is the main cause of posterior circulation ischemic stroke. We aimed to construct a predictive model for the risk of posterior circulation ischemic stroke in patients with posterior circulation atherosclerosis based on high-resolution MRI (HR-MRI). A total of 208 consecutive patients with posterior circulation atherosclerosis confirmed by HR-MRI, from January 2020 to July 2021, were retrospectively assessed. Read More

Neurol Sci 2022 Apr 20. Epub 2022 Apr 20.

Department of Neurology, Columbia University Irving Medical Center, 710 W 168th Street, 6th Floor, Suite 639, New York, NY, 10032, USA.

Introduction: Dolichoectasia is a form of brain large artery disease associated with a high risk of mortality and morbidity. Progressive enlargement of arterial size is a predictor of mortality, but there are no specific treatments for arresting or slowing down dilatation. Additionally, dilated brain arteries can cause flow stagnation, which can trigger thrombosis and cause stroke. Read More

J Stroke Cerebrovasc Dis 2022 06 6;31(6):106437. Epub 2022 Apr 6.

Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. Electronic address:

Br J Hosp Med (Lond) 2022 Mar 31;83(3):1-9. Epub 2022 Mar 31.

Department of Neurological Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.

Compressive syndromes of the cervical arteries caused by musculoskeletal structures include bow hunter's syndrome, beauty parlour stroke syndrome, carotid compression by the hyoid bone, carotid compression by the digastric muscle and Eagle syndrome. They are a rare but increasingly recognised group of syndromes, so a high level of suspicion is needed so the diagnosis is not missed. The diagnosis is typically based on a combination of clinical history and advanced imaging investigations. Read More

Brain Circ 2022 Jan-Mar;8(1):50-56. Epub 2022 Mar 21.

Department of Neurology, University of Regensburg, Medbo Bezirksklinikum Regensburg, Landshut 84034, Germany.

Detecting the stroke etiology in young patients can be challenging. Among others, determining causality between ischemic stroke and patent foramen ovale (PFO) remains a complicated task for stroke neurologists, given the relatively high prevalence of PFOs. Thorough diagnostic workup to identify incidental vascular risk factors and rare embolic sources is crucial to avoid premature PFO closure suggesting successful secondary stroke prevention. Read More

Support Care Cancer 2022 Jul 31;30(7):5821-5830. Epub 2022 Mar 31.

Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan.

Purpose: Radiotherapy for nasopharyngeal carcinoma (NPC) may induce cerebrovascular diseases including ischemic stroke and transient ischemic attack (TIA), which can cause severe disability. However, information on the incidence and predictors of cerebrovascular diseases is scarce. This study aimed to estimate the incidence of cerebrovascular diseases following NPC, and attempts to ascertain the predictors of cerebrovascular diseases to facilitate early prevention. Read More

Transl Stroke Res 2022 Mar 29. Epub 2022 Mar 29.

Departments of Radiology & Biomedical Imaging, Neurosurgery, Neurology, & Anesthesiology, University of California, San Francisco, CA, USA.

Randomized controlled trials (RCTs) have demonstrated powerful efficacy of endovascular thrombectomy (EVT) for large vessel occlusion in the anterior circulation. The effect of EVT for acute basilar artery occlusion (BAO) in the posterior circulation remains unproven. Here, we highlight the latest findings of observational studies and RCTs of EVT for BAO, with a focus on the predictors of functional outcomes, the limitations of recent RCTs, and critical thinking on future study design. Read More

Eur Radiol 2022 Jul 25;32(7):4491-4499. Epub 2022 Mar 25.

Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.

Objective: In ischemic posterior circulation stroke, the utilization of standardized image scores is not established in daily clinical practice. We aimed to test a novel imaging score that combines the collateral status with the rating of the posterior circulation Acute Stroke Prognosis Early CT score (pcASPECTS). We hypothesized that this score (pcASCO) predicts functional outcome and malignant cerebellar edema (MCE). Read More

Curr Cardiol Rev 2022 Mar 17. Epub 2022 Mar 17.

John Ochsner Heart and Vascular Center, New Orleans, LA, USA.

Patients with posterior circulation ischemia due to vertebral artery stenosis account for 20 to 25% of ischemic strokes and have an increased risk of recurrent stroke. In patients treated with medical therapy alone, the risk of recurrence is particularly increased in the first few weeks after symptoms occur with an annual stroke rate of 10 to 15%. Additionally, obstructive disease of the vertebrobasilar system carries a worse prognosis, with a 30% mortality at 2-years if managed medically without additional surgical or endovascular intervention. Read More

Cureus 2022 Feb 10;14(2):e22103. Epub 2022 Feb 10.

Neurology, Aster Medcity, Kochi, IND.

Multisystem inflammatory syndrome in adults (MIS-A) is an extremely rare para-infectious or post-infectious complication of coronavirus disease 2019 (COVID-19) that requires prompt recognition and early treatment to avert severe morbidity and mortality. A 55-year-old woman presented to us with fever, multiple ischemic strokes, thrombocytopenia, elevated inflammatory markers, and multiorgan dysfunction a few days after COVID-19 illness. She was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative at admission. Read More

J Magn Reson Imaging 2022 Mar 15. Epub 2022 Mar 15.

Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Background: Moyamoya is a progressive intracranial vasculopathy, primarily affecting distal segments of the internal carotid and middle cerebral arteries. Treatment may comprise angiogenesis-inducing surgical revascularization; however, lack of randomized trials often results in subjective treatment decisions.

Hypothesis: Compensatory presurgical posterior vertebrobasilar artery (VBA) flow-territory reactivity, including greater cerebrovascular reactivity (CVR) and reduced vascular delay time, portends greater neoangiogenic response verified on digital subtraction angiography (DSA) at 1-year follow-up. Read More