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[PMID]:27380826
[Au] Autor:Sand KM; Naess H; Nilsen RM; Thomassen L; Hoff JM
[Ad] Endereço:Department of Neurology, Institute for Clinical Medicine, University of Bergen, Bergen, Norway.
[Ti] Título:Less thrombolysis in posterior circulation infarction-a necessary evil?
[So] Source:Acta Neurol Scand;135(5):546-552, 2017 May.
[Is] ISSN:1600-0404
[Cp] País de publicação:Denmark
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Patients with posterior circulation infarction (PCI) have more subtle symptoms than anterior circulation infarction (ACI) and could come too late for acute intervention. This study aimed to describe the clinical presentation, management, and outcome of PCI in the NORSTROKE registry. METHODS: All patients with PCI admitted to the Department of Neurology at Haukeland University Hospital and registered in the NORSTROKE database 2006-2013 were included (n=686). Patients with ACI (n=1758) were used for comparison. RESULTS: Patients with PCI were younger (68.2 vs 71.8, P<.001), had longer median time from symptom onset to admission (3.8 hours vs 2.2 hours, P<.001), and were less likely to arrive at hospital within 4.5 hours from symptom onset (56.2% vs 72.5%, P<.001, ictus known). Patients with PCI scored lower on baseline National Institute of Health Stroke Scale (NIHSS) total score (3.2 vs 6.3, P<.001), and lower or equally on all items of NIHSS, except for ataxia in two limbs. Patients with PCI were less likely to receive i.v. thrombolytic treatment (9.9% vs 21.5%, OR 0.66, CI 0.47-0.94). On day 7, patients with PCI scored lower on NIHSS (2.8 vs 4.9, P<.001), modified Rankin Scale (2.0 vs 2.3, P<.001), and higher on Barthel Index (84.5 vs 76.0, P<.001). CONCLUSIONS: Our study is, to our knowledge, the largest series reporting comprehensively on PCI verified by diffusion-weighted imaging. PCI patients are younger than ACI and have better outcome. PCI and ACI are equally investigated in the acute setting, but thrombolysis rates remain 50% lower in PCI.
[Mh] Termos MeSH primário: Fibrinolíticos/uso terapêutico
Infarto da Artéria Cerebral Posterior/diagnóstico por imagem
Infarto da Artéria Cerebral Posterior/tratamento farmacológico
Terapia Trombolítica/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Imagem de Difusão por Ressonância Magnética/métodos
Feminino
Seres Humanos
Infarto da Artéria Cerebral Posterior/epidemiologia
Masculino
Meia-Idade
Noruega/epidemiologia
Sistema de Registros
Acidente Vascular Cerebral/diagnóstico por imagem
Acidente Vascular Cerebral/epidemiologia
Acidente Vascular Cerebral/prevenção & controle
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Fibrinolytic Agents)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170512
[Lr] Data última revisão:
170512
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160707
[St] Status:MEDLINE
[do] DOI:10.1111/ane.12627


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[PMID]:27693107
[Au] Autor:Olivato S; Nizzoli S; Cavazzuti M; Casoni F; Nichelli PF; Zini A
[Ad] Endereço:Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Department of Neuroscience, Neurology Clinic, Modena, Italy.
[Ti] Título:e-NIHSS: an Expanded National Institutes of Health Stroke Scale Weighted for Anterior and Posterior Circulation Strokes.
[So] Source:J Stroke Cerebrovasc Dis;25(12):2953-2957, 2016 Dec.
[Is] ISSN:1532-8511
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The National Institutes of Health Stroke Scale (NIHSS) is the most widespread clinical scale used in patients presenting with acute stroke. The merits of the NIHSS include simplicity, quickness, and agreement between clinicians. The clinical evaluation on posterior circulation stroke remains still a limit of NIHSS. METHODS: We assessed the application of a new version of NIHSS, the e-NIHSS (expanded NIHSS), adding specific elements in existing items to explore signs/symptoms of a posterior circulation stroke. A total of 22 consecutive patients with suspected vertebrobasilar stroke were compared with 25 patients with anterior circulation stroke using NIHSS and e-NIHSS. RESULTS: We compared the NIHSS and e-NIHSS scores obtained by the 2 examiners, in patients with posterior circulation infarct (POCI), using the Wilcoxon test. Patients with POCI evaluated with e-NIHSS had an average of 2 points higher than patients evaluated with classical NIHSS. The difference was statistically significant (P < .05), weighted by the new expanded items. CONCLUSIONS: The NIHSS is a practical scale model, with high reproducibility between trained, different examiners, focused on posterior circulation strokes, with the same total score and number of items of the existing NIHSS. The e-NHISS could improve the sensitivity of NIHSS in posterior circulation stroke and could have an impact on clinical trials, as well as on outcomes. Further studies are needed to investigate a larger number of patients and the correlation between the e-NIHSS score and neuroimaging findings.
[Mh] Termos MeSH primário: Circulação Cerebrovascular
Avaliação da Deficiência
Infarto da Artéria Cerebral Anterior/diagnóstico
Infarto da Artéria Cerebral Posterior/diagnóstico
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Nível de Saúde
Seres Humanos
Infarto da Artéria Cerebral Anterior/fisiopatologia
Infarto da Artéria Cerebral Anterior/psicologia
Infarto da Artéria Cerebral Posterior/fisiopatologia
Infarto da Artéria Cerebral Posterior/psicologia
Masculino
Meia-Idade
Exame Neurológico
Testes Neuropsicológicos
Variações Dependentes do Observador
Valor Preditivo dos Testes
Prognóstico
Reprodutibilidade dos Testes
Índice de Gravidade de Doença
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170410
[Lr] Data última revisão:
170410
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161004
[St] Status:MEDLINE


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[PMID]:27520994
[Au] Autor:Parthasarathy R; Gupta V; Goel G; Mahajan A
[Ad] Endereço:Department of Neurointerventional Surgery, Artemis Hospitals, Sector 51, Gurgaon, Haryana-122001.
[Ti] Título:Solitaire stentectomy: 'deploy and engage' and 'loop and snare' techniques.
[So] Source:BMJ Case Rep;2016, 2016 Aug 12.
[Is] ISSN:1757-790X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Solitaire FR stent-based mechanical thrombectomy provides clinical benefit in selected patients with acute ischaemic stroke due to large vessel occlusion. A dreaded device complication that is associated with poor technical and clinical outcome is stent detachment. Retrieval of the detached stent can be technically challenging and has been attempted with variable success. The key benefit of this strategy is the lack of need to administer fibrinolytic/antiplatelet agents that can potentially be catastrophic in the setting of acute stroke. Therefore, retrieval may be preferred to other strategies (balloon angioplasty, lytic/glycoprotein 2b/3a inhibitors administration) to address detached stent. We report two patients in whom the detached stent was retrieved using alternative techniques-'deploy and engage' and 'loop and snare'-as snare retrieval failed.
[Mh] Termos MeSH primário: Remoção de Dispositivo/instrumentação
Trombólise Mecânica/instrumentação
Stents
Acidente Vascular Cerebral/terapia
[Mh] Termos MeSH secundário: Idoso
Remoção de Dispositivo/métodos
Feminino
Seres Humanos
Infarto da Artéria Cerebral Anterior/diagnóstico por imagem
Infarto da Artéria Cerebral Posterior/diagnóstico por imagem
Masculino
Trombólise Mecânica/métodos
Meia-Idade
Desenho de Prótese
Falha de Prótese
Acidente Vascular Cerebral/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170221
[Lr] Data última revisão:
170221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160814
[St] Status:MEDLINE


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[PMID]:27113722
[Au] Autor:Yvon C; Adams A; McLauchlan D; Ramsden C
[Ad] Endereço:Institute of Ophthalmology, University College London, London, UK.
[Ti] Título:Headache and transient visual loss as the only presenting symptoms of vertebral artery dissection: a case report.
[So] Source:J Med Case Rep;10(1):105, 2016 Apr 25.
[Is] ISSN:1752-1947
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Vertebral artery dissection is an important cause of stroke in the young and diagnosis is often challenging as symptoms are varied and subtle. CASE PRESENTATION: A 33-year-old, previously healthy, white male office worker was stretching his neck when he developed sudden left-sided visual loss lasting 5 minutes associated with headache. He had no other neurological symptoms or signs. He was investigated with a computed tomography angiogram, which revealed a left vertebral artery dissection with a right posterior cerebral artery vascular occlusion. CONCLUSIONS: We describe an atypical case of vertebral artery dissection presenting with sudden transient visual disturbance without neurological signs in an otherwise healthy man. This is a rare but potentially fatal condition that can result in thromboembolic infarction. A high index of suspicion is crucial to make an early diagnosis and avoid devastating neurological outcomes.
[Mh] Termos MeSH primário: Cefaleia/etiologia
Infarto da Artéria Cerebral Posterior/complicações
Dissecação da Artéria Vertebral/complicações
Transtornos da Visão/etiologia
[Mh] Termos MeSH secundário: Adulto
Angiografia Cerebral
Angiografia por Tomografia Computadorizada
Imagem de Difusão por Ressonância Magnética
Seres Humanos
Infarto da Artéria Cerebral Posterior/diagnóstico por imagem
Masculino
Tomografia Computadorizada por Raios X
Dissecação da Artéria Vertebral/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170111
[Lr] Data última revisão:
170111
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160427
[St] Status:MEDLINE
[do] DOI:10.1186/s13256-016-0893-8


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[PMID]:27103271
[Au] Autor:Sauer T; Wolf ME; Ebert AD; Szabo K; Chatzikonstantinou A
[Ad] Endereço:Department of Neurology, Universitaetsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
[Ti] Título:Vertebral Artery Hypoplasia Does Not Influence Lesion Size and Clinical Severity in Acute Ischemic Stroke.
[So] Source:J Stroke Cerebrovasc Dis;25(7):1770-1775, 2016 Jul.
[Is] ISSN:1532-8511
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Vertebral artery hypoplasia (VAH) is common, but its role in acute ischemic stroke (AIS) is uncertain. We aimed to evaluate the frequency, characteristics, and role of VAH in a large typical cohort of patients with AIS. METHODS: Up to 815 AIS patients (52.8% men, mean age 70 ± 14 years) were included in the study. All patients received a stroke work-up including brain imaging and duplex ultrasound. VAH was defined by a vessel diameter of less than or equal to 2.5 mm or a difference to the contralateral side of greater than 1:1.7. Vascular risk factors and stroke features were recorded. The subgroup of patients with posterior circulation AIS and magnetic resonance imaging was analyzed additionally, including the parameter of stroke extent. RESULTS: Up to 111 patients (13.6%) had VAH, with a mean diameter of 2.4 ± .4 mm. Patients with VAH were significantly younger (P = .037) and more often male (P = .033). There was no difference considering the National Institutes of Health Stroke Scale and modified Rankin Scale scores on admission or history of stroke. The distribution of patients without VAH was significantly different among the groups with anterior, posterior, and both circulations ischemia (P = .009). In the group with posterior circulation stroke, 36 patients (20.9%) had VAH. There were no differences in age, sex, history of stroke, risk factors, vascular territory, stroke size, or etiology. VAH patients had less often embolic stroke patterns (P = .009). CONCLUSIONS: VAH is more common in patients with posterior circulation stroke and in younger patients. Apart from that, we found no clear evidence that VAH would be a predisposing factor for stroke or that it increased the risk for larger ischemic lesions in the posterior circulation.
[Mh] Termos MeSH primário: Isquemia Encefálica/epidemiologia
Malformações Vasculares do Sistema Nervoso Central/epidemiologia
Acidente Vascular Cerebral/epidemiologia
Artéria Vertebral/anormalidades
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Isquemia Encefálica/diagnóstico por imagem
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem
Avaliação da Deficiência
Feminino
Alemanha/epidemiologia
Seres Humanos
Infarto da Artéria Cerebral Posterior/diagnóstico por imagem
Infarto da Artéria Cerebral Posterior/epidemiologia
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Prevalência
Fatores de Risco
Índice de Gravidade de Doença
Fatores Sexuais
Acidente Vascular Cerebral/diagnóstico por imagem
Tomografia Computadorizada por Raios X
Artéria Vertebral/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170811
[Lr] Data última revisão:
170811
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160423
[St] Status:MEDLINE


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[PMID]:26970141
[Au] Autor:Petersen A; Vangkilde S; Fabricius C; Iversen HK; Delfi TS; Starrfelt R
[Ad] Endereço:Department of Psychology, University of Copenhagen, Denmark. Electronic address: anders.petersen@psy.ku.dk.
[Ti] Título:Visual attention in posterior stroke and relations to alexia.
[So] Source:Neuropsychologia;92:79-89, 2016 Nov.
[Is] ISSN:1873-3514
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Impaired visual attention is common following strokes in the territory of the middle cerebral artery, particularly in the right hemisphere, while attentional effects of more posterior lesions are less clear. Commonly, such deficits are investigated in relation to specific syndromes like visual agnosia or pure alexia. The aim of this study was to characterize visual processing speed and apprehension span following posterior cerebral artery (PCA) stroke. In addition, the relationship between these attentional parameters and single word reading is investigated, as previous studies have suggested that reduced visual speed and span may explain pure alexia. Eight patients with unilateral PCA strokes (four left hemisphere, four right hemisphere) were selected on the basis of lesion location, rather than the presence of any visual symptoms. Visual attention was characterized by a whole report paradigm allowing for hemifield-specific measurements of processing speed and apprehension span. All patients showed reductions in visual span contralateral to the lesion site, and four patients showed bilateral reductions in visual span despite unilateral lesions (2L; 2R). Six patients showed selective deficits in visual span, though processing speed was unaffected in the same field (ipsi- or contralesionally). Only patients with right hemifield reductions in visual span were impaired in reading, and this could follow either right or left lateralized stroke and was irrespective of visual field impairments. In conclusion, visual span may be affected bilaterally by unilateral PCA-lesions. Reductions in visual span may also be confined to one hemifield, and may be affected in spite of preserved visual processing speed. Furthermore, reduced span in the right visual field seems to be related to reading impairment in this group, regardless of lesion lateralization.
[Mh] Termos MeSH primário: Alexia Pura/etiologia
Atenção
Infarto da Artéria Cerebral Posterior/complicações
Infarto da Artéria Cerebral Posterior/psicologia
Percepção Visual
[Mh] Termos MeSH secundário: Idoso
Alexia Pura/diagnóstico por imagem
Encéfalo/diagnóstico por imagem
Feminino
Lateralidade Funcional
Seres Humanos
Infarto da Artéria Cerebral Posterior/diagnóstico por imagem
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Testes Neuropsicológicos
Tempo de Reação
Leitura
Testes de Campo Visual
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170426
[Lr] Data última revisão:
170426
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160313
[St] Status:MEDLINE


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[PMID]:26914571
[Au] Autor:Nakadate M; Miyamoto N; Starkey J; Toriihara A; Tateishi U
[Ad] Endereço:From the *Department of Diagnostic Radiology, Medical Hospital, Tokyo Medical and Dental University, Tokyo; †Department of Internal Medicine, Chiba-Nishi General Hospital, Chiba; and ‡Department of Radiology, St Luke's International Hospital, Tokyo, Japan.
[Ti] Título:Anterograde Degeneration of the Nigrostriatal Pathway Visualized by 123I-FP-CIT SPECT in a Patient With Artery of Percheron Infarction.
[So] Source:Clin Nucl Med;41(6):483-4, 2016 Jun.
[Is] ISSN:1536-0229
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:I-FP-CIT SPECT is widely used for diagnosis in patients with parkinsonism. Vascular parkinsonism usually has nonspecific findings from normal uptake to radiotracer decrease in the infarcted region. Infarction of the substantia nigra has been reported as a rare cause of vascular parkinsonism. We present a case of artery of Percheron infarction involving the substantia nigra unilaterally with ipsilateral reduction of striatal uptake on I-FP-CIT SPECT, suggesting anterograde degeneration of the nigrostriatal pathway. Infarction of the substantia nigra should be considered in cases of decreased striatal uptake with marked laterality on I-FP-CIT SPECT.
[Mh] Termos MeSH primário: Infarto da Artéria Cerebral Posterior/diagnóstico por imagem
Neostriado/diagnóstico por imagem
Transtornos Parkinsonianos/diagnóstico por imagem
Artéria Cerebral Posterior/anormalidades
Substância Negra/diagnóstico por imagem
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Variação Anatômica
Artérias
Infarto Encefálico/complicações
Infarto Encefálico/diagnóstico por imagem
Infarto Encefálico/metabolismo
Corpo Estriado/diagnóstico por imagem
Corpo Estriado/metabolismo
Seres Humanos
Infarto da Artéria Cerebral Posterior/complicações
Infarto da Artéria Cerebral Posterior/metabolismo
Imagem por Ressonância Magnética
Masculino
Neostriado/metabolismo
Vias Neurais/diagnóstico por imagem
Doenças Neurodegenerativas/diagnóstico por imagem
Doenças Neurodegenerativas/etiologia
Doenças Neurodegenerativas/metabolismo
Transtornos Parkinsonianos/etiologia
Transtornos Parkinsonianos/metabolismo
Compostos Radiofarmacêuticos
Substância Negra/metabolismo
Tomografia Computadorizada de Emissão de Fóton Único
Tropanos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Radiopharmaceuticals); 0 (Tropanes); 155797-99-2 (2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane)
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170117
[Lr] Data última revisão:
170117
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160226
[St] Status:MEDLINE
[do] DOI:10.1097/RLU.0000000000001187


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[PMID]:26828207
[Au] Autor:Kurabe S; Okamoto K; Suzuki K; Matsuzawa H; Watanabe M; Suzuki Y; Nakada T; Fujii Y
[Ad] Endereço:Department of Neurosurgery and Center for Integrated Human Brain Science, Brain Research Institute, University of Niigata, Niigata, Japan.
[Ti] Título:The Posterior Limb of the Internal Capsule as the Subcortical Transitional Zone of the Anterior and Posterior Circulations: Insights from Human 7T MRI.
[So] Source:Cerebrovasc Dis;41(5-6):256-64, 2016.
[Is] ISSN:1421-9786
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In patients with cerebral infarction, identifying the distribution of infarction and the relevant artery is essential for ascertaining the underlying vascular pathophysiological mechanisms and preventing subsequent stroke. However, visualization of the basal perforating arteries (BPAs) has had limited success, and simultaneous viewing of background anatomical structures has only rarely been attempted in living human brains. Our study aimed at identifying the BPAs with 7T MRI and evaluating their distribution in the subcortical structures, thereby showing the clinical significance of the technique. METHODS: Twenty healthy subjects and 1 patient with cerebral infarction involving the posterior limb of the internal capsule (ICpost) and thalamus underwent 3-dimensional fast spoiled gradient-echo sequence as time-of-flight magnetic resonance angiography (MRA) at 7T with a submillimeter resolution. The MRA was modified to detect inflow signals from BPAs, while preserving the background anatomical signals. BPA stems and branches in the subcortical structures and their origins were identified on images, using partial maximum intensity projection in 3 dimensions. RESULTS: A branch of the left posterior cerebral artery (PCA) in the patient ran through both the infarcted thalamus and ICpost and was clearly the relevant artery. In 40 intact hemispheres in healthy subjects, 571 stems and 1,421 branches of BPAs were detected in the subcortical structures. No significant differences in the numbers of stems and branches were observed between the intact hemispheres. The numbers deviated even less across subjects. The distribution analysis showed that the subcortical structures of the telencephalon, such as the caudate nucleus, anterior limb of the internal capsule, and lenticular nucleus, were predominantly supplied by BPAs from the anterior circulation. In contrast, the thalamus, belonging to the diencephalon, was mostly fed by BPAs from the posterior circulation. However, compared with other subcortical structures, the ICpost, which marks the anatomical boundary between the telencephalon and the diencephalon, was supplied by BPAs with significantly more diverse origins. These BPAs originated from the internal carotid artery (23.1%), middle cerebral artery (38.5%), PCA (17.3%), and the posterior communicating artery (21.1%). CONCLUSIONS: The modified MRI method allowed the detection of the relevant BPA within the infarcted area in the stroke survivor as well as the BPAs in the subcortical structures of living human brains. Based on in vivo BPA distribution analyses, the ICpost is the transitional zone of the anterior and posterior cerebral circulations.
[Mh] Termos MeSH primário: Artéria Cerebral Anterior/diagnóstico por imagem
Angiografia Cerebral/métodos
Circulação Cerebrovascular
Infarto da Artéria Cerebral Anterior/diagnóstico por imagem
Infarto da Artéria Cerebral Posterior/diagnóstico por imagem
Cápsula Interna/diagnóstico por imagem
Angiografia por Ressonância Magnética
Artéria Cerebral Posterior/diagnóstico por imagem
Doenças Talâmicas/diagnóstico por imagem
Tálamo/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Idoso de 80 Anos ou mais
Artéria Cerebral Anterior/fisiopatologia
Artéria Carótida Interna/diagnóstico por imagem
Artéria Carótida Interna/fisiopatologia
Estudos de Casos e Controles
Feminino
Seres Humanos
Infarto da Artéria Cerebral Anterior/fisiopatologia
Infarto da Artéria Cerebral Posterior/fisiopatologia
Cápsula Interna/irrigação sanguínea
Artéria Cerebral Média/diagnóstico por imagem
Artéria Cerebral Média/fisiopatologia
Artéria Cerebral Posterior/fisiopatologia
Valor Preditivo dos Testes
Doenças Talâmicas/fisiopatologia
Tálamo/irrigação sanguínea
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160202
[St] Status:MEDLINE
[do] DOI:10.1159/000443538


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[PMID]:26820989
[Au] Autor:Sporns P; Schmidt R; Minnerup J; Dziewas R; Kemmling A; Dittrich R; Zoubi T; Heermann P; Cnyrim C; Schwindt W; Heindel W; Niederstadt T; Hanning U
[Ad] Endereço:Department of Clinical Radiology, University Hospital of Muenster, Muenster, Germany.
[Ti] Título:Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke.
[So] Source:Cerebrovasc Dis;41(5-6):242-7, 2016.
[Is] ISSN:1421-9786
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Computed tomography perfusion (CTP) has a high diagnostic value in the detection of acute ischemic stroke in the anterior circulation. However, the diagnostic value in suspected posterior circulation (PC) stroke is uncertain, and whole brain volume perfusion is not yet in widespread use. We therefore studied the additional value of whole brain volume perfusion to non-contrast CT (NCCT) and CT angiography source images (CTA-SI) for infarct detection in patients with suspected acute ischemic PC stroke. METHODS: This is a retrospective review of patients with suspected stroke in the PC in a database of our stroke center (n = 3,011) who underwent NCCT, CTA and CTP within 9 h after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and pc-ASPECTS locations of ischemia. Three imaging models - A (NCCT), B (NCCT + CTA-SI) and C (NCCT + CTA-SI + CTP) - were compared with regard to the misclassification rate relative to gold standard (infarction in follow-up imaging) using the McNemar's test. RESULTS: Of 3,011 stroke patients, 267 patients had a suspected stroke in the PC and 188 patients (70.4%) evidenced a PC infarct on follow-up imaging. The sensitivity of Model C (76.6%) was higher compared with that of Model A (21.3%) and Model B (43.6%). CTP detected significantly more ischemic lesions, especially in the cerebellum, posterior cerebral artery territory and thalami. CONCLUSIONS: Our findings in a large cohort of consecutive patients show that CTP detects significantly more ischemic strokes in the PC than CTA and NCCT alone.
[Mh] Termos MeSH primário: Angiografia Cerebral/métodos
Circulação Cerebrovascular
Infarto da Artéria Cerebral Posterior/diagnóstico por imagem
Tomografia Computadorizada Multidetectores
Imagem de Perfusão/métodos
Artéria Cerebral Posterior/diagnóstico por imagem
[Mh] Termos MeSH secundário: Idoso
Meios de Contraste/administração & dosagem
Imagem de Difusão por Ressonância Magnética
Feminino
Seres Humanos
Infarto da Artéria Cerebral Posterior/fisiopatologia
Iohexol/administração & dosagem
Iohexol/análogos & derivados
Masculino
Artéria Cerebral Posterior/fisiopatologia
Valor Preditivo dos Testes
Reprodutibilidade dos Testes
Estudos Retrospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contrast Media); 4419T9MX03 (Iohexol); 712BAC33MZ (iopromide)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160129
[St] Status:MEDLINE
[do] DOI:10.1159/000443618


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[PMID]:26580422
[Au] Autor:Kim BJ; Kim SM; Ahn SH; Kang DW; Kwon SU; Kim JS
[Ad] Endereço:Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, South Korea.
[Ti] Título:Lateral Thalamic Infarction and the Vascular Geometry of the Posterior Cerebral Artery.
[So] Source:Cerebrovasc Dis;41(1-2):8-12, 2016.
[Is] ISSN:1421-9786
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The geometric properties of the parental artery affect the development of local atherosclerosis and perforator infarction. In this study, we aimed at investigating the association between vascular geometry of the posterior cerebral artery (PCA) and the development of isolated lateral thalamic infarction (LTI), the most frequent type of thalamic infarction. METHODS: The geometric properties of the corresponding PCA in LTI patients were assessed and they include the diameters of the distal basilar artery (BA) and proximal PCA, distal BA - PCA angle, first PCA angle (angle between P1 and P2), and the presence of the posterior communicating artery (Pcom). These parameters obtained from the ipsilesional PCA were compared with the contralesional PCA and the corresponding PCA in age- and sex-matched controls. RESULTS: Forty-five LTI patients were enrolled. The ipsilesional PCA in LTI patients demonstrated a greater ipsilesional P1 - P2 angle (81.4 ± 22.6 vs. 71.3 ± 23.2°, respectively; p = 0.04) and a higher prevalence of Pcom (42.2 vs. 13.3%; p = 0.002) when compared to control subjects. In comparison with the contralesional PCA, ipsilesional PCA demonstrated a smaller diameter, larger angle between P1 and P2 segment, and a higher prevalence of Pcom. The presence of hyperlipidemia (OR 3.548 (1.283-9.811); p = 0.02) and Pcom (OR 3.507 (1.104-11.135); p = 0.03) was a factor that was independently associated with LTI. CONCLUSIONS: Local hemodynamics in the PCA may be influenced by the P1 - P2 angle and the presence of Pcom, which are associated with the development of LTI.
[Mh] Termos MeSH primário: Artéria Basilar/anatomia & histologia
Círculo Arterial do Cérebro/anatomia & histologia
Infarto da Artéria Cerebral Posterior/epidemiologia
Artéria Cerebral Posterior/anatomia & histologia
Tálamo/irrigação sanguínea
[Mh] Termos MeSH secundário: Idoso
Estudos de Casos e Controles
Angiografia Cerebral
Circulação Cerebrovascular
Feminino
Hemodinâmica
Seres Humanos
Hiperlipidemias/epidemiologia
Infarto da Artéria Cerebral Posterior/diagnóstico
Angiografia por Ressonância Magnética
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1611
[Cu] Atualização por classe:161230
[Lr] Data última revisão:
161230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151119
[St] Status:MEDLINE
[do] DOI:10.1159/000439062



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