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[PMID]:29489696
[Au] Autor:Ren H; Ma L; Wei M; Li J; Yu M; Yin L
[Ad] Endereço:Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
[Ti] Título:Duplicated middle cerebral artery origin with an aneurysm.
[So] Source:Medicine (Baltimore);97(9):e9947, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Middle cerebral artery (MCA) anomalies are relatively rare and often related to aneurysms. Familiarity with these anomalies is important in resolving problems that arise in the complex angioarchitecture. Reports often describe that aneurysms that are related to accessory or duplicated MCA are often located at its origin. PATIENT CONCERNS: A 59-year-old man presented with a headache for 10 days, without nausea and vomiting. The physical examination was negative. DIAGNOSIS: A computed tomography (CT) scan revealed an intracerebral hematoma in the deep right frontal lobe, near the caudate nucleus. Digital subtraction angiography (DSA) revealed an anomalous duplicated origin of the right MCA, with occlusion of the main MCA trunk as well as twisting and dilation of the accessory MCA trunk. A wide-necked aneurysm was located at a sharp curve of the tortuous accessory MCA trunk. A ruptured aneurysm related to a duplicated MCA origin was diagnosed. INTERVENTIONS: Open surgery was rejected by the patient; hence, palliative endovascular coil embolization of the larger daughter sac was performed. OUTCOMES: The postoperative course was uneventful. There was no rebleeding at 8-months follow-up. LESSONS: MCA anomalies are relatively rare and often related to aneurysms. It is important to be familiar with these anomalies as related lesions often manifest within a complex angioarchitecture. Aneurysms at the trunk of an anomalous MCA are a rare entity and open surgery may be recommended.
[Mh] Termos MeSH primário: Aneurisma Roto/diagnóstico por imagem
Aneurisma Intracraniano/diagnóstico por imagem
Artéria Cerebral Média/anormalidades
[Mh] Termos MeSH secundário: Aneurisma Roto/complicações
Angiografia Digital
Angiografia Cerebral
Cefaleia/diagnóstico por imagem
Cefaleia/etiologia
Seres Humanos
Aneurisma Intracraniano/complicações
Masculino
Meia-Idade
Artéria Cerebral Média/diagnóstico por imagem
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009947


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[PMID]:28455321
[Au] Autor:Derdeyn CP; Fiorella D; Lynn MJ; Turan TN; Cotsonis GA; Lane BF; Montgomery J; Janis LS; Chimowitz MI; SAMMPRIS Investigators
[Ad] Endereço:From the Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, State University of New York, Stony Brook (D.F.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta,
[Ti] Título:Nonprocedural Symptomatic Infarction and In-Stent Restenosis After Intracranial Angioplasty and Stenting in the SAMMPRIS Trial (Stenting and Aggressive Medical Management for the Prevention of Recurrent Stroke in Intracranial Stenosis).
[So] Source:Stroke;48(6):1501-1506, 2017 06.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: The purpose of this study was to investigate the frequency of symptomatic in-stent restenosis (ISR) and its contribution to nonprocedural symptomatic infarction in the SAMMPRIS trial (Stenting and Aggressive Medical Management for the Prevention of Recurrent Stroke in Intracranial Stenosis). METHODS: Patients without a periprocedural primary end point were followed up to determine the occurrence of any of the following events: ischemic stroke, cerebral infarct with temporary signs, or transient ischemic attack in the territory of the stented artery. Vascular imaging performed after these events was reviewed for ISR. Annual rates for symptomatic ISR were calculated using Kaplan-Meier estimates. RESULTS: Of 183 patients in the stenting group without a periprocedural primary end point, 27 (14.8%) had a symptomatic infarction (stroke or cerebral infarct with temporary signs) and 16 (8.7%) had transient ischemic attack alone in the territory during a median follow-up of 35.0 months. Of the 27 patients with infarctions, 17 (9.3%) had an ischemic stroke and 10 (5.5%) had a cerebral infarct with temporary signs alone. Adequate vascular imaging to evaluate ISR was available in 24 patients with infarctions (showing ISR in 16 [66.7%]) and in 10 patients with transient ischemic attack alone (showing ISR in 8 [80%]). The 1-, 2-, and 3-year rates (with 95% confidence limits) for symptomatic ISR in the SAMMPRIS stent cohort were 9.6% (6.1%-14.9%), 11.3% (7.5%-17.0%), and 14.0% (9.6%-20.2%), respectively. CONCLUSIONS: Symptomatic ISR occurred in at least 1 of 7 patients in SAMMPRIS by 3 years of follow-up and was likely responsible for the majority of nonprocedural cerebral infarctions. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT00576693.
[Mh] Termos MeSH primário: Angioplastia com Balão/estatística & dados numéricos
Isquemia Encefálica/epidemiologia
Constrição Patológica/epidemiologia
Doenças Arteriais Intracranianas/epidemiologia
Doenças Arteriais Intracranianas/terapia
Complicações Pós-Operatórias/epidemiologia
Stents/estatística & dados numéricos
Acidente Vascular Cerebral/epidemiologia
[Mh] Termos MeSH secundário: Assistência ao Convalescente
Idoso
Angioplastia com Balão/efeitos adversos
Isquemia Encefálica/diagnóstico
Angiografia Cerebral
Infarto Cerebral/diagnóstico por imagem
Infarto Cerebral/epidemiologia
Constrição Patológica/diagnóstico por imagem
Feminino
Seres Humanos
Doenças Arteriais Intracranianas/diagnóstico por imagem
Ataque Isquêmico Transitório/diagnóstico por imagem
Ataque Isquêmico Transitório/epidemiologia
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Complicações Pós-Operatórias/diagnóstico por imagem
Recidiva
Risco
Stents/efeitos adversos
Acidente Vascular Cerebral/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.116.014537


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[PMID]:29364767
[Au] Autor:Albers GW; Marks MP; Kemp S; Christensen S; Tsai JP; Ortega-Gutierrez S; McTaggart RA; Torbey MT; Kim-Tenser M; Leslie-Mazwi T; Sarraj A; Kasner SE; Ansari SA; Yeatts SD; Hamilton S; Mlynash M; Heit JJ; Zaharchuk G; Kim S; Carrozzella J; Palesch YY; Demchuk AM; Bammer R; Lavori PW; Broderick JP; Lansberg MG; DEFUSE 3 Investigators
[Ad] Endereço:From the Departments of Neurology and Neurological Sciences (G.W.A., S. Kemp, S.C., J.P.T., S.H., M.M., M.G.L.), Diagnostic Radiology (M.P.M., J.J.H., G.Z.), Radiology (R.B.), and Biomedical Data Science (P.W.L.), Stanford University School of Medicine, Stanford, and the Department of Neurology, Kec
[Ti] Título:Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging.
[So] Source:N Engl J Med;378(8):708-718, 2018 02 22.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Thrombectomy is currently recommended for eligible patients with stroke who are treated within 6 hours after the onset of symptoms. METHODS: We conducted a multicenter, randomized, open-label trial, with blinded outcome assessment, of thrombectomy in patients 6 to 16 hours after they were last known to be well and who had remaining ischemic brain tissue that was not yet infarcted. Patients with proximal middle-cerebral-artery or internal-carotid-artery occlusion, an initial infarct size of less than 70 ml, and a ratio of the volume of ischemic tissue on perfusion imaging to infarct volume of 1.8 or more were randomly assigned to endovascular therapy (thrombectomy) plus standard medical therapy (endovascular-therapy group) or standard medical therapy alone (medical-therapy group). The primary outcome was the ordinal score on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at day 90. RESULTS: The trial was conducted at 38 U.S. centers and terminated early for efficacy after 182 patients had undergone randomization (92 to the endovascular-therapy group and 90 to the medical-therapy group). Endovascular therapy plus medical therapy, as compared with medical therapy alone, was associated with a favorable shift in the distribution of functional outcomes on the modified Rankin scale at 90 days (odds ratio, 2.77; P<0.001) and a higher percentage of patients who were functionally independent, defined as a score on the modified Rankin scale of 0 to 2 (45% vs. 17%, P<0.001). The 90-day mortality rate was 14% in the endovascular-therapy group and 26% in the medical-therapy group (P=0.05), and there was no significant between-group difference in the frequency of symptomatic intracranial hemorrhage (7% and 4%, respectively; P=0.75) or of serious adverse events (43% and 53%, respectively; P=0.18). CONCLUSIONS: Endovascular thrombectomy for ischemic stroke 6 to 16 hours after a patient was last known to be well plus standard medical therapy resulted in better functional outcomes than standard medical therapy alone among patients with proximal middle-cerebral-artery or internal-carotid-artery occlusion and a region of tissue that was ischemic but not yet infarcted. (Funded by the National Institute of Neurological Disorders and Stroke; DEFUSE 3 ClinicalTrials.gov number, NCT02586415 .).
[Mh] Termos MeSH primário: Fibrinolíticos/uso terapêutico
Imagem de Perfusão
Acidente Vascular Cerebral/cirurgia
Trombectomia
[Mh] Termos MeSH secundário: Idoso
Isquemia Encefálica/diagnóstico por imagem
Isquemia Encefálica/cirurgia
Angiografia Cerebral
Terapia Combinada
Procedimentos Endovasculares
Feminino
Seres Humanos
Masculino
Meia-Idade
Método Simples-Cego
Acidente Vascular Cerebral/diagnóstico por imagem
Acidente Vascular Cerebral/tratamento farmacológico
Acidente Vascular Cerebral/mortalidade
Tempo para o Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Fibrinolytic Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180125
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1713973


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[PMID]:29342213
[Au] Autor:Tutino VM; Poppenberg KE; Jiang K; Jarvis JN; Sun Y; Sonig A; Siddiqui AH; Snyder KV; Levy EI; Kolega J; Meng H
[Ad] Endereço:Toshiba Stroke and Vascular Research Center; University at Buffalo, State University of New York, Buffalo, New York, United States of America.
[Ti] Título:Circulating neutrophil transcriptome may reveal intracranial aneurysm signature.
[So] Source:PLoS One;13(1):e0191407, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Unruptured intracranial aneurysms (IAs) are typically asymptomatic and undetected except for incidental discovery on imaging. Blood-based diagnostic biomarkers could lead to improvements in IA management. This exploratory study examined circulating neutrophils to determine whether they carry RNA expression signatures of IAs. METHODS: Blood samples were collected from patients receiving cerebral angiography. Eleven samples were collected from patients with IAs and 11 from patients without IAs as controls. Samples from the two groups were paired based on demographics and comorbidities. RNA was extracted from isolated neutrophils and subjected to next-generation RNA sequencing to obtain differential expressions for identification of an IA-associated signature. Bioinformatics analyses, including gene set enrichment analysis and Ingenuity Pathway Analysis, were used to investigate the biological function of all differentially expressed transcripts. RESULTS: Transcriptome profiling identified 258 differentially expressed transcripts in patients with and without IAs. Expression differences were consistent with peripheral neutrophil activation. An IA-associated RNA expression signature was identified in 82 transcripts (p<0.05, fold-change ≥2). This signature was able to separate patients with and without IAs on hierarchical clustering. Furthermore, in an independent, unpaired, replication cohort of patients with IAs (n = 5) and controls (n = 5), the 82 transcripts separated 9 of 10 patients into their respective groups. CONCLUSION: Preliminary findings show that RNA expression from circulating neutrophils carries an IA-associated signature. These findings highlight a potential to use predictive biomarkers from peripheral blood samples to identify patients with IAs.
[Mh] Termos MeSH primário: Aneurisma Intracraniano/genética
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Aneurisma Roto/genética
Biomarcadores/sangue
Angiografia Cerebral
Estudos de Coortes
Biologia Computacional
Feminino
Perfilação da Expressão Gênica
Seres Humanos
Aneurisma Intracraniano/sangue
Aneurisma Intracraniano/metabolismo
Masculino
Meia-Idade
Neutrófilos/metabolismo
Fatores de Risco
Transcriptoma
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Biomarkers)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180118
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191407


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[PMID]:28457861
[Au] Autor:Binyamin TR; Dahlin BC; Waldau B
[Ad] Endereço:Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95811, United States.
[Ti] Título:Comparison of 3D TOF MR angiographic accuracy in predicting Raymond grade of flow-diverted versus coiled intracranial aneurysms.
[So] Source:J Clin Neurosci;42:182-185, 2017 Aug.
[Is] ISSN:1532-2653
[Cp] País de publicação:Scotland
[La] Idioma:eng
[Ab] Resumo:The accuracy of 3D time of Flight Magnetic Resonance Angiography (TOF MRA) has been studied extensively for following coiled intracranial aneurysms. It is used by many clinicians for non-invasive follow-up because of its adequate sensitivity in predicting aneurysmal recanalization compared to diagnostic cerebral angiography. The data on the accuracy of 3D TOF MRA for the Pipeline™ Embolization Device (PED) are sparse. In a retrospective chart review, we compared the accuracy of 3D TOF MRA of PED to coil embolization at our institution. 3D TOF MRA had a lower sensitivity and positive predictive value in detecting aneurysmal filling in PED-treated versus coiled aneurysms (57% versus 87% and 80% versus 100%, respectively). Analysis of discrepancies between conventional diagnostic angiography and 3D TOF MRA revealed that 3D TOF MRA was inaccurate in the setting of small residual necks and slow residual filling of the dome with fluid-fluid layers. Therefore, contrasted studies such as contrast-enhanced MRA may be preferred for non-invasively following PED-treated aneurysms to increase accuracy.
[Mh] Termos MeSH primário: Angiografia Digital/métodos
Angiografia Cerebral/métodos
Aneurisma Intracraniano/diagnóstico por imagem
Angiografia por Ressonância Magnética/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Angiografia Digital/normas
Angiografia Cerebral/normas
Meios de Contraste
Feminino
Seres Humanos
Imagem Tridimensional/métodos
Imagem Tridimensional/normas
Angiografia por Ressonância Magnética/normas
Meia-Idade
Sensibilidade e Especificidade
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contrast Media)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:28743241
[Au] Autor:Herath HMMTB; Pahalagamage SP; Withana D; Senanayake S
[Ad] Endereço:National Hospital, Colombo, Sri Lanka. tharukaherath11@gmail.com.
[Ti] Título:Complete ophthalmoplegia, complete ptosis and dilated pupil due to internal carotid artery dissection: as the first manifestation of Takayasu arteritis.
[So] Source:BMC Cardiovasc Disord;17(1):201, 2017 07 25.
[Is] ISSN:1471-2261
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Takayasu arteritis is a rare, chronic large vessel vasculitis involving the aorta and its primary branches. As the disease progresses, the active inflammation of large vessels leads to dilation, narrowing and occlusion of the arteries. Arterial dissection is due to separation of the layers of the arterial wall resulting in a false lumen, where blood seeps into the vessel wall. Neurological sequelae of intracranial arterial dissection results from cerebral ischemia due to thromboembolism and hypo perfusion. Internal carotid artery dissection in Takayasu arteritis is very rare and complete ophthalmoplegia due to internal carotid artery dissection is also rare. This is the first case report of Takayasu arteritis presenting as complete ophthalmoplegia due to internal carotid artery dissection. CASE PRESENTATION: A 38-year-old Sri Lankan female presented with sudden onset severe headache, fixed dilated pupil, complete ptosis and ophthalmoplegia on the right side. On imaging, dissection and dilatation was evident in the right internal carotid artery from the origin up to the cavernous segment. She also had stenosis and aneurysmal dilatation of right subclavian artery. Takayasu arteritis was diagnosed subsequently. She was started on aspirin and high dose steroids. CONCLUSIONS: Internal carotid artery dissection within the cavernous sinus can lead to third, fourth and sixth nerve palsy due to compression, stretching and ischemia from occlusion of the nutritional arteries. This case report illustrates that internal carotid artery dissection should be a differential diagnosis in palsies of the third, fourth, or sixth cranial nerves, especially when associated with headache. In cases of internal carotid artery dissection, vasculitis such as Takayasu arteritis should also be considered.
[Mh] Termos MeSH primário: Aneurisma Dissecante/etiologia
Blefaroptose/etiologia
Doenças das Artérias Carótidas/etiologia
Artéria Carótida Interna
Aneurisma Intracraniano/etiologia
Oftalmoplegia/etiologia
Pupila
Arterite de Takayasu/complicações
[Mh] Termos MeSH secundário: Adulto
Aneurisma Dissecante/diagnóstico por imagem
Angiografia Digital
Aspirina/administração & dosagem
Blefaroptose/diagnóstico
Blefaroptose/fisiopatologia
Doenças das Artérias Carótidas/diagnóstico por imagem
Artéria Carótida Interna/diagnóstico por imagem
Angiografia Cerebral/métodos
Angiografia por Tomografia Computadorizada
Feminino
Seres Humanos
Aneurisma Intracraniano/diagnóstico por imagem
Imagem por Ressonância Magnética
Oftalmoplegia/diagnóstico
Oftalmoplegia/fisiopatologia
Esteroides/administração & dosagem
Arterite de Takayasu/diagnóstico
Arterite de Takayasu/tratamento farmacológico
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Steroids); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1186/s12872-017-0638-7


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[PMID]:29261469
[Au] Autor:Lindenholz A; van der Kolk AG; Zwanenburg JJM; Hendrikse J
[Ad] Endereço:From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands.
[Ti] Título:The Use and Pitfalls of Intracranial Vessel Wall Imaging: How We Do It.
[So] Source:Radiology;286(1):12-28, 2018 Jan.
[Is] ISSN:1527-1315
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Intracranial vessel wall magnetic resonance (MR) imaging has gained much attention in the past decade and has become part of state-of-the-art MR imaging protocols to assist in diagnosing the cause of ischemic stroke. With intracranial vessel wall imaging, vessel wall characteristics have tentatively been described for atherosclerosis, vasculitis, dissections, Moyamoya disease, and aneurysms. With the increasing demand and subsequently increased use of intracranial vessel wall imaging in clinical practice, radiologists should be aware of the choices in imaging parameters and how they affect image quality, the clinical indications, methods of assessment, and limitations in the interpretation of these images. In this How I do It article, the authors will discuss the technical requirements and considerations for vessel wall image acquisition in general, describe their own vessel wall imaging protocol at 3 T and 7 T, show a step-by-step basic assessment of intracranial vessel wall imaging as performed at their institution-including commonly encountered artifacts and pitfalls-and summarize the commonly reported imaging characteristics of various intracranial vessel wall diseases for direct clinical applicability. Finally, future technical and clinical considerations for full implementation of intracranial vessel wall imaging in clinical practice, including the need for histologic validation and acquisition time reduction, will be discussed.
[Mh] Termos MeSH primário: Encéfalo/irrigação sanguínea
Encéfalo/diagnóstico por imagem
Interpretação de Imagem Assistida por Computador/métodos
Doenças Arteriais Intracranianas/diagnóstico por imagem
Imagem por Ressonância Magnética/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Angiografia Cerebral
Meios de Contraste
Feminino
Seres Humanos
Imagem Tridimensional
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contrast Media)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE
[do] DOI:10.1148/radiol.2017162096


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[PMID]:29190051
[Au] Autor:Mäkitie L; Korja M; Kangasniemi M; Kallela M; Forss N; Niemelä M; Lindsberg PJ
[Ti] Título:Headache as symptom of intracranial hemorrhage.
[So] Source:Duodecim;132(21):1993-9, 2016.
[Is] ISSN:0012-7183
[Cp] País de publicação:Finland
[La] Idioma:eng
[Ab] Resumo:The most important signs of danger of a headache patient include exceptionally intense or acute headache, transient loss or progressive impairment of consciousness, and neurological deficit symptoms. These patients are referred to an urgent assessment by a physician. Computed tomography scanning of the head is carried out in the case of suspected hemorrhage of a headache patient. Routine diagnosis employing cerebrospinal fluid analysis can be abandoned when excluding subarachnoid hemorrhage in a patient with headache symptoms, if blood is with certainty not observed in the CT scan of the head and no more than six hours have passed after the onset of the symptom. If subarachnoid hemorrhage is detected, cerebral CT angiography will be performed at the same time and a neurosurgeon consulted about the need of operative treatment.
[Mh] Termos MeSH primário: Angiografia Cerebral
Angiografia por Tomografia Computadorizada
Cefaleia/diagnóstico por imagem
Cefaleia/etiologia
Hemorragias Intracranianas/complicações
Hemorragias Intracranianas/diagnóstico por imagem
[Mh] Termos MeSH secundário: Diagnóstico Diferencial
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE


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[PMID]:29190049
[Au] Autor:Vanninen R; Putaala J; Bode M; Nyman M; Pekkola J; Manninen H
[Ti] Título:Imaging of an acute stroke patient when planning therapy for arterial thrombosis.
[So] Source:Duodecim;132(21):1973-82, 2016.
[Is] ISSN:0012-7183
[Cp] País de publicação:Finland
[La] Idioma:eng
[Ab] Resumo:Intra-arterial thrombectomy is a highly effective mode of treatment for properly selected patients with acute cerebral ischemia. Imaging studies are essential for making a decision on the treatment of acute cerebral infarction. In imaging, a combination of unenhanced CT scan of the head and CT angiography of the carotid and cerebral arteries during one imaging procedure is recommended for all patients coming into the hospital within the time window for thrombectomy, for patients with unclear time of onset of the symptoms and for whom cerebral hemorrhage is excluded as the cause in unenhanced CT scan. This may further be complemented with CT perfusion imaging. In certain acute situations magnetic resonance imaging is also useful.
[Mh] Termos MeSH primário: Angiografia Cerebral
Angiografia por Tomografia Computadorizada
Acidente Vascular Cerebral/diagnóstico por imagem
Acidente Vascular Cerebral/terapia
Trombectomia
Terapia Trombolítica
[Mh] Termos MeSH secundário: Tomada de Decisões
Seres Humanos
Imagem por Ressonância Magnética
Planejamento de Assistência ao Paciente
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE


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[PMID]:28463833
[Au] Autor:Fujimura M; Joo JY; Kim JS; Hatta M; Yokoyama Y; Tominaga T
[Ad] Endereço:Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
[Ti] Título:Preventive Effect of Clazosentan against Cerebral Vasospasm after Clipping Surgery for Aneurysmal Subarachnoid Hemorrhage in Japanese and Korean Patients.
[So] Source:Cerebrovasc Dis;44(1-2):59-67, 2017.
[Is] ISSN:1421-9786
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Clazosentan has been explored worldwide for the prophylaxis of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). In a dose-finding trial (CONSCIOUS-1) conducted in Israel, Europe, and North America, clazosentan (1, 5, and 15 mg/h) significantly reduced the incidence of cerebral vasospasm, but its efficacy in Japanese and Korean patients was unknown. We conducted a double-blind comparative study to evaluate the occurrence of cerebral vasospasm in Japanese and Korean patients with aSAH. METHODS: The aim of this multicenter, double-blind, randomized, placebo-controlled, dose-finding phase 2 clinical trial, was to evaluate the efficacy, pharmacokinetics, and safety of clazosentan (5 and 10 mg/h) against cerebral vasospasm after clipping surgery in Japanese and Korean patients with aSAH. Patients aged between 20 and 75 years were administered the study drug within 56 h after the aneurysm rupture and up to day 14 post-aSAH. The incidence of vasospasm, defined as an inner artery diameter reduction of major intracranial arteries ≥34% based on catheter angiography, was compared between each treatment group. Cerebral infarction due to vasospasm at 6 weeks and patients' outcome at 3 months was also compared. RESULTS: Among 181 enrolled patients, 158 completed the study and were analyzed. The incidence of vasospasm up to day 14 after aSAH onset was 80.0% in the placebo group (95% CI 67.0-89.6), 38.5% in the 5 mg/h clazosentan group (95% CI 25.3-53.0), and 35.3% in the 10 mg/h clazosentan group (95% CI 22.4-49.9), indicating that the incidence of vasospasm was significantly reduced by clazosentan treatment (placebo vs. 5 mg/h clazosentan, p < 0.0001; placebo vs. 10 mg/h clazosentan, p < 0.0001). The occurrence of cerebral infarction due to vasospasm was 20.8% in the placebo group (95% CI 10.8-34.1), 3.8% in the 5 mg/h clazosentan group (95% CI 0.5-13.2), and 4.2% in the 10 mg/h clazosentan group (95% CI 0.5-14.3), indicating that clazosentan significantly reduced the occurrence of cerebral infarctions caused by vasospasm (placebo vs. 5 mg/h clazosentan, p = 0.0151; placebo vs. 10 mg/h clazosentan, p = 0.0165). The overall incidence of all-cause death and/or vasospasm-related morbidity/mortality was significantly reduced in the 10 mg/h clazosentan group compared with the placebo group (p = 0.0003). CONCLUSION: These results suggest that clazosentan prevents cerebral vasospasm and subsequent cerebral infarction, and could thereby improve outcomes after performing a clipping surgery for aSAH in Japanese and Korean patients.
[Mh] Termos MeSH primário: Infarto Cerebral/prevenção & controle
Dioxanos/uso terapêutico
Antagonistas do Receptor de Endotelina A/uso terapêutico
Procedimentos Neurocirúrgicos/efeitos adversos
Piridinas/uso terapêutico
Pirimidinas/uso terapêutico
Hemorragia Subaracnóidea/cirurgia
Sulfonamidas/uso terapêutico
Tetrazóis/uso terapêutico
Vasodilatadores/uso terapêutico
Vasoespasmo Intracraniano/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Idoso
Angiografia Digital
Angiografia Cerebral/métodos
Infarto Cerebral/diagnóstico por imagem
Infarto Cerebral/etiologia
Infarto Cerebral/fisiopatologia
Dioxanos/efeitos adversos
Dioxanos/farmacocinética
Método Duplo-Cego
Antagonistas do Receptor de Endotelina A/efeitos adversos
Antagonistas do Receptor de Endotelina A/farmacocinética
Feminino
Seres Humanos
Japão
Masculino
Meia-Idade
Piridinas/efeitos adversos
Piridinas/farmacocinética
Pirimidinas/efeitos adversos
Pirimidinas/farmacocinética
República da Coreia
Hemorragia Subaracnóidea/diagnóstico por imagem
Hemorragia Subaracnóidea/fisiopatologia
Sulfonamidas/efeitos adversos
Sulfonamidas/farmacocinética
Tetrazóis/efeitos adversos
Tetrazóis/farmacocinética
Fatores de Tempo
Resultado do Tratamento
Vasodilatadores/efeitos adversos
Vasodilatadores/farmacocinética
Vasoespasmo Intracraniano/diagnóstico por imagem
Vasoespasmo Intracraniano/etiologia
Vasoespasmo Intracraniano/fisiopatologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Dioxanes); 0 (Endothelin A Receptor Antagonists); 0 (Pyridines); 0 (Pyrimidines); 0 (Sulfonamides); 0 (Tetrazoles); 0 (Vasodilator Agents); 3DRR0X4728 (clazosentan)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1159/000475824



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