Omega-3 fatty acid supplement reduces activation of NADPH oxidase in intracranial atherosclerosis stenosis

Objectives Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of stroke worldwide. We adapted a rat model of atherosclerosis to study brain intracranial atherosclerosis, and further investigated how omega-3 fatty acids (O3FA) attenuated the development of ICAS by reducing the generation of reactive oxygen species (ROS) and the activation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) activity.

Methods Adult male Sprague-Dawley rats were divided into control normal-cholesterol or high-cholesterol diet groups with or without O3FA for up to 6 weeks. NG-nitro-L-arginine methyl ester (L-NAME, 3 mg/mL), a nitric oxide synthase inhibitor, was added to the drinking water of the high-cholesterol groups during the first 2 weeks. The rats received supplementation with O3FA (5 mg/kg/day) by gavage. At 3 and 6 weeks, we measured blood lipid levels, including low-density lipoprotein (LDL), cholesterol (CHO), triglycerides (TG), and high-density lipoprotein (HDL) as atherosclerotic blood markers. The lumen of middle cerebral artery (MCA) and the thickness of the vessel wall were assessed histologically. ROS production was measured. NOX activity and mRNA and protein expression of NOX subunits (p47^phox, gp91^phox, p22^phox, and p67^phox) were measured.

Results A high-cholesterol diet exhibited a significant increase in the classic blood markers (LDL, CHO, and TG) for atherosclerosis, as well as a decrease in HDL. These markers were found to be progressively more severe with time. Additionally, increased lumen stenosis and intimal thickening were observed in the MCA for this group. Rats given O3FA demonstrated attenuation of blood lipid levels with an absence of morphological changes.O3FA significantly reduced ROS production and NOX activity in the brain. Moreover, O3FA decreased the mRNA and protein expression of the NOX subunits p47^phox, gp91^phox, and p67^phox.

Conclusions Long-term O3FA dietary supplementation prevents the development of intracranial atherosclerosis. This O3FA effect appears to be mediated by its attenuation of NOX subunit expression and NOX activity, therefore reducing ROS production. O3FA dietary supplement shows promising results in the prevention of ICAS.     

颅内动脉狭窄支架成形术后影响分支缺血性事件的临床因素探讨

目的 探讨颅内动脉狭窄支架成形术（ICASS）后支架置入与临床对应分支缺血性事件的相关性及其影响因素.方法 21例24支颅内大动脉狭窄,行血管内支架成形术.其中大脑中动脉（MCA）15支,椎动脉（VA）5支,基底动脉（BA）3支和颈内动脉（ICA）1支.20支血管（MCA 14支,VA 3支,BA 2支和ICA 1支）为症状性重度狭窄、1支（BA）为无症状性重度狭窄;3支血管（MCA 1支和VA 2支）为症状性中度狭窄.比较评价支架成形术对分支缺血性损害、总体预后等方面的影响.结果 无支架置入性相关分支缺血性损害的表现,随访期（6～27个月）内无再狭窄;所有患者均无手术相关性并发症.结论 在围手术期规范化临床干预下,颅内动脉狭窄支架成形术不会导致明显的理论性支架相关性分支缺血性并发症,但这还需要进一步的验证.     

What influenced the lesion patterns and hemodynamic characteristics in patients with internal carotid artery stenosis? A retrospective study

Objectives

This study aimed to explore the dynamic changes of lesion patterns and hemodynamic characteristics in patients with internal carotid artery stenosis (ICAS).

Risk factors for occlusive lesions of intracranial arteries in stroke-free Japanese.

The aim of this study was to identify relevant risk factors for occlusive lesions of the intracranial arteries in stroke-free population. The subjects of this study were 425 patients without a history of stroke or transient ischemic attack and without any abnormality on a neurological examination who consecutively visited a neurology clinic between January 1994 and June 2001 requesting medical evaluation for possible cerebrovascular diseases. Subjects included 245 men and 180 women ranging in age from 33 to 89 years (mean+/-SD=64.0+/-10.0 years). We performed cervical and intracranial magnetic resonance angiography (MRA) in all subjects. Using a validated rating scheme of MRA for occlusive lesions, we evaluated the degree of stenoses in the extracranial portion of the internal carotid artery (ICA) and the intracranial arteries including the intracranial portion of the ICA, middle cerebral artery (MCA) stem, intracranial portion of the vertebral artery (VA), and basilar artery (BA). More than 25% stenoses were regarded as significant lesions in this study. Multiple logistic regression analyses showed that significant and independent predictors for extracranial ICA lesions were age, hyperlipidemia, and ischemic heart disease (IHD), those for intracranial ICA lesions were age, hypertension, diabetes mellitus, and IHD, those for MCA lesions were age and hypertension, those for intracranial VA lesions were hyperlipidemia and IHD, and those for BA lesions were hypertension and diabetes mellitus. The present study suggested that atherosclerosis of the intracranial VA was related to hyperlipidemia and IHD as was the case for the extracranial carotid artery, whilst atherosclerosis of other sites of intracranial arteries was associated with hypertension and diabetes mellitus in stroke-free Japanese.     

A transcranial Doppler study of basilar hemodynamics in progressive carotid artery disease

Abstract

In carotid artery disease (CAD) the basilar artery (BA) may act as an important intracranial collateral to supply hypoperfused middle cerebral artery (MCA) territories. Transcranial Doppler studies were performed to study the dependency between BA hemodynamics in relation to the MCA perfusion status. BA and MCA blood flow velocities (BFV), pulsatility indices (API) and cerebrovascular reactivity (CVR) were assessed in 40 patients with a progressive MCA hypoperfusion due to progressive CAD. All patients had patent cervical segments of their vertebral arteries with an antegrade vertebral flow profile. Duplex studies were performed to diagnose the severi~ of CAD. Hypoperfusion of the MCA was diagnosed by the degree of vasoparalysi assessed by a Diamox procedure. Analysis showed that the basilar BFV significantly increased in cases of progressive CAD; the basilar PI decreased but the basilar CVR remained unchanged. However, in cases of bilateral hemodynamic significant CAD and bilateral exhausted CVR in the MCA territory, the basilar artery did not exhibit an increase of BFVs or a decrease of the basilar PI, but the basilar CVR showed a significant decrease. Basilar artery CVR is not impaired if this artery has a function as intracranial collateral in CAD. However in cases of bilateral hypoperfused MeA territories the basilar artery does not function as a collateral pathway. The basilar CVR declines under these circumstances which merely reflects the exhausted hemodynamics in the anterior/posterior borderzones. This situation might lead to an increased stroke risk in the distal basilar supply zones. [Neural Res 1998; 20: 493-498]     

A comparison of risk factors and prognosis between intra and extracranial acute atherosclerotic stroke in the Turkish population: a prospective study

Background: The aim of this study was to compare the differences in risk factors and prognosis between acute stroke caused by definitive intracranial atherosclerosis (ICAS) or extracranial atherosclerosis (ECAS) in the Turk?sh population.

Methods: This study was prospectively designed in a single centre and conducted with patients who were hospitalised due to acute ischaemic stroke. Inclusion criteria were the diagnosis of atherosclerotic ischaemic stroke, defined as more than 50% stenosis or occlusion in the arterial structure supplying the ischaemic area, having excluded other possible causes.

Results: Information on 58 ICAS and 57 ECAS stroke patients was collected in a 13-month period. The ECAS patients had male gender predominance (p = 0.003). Ageing, stroke history and hyperlipidaemia were related with stroke severity in ECAS, and gender was associated with severity in ICAS. Hypertension and being female were related with poor prognosis in ICAS (p = 0.081 vs. 0.087). Congestive heart failure (p = 0.002) was associated with poor prognosis and alcohol with a favourable outcome (p = 0.087) in ECAS. Stroke severity was related with poor prognosis in both groups (p < 0.001).

Conclusions: The prevalence of risk factors differs between ICAS and ECAS, and their influence differs for stroke severity and prognosis.     

颈动脉几何形态——60岁及以下无高危因素人群颅内动脉粥样硬化的潜在预测指标

目的 基于头颈联合HR-MRI技术,探讨在60岁及以下无传统心脑血管高危因素的人群中,颈动脉几何形态与大脑中动脉（middle cerebral artery,MCA）粥样硬化的相关性,寻找MCA粥样硬化的潜在预测指标。方法 回顾性分析来自60岁及以下无传统心脑血管高危因素患者的150个同侧前循环动脉单位,根据MCA是否存在动脉粥样硬化斑块将其分为MCA粥样硬化（+）组和MCA粥样硬化（-）组。分析两组间颈动脉分叉夹角、颈动脉管腔面积比值和颈内动脉颅外段及颅内段的形态分型,并采用多因素logistic回归探索MCA粥样硬化的独立相关因素,绘制ROC曲线分析颈动脉几何形态对MCA粥样硬化的预测效能。结果 与MCA粥样硬化（-）组（113个）相比,MCA粥样硬化（+）组（37个）颈动脉分叉夹角更大[41.2°（28.8°～56.5°）vs. 32.6°（24.7°～46.2°）,P=0.026],而流出道与流入道管腔面积比值更大、颈内动脉颅外段形态平滑型更少、迂曲型和扭折型更多、颅内段形态钝角型更少、直角型和锐角型更多,但差异无统计学意义。多因素logistic回归分析结果显示,颈动脉分叉夹角与MCA粥样硬化独立相关（每增加10°,OR 1.232,95%CI 1.007～1.507,P=0.042）,逐步退后logistic回归分析结果相同（每增加10°,OR 1.276,95%CI 1.050～1.550,P=0.014）;ROC曲线显示,颈动脉分叉夹角预测MCA粥样硬化的AUC为0.622（95%CI 0.515～0.730）,最佳截断值为37.0°,敏感度为57.5%,特异度为64.9%。结论 对于60岁及以下无传统心脑血管高危因素人群,颈动脉分叉夹角与MCA粥样硬化独立相关,有望成为颅内动脉粥样硬化的有效影像学标志物。     

Internal maxillary artery to intracranial artery bypass: a case series of 31 patients with chronic internal carotid/middle cerebral arterial-sclerotic steno-occlusive disease

Objective: To evaluate the effectiveness of internal maxillary artery (IMA) – radial artery graft (RAG) – middle cerebral artery (MCA) bypass surgery for chronic arterial-sclerotic severe stenosis or occlusion of the internal carotid artery (ICA) or MCA.

Methods: A retrospective study was conducted in 31 patients with ischemic cerebrovascular disease who underwent bypass surgery of the IMA with a RAG of the MCA. Twenty-seven patients had complete occlusion of the ICA or MCA, and four patients had severe stenosis of the M1 segment of the MCA.

Results: Patent IMA-RAG-MCA in 30 (96.8%) patients was confirmed by angiography after surgery. One case developed a new motor aphasia due to unsuccessful bypass. Eleven transient ischemic attacks (TIA) and five ischemic strokes resolved following surgery. The other 14 cases showed some improvement without ischemic events at one month following surgery. Prior to surgery, mean ± SD National Institute of Health Stroke Scale (NIHSS) score was 5.4 ± 1.1 in the ischemic stroke group. In the first month post-procedure, the NIHSS score decreased significantly to 3.8 ± 1.2, (p < 0.01). Perfusion weighted imaging (PWI) or computed tomography perfusion (CTP) indicated improved hemodynamics in 30 patients. In addition, seven patients demonstrated improved glucose metabolism on 18-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) positron emission tomography (PET) postoperatively. No new neurological deficit occurred in the 30 patients during a 2.19 ± 1.59 years of follow-up.

Conclusions: By supplying an adequate flow to a larger flow territory of chronically stenotic/occlusive major cerebral arteries, IMA bypass surgery is efficient for restoring hemodynamics in selected patients and improving their neurological deficits.     

In-hospital recurrence and functional outcome between ischemic stroke caused by intracranial arterial dissection and intracranial atherosclerosis: Retrospective cohort study of the nationwide multicenter registry

BackgroundIntracranial arterial dissection (ICAD) and intracranial atherosclerotic stenosis (ICAS) are often difficult to differentiate, and studies on their background factors and prognosis are scarce. Information on prognosis, including recurrence, is necessary for stroke care, and clarification of epidemiological and clinical differences between the two diseases is important for appropriately handling their heterogeneity. This study aimed to determine the association of ICAD and ICAS with in-hospital recurrence and prognosis and compare their background and clinical findings.MethodsIn this multicenter cohort study, we retrospectively analyzed data from the Saiseikai Stroke Database. Adults with ischemic stroke caused by ICAD or ICAS were included in this study. Patients’ backgrounds and clinical findings were compared between the ICAD and ICAS groups. The outcome showed an association of ICAD with in-hospital recurrence of ischemic stroke and poor functional outcome relative to ICAS. Multivariable logistic regression analyses were performed to calculate the adjusted odds ratios (ORs) for ICAD with 95% confidence intervals (CIs) for each outcome.ResultsAmong 15,622 patients registered in the Saiseikai Stroke Database, 2,020 were enrolled (ICAD group: 89; ICAS group: 1,931). In the ICAD group, 65.2% of the patients were aged <64 years. Vascular lesion location was more common in ICAD with the vertebral artery [42 (47.2%)], anterior cerebral artery [20 (22.5%)], and middle cerebral artery (MCA) [16 (18.0%)], and in ICAS with MCA 1046 (52.3%). Multivariable logistic regression analyses of the association between ICAD and in-hospital recurrence and poor functional outcome yielded a crude OR (95% CI) of 3.26 (1.06−9.97) and 0.97 (0.54−1.74), respectively, relative to ICAS.ConclusionICAD was associated with a higher in-hospital recurrence than ICAS; however, there was no significant difference in prognosis between the two groups. Differences in background characteristics and vessel lesions may be of interest in these two diseases.     

Association of ADIPOQ single nucleotide polymorphisms with the risk of intracranial atherosclerosis

Background: The genetic mechanism of the racial distribution difference of intracranial atherosclerosis (ICAS) is unclear. The single nucleotide polymorphisms (SNPs) may be associated with different genetic susceptibility to ICAS. At present, the correlation between ADIPOQ gene SNPs and the risk of ICAS remains unknown. Methods: Continuous inpatients were selected and divided into ICAS group and control group. Computed tomography angiography was performed to observe intracranial arteries. ADIPOQ SNPs were detected using the ligase detection reaction-PCR. The correlation between the identified SNPs and ICAS was determined using the binary logistic regression analysis. Results: This study contained 602 patients in total, including 199 ICAS and 403 control cases. The binary logistic regression analysis showed that the AG/AA genotype of the rs2241767 (OR = 2.242, 95% CI: 1.037–4.878, P = 0.040) and the AG/GG genotype of the rs182052 (OR = 1.822, 95% CI: 1.111–2.987, P = 0.017) were closely related to the risk of ICAS after adjusting for conventional cardiovascular risk factors. The haploid analysis results indicated that the incidence of the A-G haplotype of the rs2241767 and rs182052 was higher in the ICAS group than in the control group (P = 0.026). Conclusions: The SNPs of the ADIPOQ gene are closely related to increased risk of ICAS in Chinese Han population.     

Unilateral internal carotid artery absence in trisomy 18

BackgroundInternal carotid artery (ICA) absence (agenesis or aplasia) is a rare congenital anomaly that is usually asymptomatic and found coincidentally. There has been no report showing a specific chromosomal abnormality causes ICA absence.Case reportsMR angiography in a Japanese male infant with trisomy 18 revealed left ICA absence with the left middle cerebral artery (MCA) and anterior cerebral artery (ACA) supplied from the ipsilateral posterior communicating artery and anterior communicating artery (ACoA), respectively, type A in Lie’s classification. Another Japanese male infant with trisomy 18 showed right ICA absence with the right ACA and MCA supplied from the ACoA, that is, type B in Lie’s classification.ConclusionThere have been no pathological or radiological reports of ICA absence in trisomy 18, however, it may be underestimated because the anomaly usually causes no clinical symptoms. It is necessary to evaluate further patients to clarify whether or not unilateral ICA absence is a characteristic congenital malformation.     

症状性颅内动脉闭塞患者脑灌注缺损与侧支循环的相关性研究

目的 研究症状性颅内动脉闭塞患者脑灌注缺损与侧支循环的关系。 方法 回顾性纳入2017年1月-2018年10月于解放军总医院第一医学中心连续收治的症状性单侧颈 内动脉（internal carotid artery,ICA）颅内段或大脑中动脉（middle cerebral artery,MCA）M1/M2段闭塞 患者,根据闭塞部位分为ICA闭塞组和MCA闭塞组。收集患者临床资料并记录影像学特征,采用定量 分析软件获取患侧脑血流残余功能达峰时间（time to maximum of the residual function,Tmax）>4 s和 Tmax>6 s的低灌注区容积,并采用多时相CTA 6级评分法对侧支循环进行评分。比较两组患者低灌注 区容积与侧支循环的差异,并分析低灌注区容积与侧支循环评分的相关性。 结果 最终纳入42例患者,平均年龄54.9±13.9岁,男性29例（69.0%）,其中I CA闭塞组19例,MCA 闭塞组23例。ICA闭塞组Tmax>4 s容积（163.1±98.6 mL vs 64.6±54.2 mL,P <0.001）、Tmax>6 s容积 （92.4±87.1 mL vs 13.0±27.6 mL,P <0.001）均大于MCA闭塞组;ICA闭塞组侧支循环评分低于MCA闭 塞组[3（2～4）分 vs 4（3～4）分,P =0.021]。ICA闭塞组Tmax>4 s 、Tmax>6 s容积与侧支循环评分呈负相关 （r =-0.667,P =0.002;r =-0.717,P <0.001）;MCA闭塞组Tmax>4 s 、Tmax>6 s容积与侧支循环评分呈负 相关（r =-0.498,P =0.016;r =-0.494,P =0.017）。 结论 症状性颅内动脉闭塞患者低灌注区容积与闭塞部位及侧支循环相关,ICA闭塞患者较MCA闭 塞患者有更大的低灌注缺损和更差的侧支循环。     

Risk factors between intracranial–extracranial atherosclerosis and anterior–posterior circulation stroke in ischaemic stroke

Objectives: Atherosclerosis is an important cause of stroke and remains a challenge for stroke prevention. Risk factors involved in atherosclerotic stroke and anterior and posterior circulation strokes (ACS and PCS, respectively) are different. The purpose of this study is to investigate differences in risk factors between intracranial and extracranial atherosclerosis (ICAS and ECAS), ACS and PCS, and ICAS/ECAS with ACS/PCS in a Chinese acute ischaemic stroke population.

Methods: We analysed 551 ischaemic stroke patients who had been enrolled between August 2005 and July 2008. First, risk factors were compared between non-atherosclerosis, ICAS, ECAS, and combined ICAS and ECAS groups. ICAS and ECAS were assessed with transcranial Doppler and carotid colour Doppler ultrasound, respectively. Second, risk factors were compared between ACS and PCS groups. Stroke lesion was assessed with magnetic resonance imaging. Third, risk factors were compared in ICAS/ECAS associated with ACS/PCS.

Results: The risk factor for ICAS was high diastolic blood pressure (OR, 1.075; 95% CI, 1.016–1.138; p = 0.013), and the risk factors for ECAS were age (OR, 1.113; 95% CI, 1.046–1.183; p = 0.001) and low density lipoprotein (OR, 1.450; 95% CI, 1.087–1.935; p = 0.012). Hypertension (OR, 1.090; 95% CI, 1.001–1.109; p = 0.027) was associated with PCS. Age (OR, 1.026; 95% CI, 1.011–1.128; p = 0.003), male gender (OR, 2.278; 95% CI, 1.481–3.258; p = 0.003) and age (OR, 1.067; 95% CI, 1.013–1.123; p = 0.014), scores of NIHSS (OR, 1.069; 95% CI, 1.012–1.130; p = 0.018) were risk factors for ICAS and ECAS with ACS, respectively.

Conclusion: Risk factors are different between ICAS and ECAS, ACS and PCS, and ICAS/ECAS with ACS/PCS. Thus, targeted strategies are needed to consider these differences to prevent, treat and manage these diseases.     

颅内动脉狭窄支架成形术临床相关性因素评估研究

目的探讨颅内动脉狭窄支架成形术的临床应用和相关并发症的影响因素。方法22例25支颅内大动脉段狭窄,行血管内支架成形术。其中大脑中动脉（MCA）15支,椎动脉（VA）5支,基底动脉（BA）3支和颈内动脉（ICA）2支。21支血管（MCA14支,BA2支,VA3支和ICA2支）为症状性重度狭窄、1支（BA）为无症状性重度狭窄;3支血管（MCA1支和VA2支）为症状性中度狭窄。比较评价支架成形术相关性效／损比、总体预后等方面的临床影响因素。结果技术成功率96％（24／25）,手术死亡率0％,未发生再灌注损伤,9例随访者（6～27个月）无再狭窄;所有患者均无手术相关性并发症。结论对于具有治疗适应证的颅内动脉狭窄实施支架成形术是有效和安全的,但远期预后还有待于进一步评估。     

Neurosonographic monitoring of haemodynamic changes in tandem middle cerebral and internal carotid artery occlusion due to arterial dissection

A middle-aged man with pain in the right eye and right side of the neck was brought to the emergency department one hour after the onset of left-sided weakness. Computed tomography (CT) showed hyperdense right middle cerebral artery (MCA). On transcranial Doppler (TCD), occlusion of the right MCA and right internal carotid artery (ICA) was found. Thirty minutes after thrombolytic therapy was initiated, engagement of collateral circulation through the anterior communicating artery (AComA) was shown by TCD. Carotid duplex examination confirmed occlusion of the right ICA with intimal flap and intramural haematoma. CT angiography revealed flame-like occlusion of the right ICA, and occlusion of the right MCA with collateral supply from the left to right anterior cerebral artery through the AComA. Recanalization of the MCA and ICA was evident on both CT and ultrasound. Frequent ultrasound monitoring is useful for haemodynamic evaluation of carotid artery dissection, while TCD plays an important role in real-time monitoring of flow changes of intracranial vasculature.     

Atherosclerotic plaque burden of middle cerebral artery and extracranial carotid artery characterized by MRI in patients with acute ischemic stroke in China: association and clinical relevance

Objectives: This study sought to compare the atherosclerotic plaque burden between middle cerebral artery (MCA) and extracranial carotid artery (ECA) in ischemic stroke patients using high-resolution, black-blood (HR BB) MRI and to investigate the relationship between plaque burden found in both arteries and stroke severity.

Methods: All subjects with recent ischemic stroke underwent MCA and ECA HR BB MRI at 3.0 Tesla. For each artery segment, the thickness, area and signal intensities of plaques were recorded. Plaque burden, as measured by normalized wall index (NWI = wall area/total vessel area × 100%) were calculated. All patients received a clinical stroke severity score as measured by the National Institutes of Health Stroke Scale (NIHSS) scores at the time of admission.

Results: A total of 65 stroke subjects were included in the final analysis. MCA exhibited significantly greater NWI than the ipsilateral ECA (symptomatic MCA vs. ECA: 58.04 ± 8.19 vs. 37.53 ± 10.25, p < 0.001; asymptomatic MCA vs. ECA: 53.80 ± 4.49 vs. 34.85 ± 4.27, p < 0.001, respectively). NWI in symptomatic MCA and ECA were significantly associated with NIHSS scores (r = 0.779 vs. 0.645; p < 0.001 respectively). Moreover, stronger statistical correlations between NIHSS scores and NWI were found in MCA, as compared with ECA during multivariate linear regression analysis.

Conclusion: Greater atherosclerotic plaque burden and a closer association with stroke severity were found for the MCA as compared to the ipsilateral ECA. Identification of MCA plaque lesions by MRI may be helpful for developing more aggressive strategies for stroke prevention.     

Arterial transit artifacts observed on arterial spin labeling perfusion imaging of carotid artery stenosis patients: What are counterparts on symptomatology,dynamic susceptibility contrast perfusion,and digital subtraction angiography?

PurposeTo investigate possible relationships between the presence and location of arterial transit artifacts (ATA) and clinical symptoms, digital subtraction angiography (DSA), and dynamic susceptibility contrast (DSC) perfusion imaging abnormalities in patients with carotid artery stenosis (CAS).MethodsForty-seven patients who underwent arterial spin labeling (ASL) and DSC perfusion imaging in the same period diagnosed with > 50% unilateral internal carotid artery (ICA) stenosis by DSA performed 24 h after perfusion imaging were included. The presence of ATA, localization and hypoperfusion were evaluated using ASL interpretation. Maps derived from DSC perfusion, symptomatology, stenosis rates, and collateralization findings observed in DSA were investigated. Probable relationships were evaluated.ResultsATA on ASL were detected in 68.1% (32/47); 40.6% (13/32) of ATAs were observed in the distal middle cerebral artery (MCA) trace, 50% (16/32) in the intracranial ICA and MCA traces, and 9.4% (3/32) in the intracranial ICA trace. When classifications based on the ATA presence and localization was made, qualitative and quantitative CBF, MTT, and TTP abnormalities, symptomatology, stenosis rates, and collateralization findings significantly differed between groups (p < 0.05).ConclusionThe presence and localization of ATA in patients with CAS may provide essential insights into cerebral hemodynamics and the CAS severity. ATAs observed only in the distal MCA trace may represent early-stage perfusion abnormalities and a moderate level of stenosis. ATA in the ICA trace may related to a more advanced level of perfusion abnormalities, critical stenosis rates, symptom or collateralization presence.     

A false traumatic giant aneurysm of the supraclinoid carotid artery. A case report and review of the literature

Abstract

A patient presented with left hemiparesis and facial palsy developed 20 days after a traffic accident A computerized tomography (CT) scan revealed right suprasellar mass lesion. A repeated CT scan revealed a growing mass. Carotid angiogram demonstrated a giant aneurysm of the supraclinoid internal carotid artery (ICA) with no distal filling. Formation of the aneurysm was thought to be due to an overstretching or torsion of the artery or tearing of the ICA by nearby prominent bony structure since no basal skull fracture was detected in the plain skull film or CT scans. The aneurysm was treated by intracranial trapping of the ICA. We present this patient’s findings and review previously reported cases in the literature. [Neurol Res 1996; 18: 135–139]     

Mediterranean-style diet and intracranial large artery stenosis in the Northern Manhattan Study

ObjectivesGiven Mediterranean-style diet (MeDi) reduces risk of cardiovascular events, we hypothesized MeDi may also be protective against intracranial large artery stenosis (ICAS), a common cause of stroke worldwide.MethodsThis cross-sectional study included stroke-free participants of the Northern Manhattan Study, a diverse population-based study of stroke risk factors. We represented MeDi continuously (range 0-8) based on enrollment food frequency questionnaires, excluding alcohol consumption. We evaluated ICAS both dichotomously at clinically relevant stenosis severities and continuously as a score (possible range 0-44), summated from stenosis severity scores of major intracranial arteries from time-of-flight magnetic resonance angiography. We used logistic or zero-inflated Poisson regression, adjusting for key confounders.ResultsAmong 912 included participants (mean age 64±8 years, 59% female, 65% Hispanic, mean MeDi score 4±1.5), 5% and 8% of participants had ≥50% or ≥70% ICAS, respectively (score median [interquartile range]: 0 [0-2]). Increased MeDi score was inversely associated with ICAS, but did not reach statistical significance (≥50% stenosis odds ratio (OR) [95% confidence interval (CI)]: 0.89 [0.79-1.06]; ≥70% stenosis OR [95% CI]: 0.91 [0.74-1.13]; stenosis score β-estimate [95% CI]: -0.02 [-0.06-0.01]).ConclusionIn this stroke-free subsample, we did not find a significant association between MeDi and ICAS. We may have been limited by statistical power.     

High incidence of hyponatremia in patients with ruptured anterior communicating artery aneurysms

Abstract

We studied the incidence and timing of hyponatremia (Na < 135 mEq l~¹) after subarachnoid hemorrhage (SAH) with special reference to ruptured anterior communicating artery (A-com) aneurysms. Hunt and Kosnik (HK) grading, symptomatic vasospasm in A-com aneurysm, and hydrocephalus were analyzed for connections to hyponatremia in 55 patients with ruptured A-com aneurysms, 65 with ruptured internal cerebral artery (ICA) aneurysms, and 49 with ruptured middle cerebral artery (MCA) aneurysms. Hyponatremia occurred in 28 (51%) of 55 patients with A-com aneurysms and in nine (18%) of 49 patients with MCA aneurysms. Severe hyponatremia (Na < 130 mEq^-1) occurred in 16 patients (29%) in the A-com group, four patients (6%) in the ICA group, and three patients (6%) in the MCA group. The A-com aneurysm group had a significantly higher incidence of mild hyponatremia (p < 0.01) and severe hyponatremia (p< 0.001) than other groups. Among A-com cases, hyponatremia occurred significantly more often in HK grade III and IV cases (p < 0.05), in cases with vasospasm (p < 0.001), and in cases with hydrocephalus (p < 0.01). Respective days of onset for symptomatic vasospasm and for hyponatremia were day 7.6 ±4.4 and day 10.6± 5.8 following SAH, representing a 3-day delay for hyponatremia (p<0.05). In most patients hyponatremia resolved within 28 days following SAH. Hyponatremia occurred more often with A-com aneurysms, possibly because of vasospasm around the A-com or hydrocephalus causing hypothalamic dysfunction. Since hypervolemic therapy can cause hyponatremia, particularly careful observation is required during such therapy in patients with A-com aneurysm. [Neurol Res 2000; 22: 151-155