Vertebrobasilar Dolichoectasia (VBD) is a condition characterized by abnormal elongation, dilatation and tortuosity of the vertebrobasilar system. It is usually asymptomatic but rarely, it can present with cranial nerve compression symptoms. We present a case of simultaneous trigeminal neuralgia and hypoglossal nerve palsy due to compression by VBD. Neuroimaging plays an important role in diagnosing this condition so that further treatment can be provided.
Objective: Our aim is to determine the average intraoperative blood loss in patients who underwent pre-operative spinal tumour embolisation in PPUKM from 2010 until 2016 and to compare with other centres from literature review.Material And Methodology: 15 patients in PPUKM with spinal tumour and spinal metastatic disease underwent pre-operative embolisation before palliative spinal surgery between 2010 and 2016 in PPUKM. Intraoperative blood loss during palliative spinal surgery was documented obtaining the average and median blood loss. Secondary analyses were made on the amount of intraoperative blood loss in comparison to the embolisation materials, degree of embolisation completion, primary malignancy, level of spinal metastatic involvement and total operating time.Result: The average and median intraoperative blood loss during palliative spinal surgery were 1480mls and 1000mls respectively, which is comparable with other centre from literature review. Significant difference is noted in intraoperative blood loss between the different embolisation materials used (P
Objective: Clinically assessing the status of cerebral collaterals is thought to provide invaluable diagnostic and prognostic data in managing acute ischemic stroke (AIS) patients. In this study we present a report, based on commonly used collateral grading system, assessing the correlation between the collateral status seen on CT angiography and patients’ functional outcome at Day 90 in our institution.Method: Patients presenting to the Emergency Department within 6 hours of onset of stroke from January 2010 until December 2014 were chosen for the study. CT angiography source images were retrospectively reviewed and given a “collateral score” (CS) by a radiologist who was blinded to the patient’s clinical information on presentation, as well as theclinical outcomes at 90 days. Patients’ mRS score at 90 days was obtained retrospectively and compared against the “collateral score”. Results: 87 patients were enrolled into this study, of which 60 (69%) were male and 27 (31%) were female with a mean age of 60.3 years. In this study, 56 (64.4%) patients had a collateral score (CS) ≥ 2 and 31 (35.6%) patients had a CS < 2. Out of 56 patientswho had a CS ≥ 2, 51 of them (91%) had good clinical outcome with a mRS ≤ 2. All the patients who had CS < 2 showed poor clinical outcome with a mRS > 2. The collateral score predicts accurately the clinical outcome with an area under the curve (ROC) of 0.75 (95% CI, 0.675-0.871, P=0.001). There is significant Spearman correlation between CS and the clinical outcome at Day 90, in patients with AIS during CTA analysis.Conclusion: Our data supports the potential use of CS analysis in predicting clinical outcome of patients with AIS. Nevertheless, further study on a larger scale is strongly suggested to verify the reliability and reproducibility of CS assessment in CTA analysis prior to reperfusion in AIS patients.
Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases.Methods: A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves.Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ≥6, 6 patients (6.7%) had CBS
In this article, we evaluate the effectiveness of Cone Beam Computed Tomography, through a case study, in assessing the complication of intracranial bleeding during an endovascular treatment of brain arteriovenous malformation when compared to Multislice-Detector Computed Tomography performed immediately after the procedure. The image quality of Cone Beam Computed Tomography has enough diagnostic value in differentiating between haemorrhage, embolic materials and the arteriovenous malformation nidus to facilitate physicians to decide for further management of the patient.
Dural arteriovenous fistulas (DAVFs) are abnormal connections between branches of the intracranial arteries and dural veins or sinuses. Advancements in the technique of endovascular embolization has made it the treatment of choice for DAVFs. The goal of treatment is to completely occlude the fistula orifice while maintaining the normal cerebral venous drainage. Depending on the site of the DAVF, endovascular treatment has its own challenges to the performing physician. In this case report, we will discuss complex anterior cranial fossa DAVFs, treatment approaches, and complications of the treatment.
Intracranial dural arteriovenous fistulae (DAVF) are uncommon and account for approximately 1% of all strokes. All transverse-sigmoid sinus DAVFs require treatment because of the low rate of spontaneous regression and frequent association with aggressive neurologic symptoms. Endovascular embolization which aims for permanent obliteration of the lesion is now the primary treatment modality for all DAVFs. We present a 56-year-old patient with long standing history of intermittent transient ischaemic attack (TIA)-like symptoms. Magnetic resonance (MR) angiography revealed right transverse-sigmoid sinus DAVF and bilateral vertebral arteries occlusion. The patient’s symptoms completely resolved upon successful trans-arterial embolization of the DAVF
Thromboembolic complications are common amongst cases of COVID-19 infections. This occurrence has seen a key role of endovascular treatment in the management of this potentially fatal complication. Endovascular thrombectomy or catheter directed thrombolysis is a fast and effective method for treatment of pulmonary embolisms, especially in a pandemic. We describe a case of COVD-19 complicated with massive pulmonary embolism treated with catheter directed thrombolysis- discussing case management, patient workflow and safety measures that should be strictly adhered to ensure a favorable outcome and ensure safety of treating personnel.