Summary: Endovascular treatment of acute blockage of the middle cerebral artery may require a combination of mechanical recanalization and chemical fibrinolysis. Using a single microcatheter to perform both techniques helps shorten procedure time.

Sildenafil (Viagra), a selective inhibitor of phosphodiesterase 5 (PDE5), induces headache and migraine. Although previously supposed to be a "vascular" headache, no significant cerebral artery dilatation was found in vivo. Thus, we hypothesised that PDE5 may not be present or that sildenafil is less effective on the cGMP hydrolysis in ...

An acute intracranial embolus may be associated with a hyperdense artery sign on CT, related to acute thrombus within the affected artery, a phenomenon that is well known and has been extensively documented. We present an unusual case of a middle cerebral artery territory acute infarct with a hypodense artery ...

Duplication of the middle cerebral artery is an anomalous vessel arising from the internal carotid artery. There have only been 14 reports of aneurysms arising from the origin of a duplication of the middle cerebral artery and 5 of these patients had multiple aneurysms. Aneurysms at this site have a ...

A case of cerebral lipiodol embolism after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma is presented. A 76-year-old man underwent TACE for advanced hepatocellular carcinoma. Immediately after chemoembolization, his level of consciousness deteriorated. Computed tomography revealed deposition of iodized oil in the cerebral cortex, basal ganglia, and thalami. Magnetic resonance ...

A 71-year-old man presented with right hemiparesis and aphasia due to cerebral infarction in the frontal lobe. Computed tomography (CT) revealed a high-density mass, 12 mm in diameter, in the stem of the left sylvian fissure. Carotid angiography demonstrated occlusion of the left ascending frontal artery complex and retention of ...

A 78-year-old housewife with major depression developed a right-sided infarction in the territory of the middle cerebral arteries, followed by acute post-stroke mania. Comparison between pre- and post-stroke SPECT scans demonstrated a unique pattern of left orbitofrontal hyperperfusion with extensive right frontal hypoperfusion. A functional imbalance between right and left ...

Transient ischemic attacks (TIAs) or ischemic stroke may complicate thromboangiitis obliterans (TAO). However, there has been debate regarding the mechanism of ischemic stroke in TAO. We report the case of a patient with TAO who developed repeated TIAs. An angiogram showed multiple alternative areas of arterial occlusions in the distal ...

The ability to visualize the perfusion territories of major feeding arteries to the brain is important for many clinical applications. Since the work of Duret in 1874 on vascularization of the brain, many textbooks and atlases have shown schematic drawings of the supply areas of the major cerebral arteries. Recent ...

OBJECT: The usefulness of motor evoked potential (MEP) monitoring to detect blood flow insufficiency (BFI) in the cortical branches of the middle cerebral artery (MCA) and lenticulostriate arteries (LSAs) during MCA aneurysm surgery was investigated based on the correlation between MEP and somatosensory evoked potential (SEP) monitoring. METHODS: Fifty-three patients ...

This study aimed at describing and systematizing the arteries of the base of the brain of the wild boar (Sus scrofa scrofa). Thirty-three heads were used, of which 30 were injected with latex, and three with acrylic dental resin through the common carotid arteries. The brain carotid artery arose from ...

Atherosclerotic middle cerebral artery stenosis is a rare but potentially devastating cause of cerebral ischemia and stroke. While medical management remains the mainstay for stroke prevention, surgical and/or endovascular intervention is indicated in selected patients. This article reviews the role of surgery and endovascular techniques in the treatment of middle ...

OBJECTIVE: The main objective of this study was to display the morphological characteristics of the posterior communicating artery and its perforating branches in various configurations of the circle of Willis and their relationship with neighbouring anatomic structures by microscopic examination of the brain hemispheres and endoscopic examination of cadaver specimens. ...

OBJECTIVE: To report a case of proximal occlusion of 2 major cerebral vessels associated with moyamoya network circulation that manifested by spontaneous intraventricular hemorrhage. DESIGN: Case report. PATIENT AND RESULTS: A 36-year-old Syrian man presented with symptoms of sudden-onset headache, neck stiffness, and confusion. The computed tomography scan of his ...

We reported a case of an 8-year-old boy who was presented to the emergency department with left-sided hemiparesis. Computed tomography showed hypodense areas in the territory of the right middle cerebral artery, indicating acute cerebral infarct. Diagnostic evaluation was performed to identify the etiology. On the eighteenth day of hospitalization, ...

Lacunar infarcts are commonly found in the basal ganglia, though little is known about the organization of small-scale microvascular territories that presumably subtend lacunae. We investigated microvascular territories of the lenticulostriate arteries, the recurrent artery of Heubner, the anterior choroidal artery, and striate branches of the anterior cerebral and anterior ...

While the intraluminal thread technique to induce middle cerebral artery occlusion is widely used in animal models of focal cerebral ischemia, it has several drawbacks. The present study describes a new technique involving transfemoral selective intraluminal wiring, and evaluates its technical feasibility, effectiveness, and safety. Twenty-four Wistar rats were used ...

We report a unique case of an anterior cerebral artery aneurysm in a patient with embryonic unfused middle cerebral artery anomaly. The arterial twigs of the middle cerebral artery supply the entire middle cerebral artery territory including the lenticulostriate branches. There was a vessel incorporated into the aneurysm, which was ...

BACKGROUND AND PURPOSE: The most common presentation of ischemic stroke related to pregnancy is arterial occlusion, occurring during the third trimester or postpartum. The authors present the first successful administration of intra-arterial cerebral tissue plasminogen activator to treat an embolic cerebral vascular accident in a 37-week parturient resulting in complete ...

Despite an overall decrease in perioperative morbidity and mortality, evidence of some degree of central nervous system dysfunction associated with coronary artery bypass graft (CABG) surgery-with or without cardiopulmonary bypass-has steadily mounted. From preoperative studies of CABG patients, it is apparent that over 50% of patients who present for cardiac ...

BACKGROUND: The microsurgical anatomy of the middle cerebral artery (MCA) is of particular interest to the cerebrovascular surgeon. The purpose of this study was to define the microsurgical anatomy of the MCA and its various branches in the Indian population. METHODS: Ten MCAs were studied from five cadaveric brain specimens. ...

A 46-year-old woman presented with non-traumatic anterior cerebral artery dissection manifesting as sudden onset of headache and motor weakness of the right lower limb. Angiography revealed luminal narrowing of the left anterior cerebral artery from the A(3) portion to the distal portion. Sagittal T(1)-weighted magnetic resonance imaging showed hyperintensity due ...

OBJECTIVE, BACKGROUND: Cerebral angiography, performed within 24 hr of aneurysmal rupture, carries an increased risk of rebleeding. We have investigated the rerupture rate during angiography procedures under deep general anesthesia and the factors that contribute to rebleeding. We divided 69 patients who had experienced aneurysmal rerupture into 2 groups. Group ...

A rare abnormality of the A1 segment of the anterior cerebral artery (ACA) is reported. The right ACA bifurcated into two parts at the middle point of the A1 segment, and these segments did not rejoin. The superior right A1 segment connected with the left A1 and formed a single ...

The superficial temporal artery to middle artery bypass is a technique that allows the blood supply from the extracranial carotid circulation to be routed to the distal middle cerebral artery branches. The procedure allows blood flow to bypass proximal lesions of the intracranial vasculature. The performance of this bypass requires ...

A new technique for selective spin labeling of individual arteries is presented. It is based on continuous arterial spin labeling (CASL) with an amplitude-modulated control experiment. Precessionary motion of the labeling gradient about the axis of the artery, combined with an appropriate frequency modulation of the labeling RF pulse, restricts ...

Physiologic cerebral monitoring has become an important part of our cardiovascular surgical unit. We recently encountered an unusual variant of aortic atresia that was first suggested by physiologic cerebral monitoring and required modification of our operative technique. We describe and discuss the anatomy, its translation into cerebral monitor findings, and ...

BACKGROUND AND OBJECTIVE: Neurological dysfunction is a common problem after cardiac surgery with cardiopulmonary bypass (CPB). Cerebral ischaemia associated with the use of CPB may result in a release of neuronal-ischaemic markers and a subsequent cerebral inflammatory response which may additionally release inflammatory cytokines. In order to locate the origin ...

A 9-year-old girl presented with an acute right-sided hemiparesis. Initially, the clinical presentation and stable vasculopathic abnormalities on MR and conventional angiography were suspicious of a so-called "transient cerebral arteriopathy". Mild but persistent pleocytosis and an elevated CSF IgG index led to an extensive search for infectious and immunological causes ...

OBJECTIVE: The objective was to examine the microsurgical anatomy basic to the microsurgical and endovascular management of lesions involving the dural arteries. METHODS: Adult cadaveric heads and skulls were examined using the magnification provided by the surgical microscope to define the origin, course, and distribution of the individual dural arteries. ...

Astasia, inability to stand unsupported despite good strength, resembles the marked balance impairment of patients with vestibulocerebellar disease. We describe a patient with unilateral thalamic infarct that presented with astasia. A 76-year-old hypertensive woman was admitted to our hospital because of marked unsteadiness. On neurological examination, she could not stand ...

OBJECTIVE: Although previous reports have described patients with both cerebral and aortic aneurysms, any association was believed to be coincidental. In this study, we provide evidence that aortic and cerebral aneurysm formation may share a common genetic predisposition in some families. METHODS: A prospective enrollment of consecutive patients treated for ...

OBJECT: The formation of cerebral aneurysms involves complex processes and little is known about the mechanisms by which they originate, grow, and rupture. The purpose of this study was to identify early ultrastructural morphological changes that lead to the formation of experimental cerebral aneurysms. METHODS: Twenty male Sprague-Dawley rats were ...

Left atrial myxoma commonly leads to cerebral embolic ischemic stroke. The subsequent formation of cerebral aneurysms due to myxomatous emboli is a phenomenon that may lead to severe neurologic complications such as intracerebral hemorrhage. In addition to the formation of aneurysms in cerebral arteries, we report here the unique picture ...

Transcranial Doppler (TCD) was carried out to determine the resistive index (RI) values of normal canine cerebral arteries and its reproducibility and to evaluate the change of cerebral vascular resistance following diuretics administration. RI values of rostral cerebral artery (RCA) were compared between fontanelle window and temporal window. Normal ranges ...

Cerebral aneurysm rupture and subarachnoid hemorrhage (SAH) inflict disability and death on thousands of individuals each year. In addition to vasospasm in large diameter arteries, enhanced constriction of resistance arteries within the cerebral vasculature may contribute to decreased cerebral blood flow and the development of delayed neurological deficits after SAH. ...

OBJECTIVE: Although the necessity of craniotomy for an unruptured cerebral aneurysm (UCA) is controversial, surgery is warranted if surgical risks are less than the risks of natural history. In this study, we investigated the need for craniotomy for UCAs on the basis of surgical risk. METHODS: History of cerebrovascular disorders, ...

BACKGROUND AND PURPOSE: Anatomic evaluation of the lenticulostriate arteries (LSAs) is important, especially in cases of surgical or endovascular treatment, but biplanar angiography provides limited information. We analyzed the LSAs with rotational angiography (RA) and 3D reconstruction and compared the findings with those of previous autopsy studies. METHODS: We retrospectively ...

Moyamoya syndrome, a vasculopathy characterized by chronic progressive stenosis at the apices of the intracranial internal carotid arteries, is an increasingly recognized entity which is associated with cerebral ischemia. Diagnosis is made on the basis of clinical and radiographic findings, including a characteristic stenosis of the internal carotid arteries in ...

Almost all diseases affect blood vessel attributes (vessel number, radius, tortuosity, and branching pattern). Quantitative measurement of vessel attributes over relevant vessel populations could thus provide an important means of diagnosing and staging disease. Unfortunately, little is known about the statistical properties of vessel attributes. In particular, it is unclear ...

A 53-year-old man was admitted with diplopia, right ptosis, left lid retraction, mild left sided weakness and involuntary movements. Neurological examination revealed plus-minus lid and Benedikt's syndromes together. Magnetic resonance imaging (MRI) showed two distinct mesencephalic infarctions in territories of paramedian and pedincular perforating arteries. Magnetic resonance angiography (MRA) showed ...

OBJECT: Revascularization is an important component of treatment for complex aneurysms, skull base tumors, and vertebrobasilar ischemia in the posterior circulation. In this study, the authors examined the microsurgical anatomy related to cerebral revascularization in the posterior circulation and demonstrate various procedures for bypass surgery. METHODS: The microsurgical anatomy of ...

BACKGROUND: The causes of the common dementias remain unknown. Paradoxical embolisation of the cerebral circulation by venous thrombi passing through venous to arterial shunts (v-aCS) in the heart or pulmonary circulation is known to occur in cryptogenic stroke and post-operative confusion following hip replacement. OBJECTIVES: To explore the role of ...

The superficial temporal artery-to-middle cerebral artery bypass represents the mainstay of bypass operations for cerebral revascularization. The role of this operation in the setting of cerebrovascular occlusive disease, with compromised cerebral hemodynamic reserve, is a topic of current investigation. In this report, we describe technical nuances to avert potential pitfalls ...

In this paper a method to extract cerebral arteries from computed tomographic angiography (CTA) is proposed. Since CTA shows both bone and vessels, the examination of vessels is a difficult task. In the upper part of the brain, the arteries of main interest are not close to bone and can ...

BACKGROUND: Assess the accuracy of transcranial color-coded sonography (TCCS) for detecting middle cerebral artery (MCA) stem occlusion and compare it with cerebral angiography. METHODS: This study enrolled a series of patients who received TCCS and cerebral angiography at the Department of Neurology in Chang Gung Memorial Hospital, Linkou Medical Center, ...

OBJECTIVE: To describe techniques of reconstruction for unclippable and uncoilable middle cerebral artery aneurysms. METHODS: A retrospective review was performed of seven patients who underwent eight operations during a 9-year period to treat complex middle cerebral artery bifurcation aneurysms not amenable to direct clipping or endovascular coiling. All preoperative and ...

We previously posited that impaired washout of emboli was an important mechanism of brain infarction in patients with cerebral hypoperfusion. Hyperviscosity and hypoperfusion enhance thrombus formation promoting embolization of fresh thrombi. Hypoperfusion also reduces dissolution of emboli due to reduced flow velocity leading to classic hemodynamic patterns of stroke. To ...

OBJECTIVE: To evaluate by MR diffusion weighted image (DWI-MR) the presence of new ischemic cerebral lesions after carotid artery stenting (CAS) and distal cerebral protection, in patients with internal carotid artery (ICA) stenosis >70. METHODS: Sixty-seven CAS were performed under cerebral protection with a distal filter. Mean age of the ...

OBJECTIVE: Dynamic MR perfusion imaging can detect cerebral perfusion deficits resulting from severe internal carotid artery (ICA) stenosis. It is unknown, however, whether moderate ICA stenosis (50-69%) also causes haemodynamic disturbance. We investigated whether cerebral perfusion deficits were detectable in patients with moderate ICA stenosis. METHODS: Eighteen patients underwent T2* ...