Acute event in cerebrovascular disease is the second most common cause of death in Korea following cancer, and it can also cause serious neurologic deficits. Understanding of perfusion status is important for clinical applications in management of patients with cerebrovascular diseases, and then the attacks of ischemic neurologic symptoms and the risk of acute events can be reduced. Therefore, the normal vascular anatomy of brain, various clinical applications of acetazolamide-enhanced brain perfusion SPECT, including meaning and role of assessment of vascular reserve in carotid stenosis before procedure, in pediatric Moyamoya disease before and after operation, in prediction of development of hyperperfusion syndrome before procedure, and in prediction of vasospasm and of prognosis in subarachnoid hemorrahge were reviewed in this paper.
Kim, Seung Min;Ha, Sang Hee;Kwon, Hanim;Kim, Yeon Jung;Ahn, Sung Ho;Kim, Bum Joon
Annals of Clinical Neurophysiology
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v.23
no.1
/
pp.17-28
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2021
The pathogenesis of many strokes originates in the vessel wall. Despite this, most traditional imaging focuses on the vascular lumen. Vessel-wall magnetic resonance imaging (VWMRI) is useful for establishing the etiology of intracranial stenosis. It also provides information regarding atherosclerotic plaque composition and thus plaque vulnerability, which is an indication of its potential to cause a stroke. In this review we focus on the characteristics of VWMRI findings in various arteriopathies related to intracranial artery stenosis, and discuss the clinical implications of these findings.
Kim, Hyung-Syup;Lee, Hyung-Jin;Yeu, In-Seung;Yi, Jin-Seok;Yang, Ji-Ho;Lee, Il-Woo
Journal of Korean Neurosurgical Society
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v.44
no.4
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pp.249-255
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2008
Objective : In Moyamoya disease, the primary goal of treatment is to improve collateral circulation through angiogenesis. In the present study, we obtained and sub-cultured bone marrow stromal cells (BMSCs) from rats without a cell-mediated immune response. Then, we injected the labeled BMSCs directly into adjacent temporal muscle during encephalomyosynangiosis (EMS). Three weeks after BMSC transplantation, we examined the survival of the cells and the extent of neovascularization. Methods : We divided 20 rats into a BMSC transplantation group (n=12) and a control group (n=8). Seven days after the induction of chronic cerebral ischemia, an EMS operation was performed, and labeled BMSCs ($1{\times}106^6/100\;{\mu}L$) were injected in the temporal muscle for the transplantation group, while an equivalent amount of culture solution was injected for the control group. Three weeks after the transplantation, temporal muscle and brain tissue were collected for histological examination and western blot analysis. Results : The capillary/muscle ratio in the temporal muscle was increased in the BMSC transplantation group compared to the control group, showing a greater increase of angiogenesis (p<0.05). In the brain tissue, angiogenesis was not significantly different between the two groups. The injected BMSCs in the temporal muscle were vascular endothelial growth factor (VEGF)-positive by immunofluorescence staining. In both temporal muscle and brain tissue, the expression of VEGF by western blot analysis was not much different between the two groups. Conclusion : During EMS in a chronic cerebral ischemia rat model, the injection of BMSCs resulted in accelerated angiogenesis in the temporal muscle compared to the control group.
Objective : We investigated the incidence of the vascular abnormalities associated with spontaneous intracerebral hemorrhage [ICH] using three-dimensional computed tomographic angiography [3D-CTA]. Methods : We prospectively assessed consecutive 76 patients with spontaneous intracerebral hemorrhage [ICH] who underwent 3D-CTA between June 2003 and May 2005. The patients with a recent history of trauma or mainly subarachnoid hemorrhage were excluded. We investigated relationship between vascular abnormality and ICH location. The findings of 3D-CTA were classified as one of three patterns with ICH; type A [without evidence of vascular abnormality], type B [with no vascular abnormality as the source of hemorrhage, but with incidental vascular abnormality], and type C [presence of a vascular abnormality as the source of hemorrhage]. Results : Sites of ICH were lobar 26, basal ganglia 23, thalamus 17, posterior fossa 6 and dominant intraventricular hemorrhage [IVH] 4. Among 76 patients, sixteen [21.1%] vascular abnormalities were noted excluding 13 cases of stenoocclusive disease. Sixteen cases included 6 cases of cerebral aneurysms [7.9%], 5 moyamoya diseases [6.6%], 4 arteriovenous malformations [5.3%] and 1 dural sinus thrombosis [1.3%]. Lobar ICH [30.8%] had a higher vascular abnormalities than other types, and younger age [<40] group had a higher incidence of vascular abnormalities than old age group. The patterns of 3D-CTA include sixty cases [79.0%] of type A, 6 cases [7.8%] of type Band 10 cases [13.2%] of type C. The vascular abnormalities were found in 8 [13.5%] of 59 hypertensive patients and 8 [47.0%] of 17 non-hypertensive patients [p=0.006]. Conclusion : 3D-CT angiography is considered a useful screening tool for ICH patients with suspected cerebrovascular abnormalities and should be considered in such clinical settings, especially in lobar type and in non-hypertensive younger patients.
Kim, Young-Ok;Suh, Jung-Pil;Kim, Eun-Il;Cho, Seok-Goo;Lee, Chang-Don;Yi, Jong-Yuk;Yoo, Do-Sung;Kim, Dal-Soo
Journal of Korean Neurosurgical Society
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v.29
no.12
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pp.1673-1676
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2000
Anticonvulsant hypersensitivity syndrome is a rare but fatal complication. It manifests as fever, skin rash, lymphadenopathy, and hepatitis. Phenytoin, phenobarbital, and carbamazepine are the most frequently involved drugs. We here report a case of phenytoin-induced anticonvulsant hypersensitivity syndrome. A 37-year-old woman presented with fever and generalized skin rash, 3 weeks following commencement of phenytoin 400mg daily for treatment of seizure after superficial temporal artery-middle cerebral artery(STA-MCA) anastomosis for moyamoya disease. Her temperature was $39.3^{\circ}C$ and her face was edematous. Laboratory findings showed elevated hepatic enzymes and eosinophilia. Blood and urine culture were all negative. Initially, prednisolone was commenced at 30 mg daily. But fever and skin rash did not improved and hepatic function was more aggravated. After increasing dose of steroid(methylprednisolone 125mg/day), fever and skin rash disappeared and hepatic enzymes returned to normal range.
Objective : Transfemoral catheter angiography (TFCA) is a basic procedure in neurovascular surgery with increasing importance in surgical and non-invasive treatments. Unfortunately, resident neurosurgeons have relatively few opportunities to perform TFCA in most institutions. We report a method developed in our hospital for training resident neurosurgeons to perform TFCA and evaluate the efficacy of this training. Methods : From May 2011 to September 2011, a total of 112 consecutive patients underwent TFCA by one resident neurosurgeon supervised by two neuroendovascular specialists. Patients who underwent elective diagnostic procedures were included in this study. Patients who underwent endovascular treatment were excluded. Demographic data, indications for TFCA, side of approach, number of selected arteries, and complications were analyzed. Results : This study included 64 males and 48 females with a mean age of 51.6 (12-81) years. All procedures were performed in the angiography suite. Common indications for procedures were as follows : stroke-induced symptoms in 61 patients (54.5%), Moyamoya disease and arteriovenous malformation in 13 patients (11.6%), and unruptured intracranial aneurysm in eight patients (7.1%). Right and left femoral puncture was performed in 98.2% and 1.8% of patients, respectively. A total of 465 selective angiographies were performed without complications. Angiographic examination was performed on 4.15 vessels per patient. Conclusion : TFCA can be performed safely by resident neurosurgeons based on anatomical study and a meticulous protocol under the careful supervision of neuroendovascular specialists.
Purpose: Head movement during brain perfusion SPECT (Diamox) scan is a one of important issues which decreases image quality. It also causes repeated scans. This study was designed to evaluate variable factors causing scan failures. Materials and Methods: 676 patients (359 men, 317 women, age average $54.5{\pm}18.4$) for brain perfusion SPECT (Diamox) scan from March, 2010 to Feb. 2011 were used as a subject. Age data and the kind of disease(Moyamoya disease (MMD), None moyamoya disease (NMMD), Cerebral infarction (CI)), test performance outcome (success,failure) were collected. The head movement factors(gender, disease, age, head fixation device) were evaluated by chi-square test and logistic regression analysis Results: The result showed that men had higher scan failure rate than women. Seniors in seventies(men 3.4%, women 1.5%) showed the most highest failure rate. Using head fixation device increased scan success rate up to 94.4~97.7%. The scan success rate is dependent upon gender, head fixation device by chi-square test(${\chi}^2$=3.8 (df=1, p<0.05), ${\chi}^2$=10.4 (df=1, p<0.001)) Gender, disease(CI), head fixation device showed very effective result in logistic regression analysis.(Wald=3.3 (p<0.07), Wald=3.7 (p<0.05), Wald=9.3 (p<0.05) Conclusion: It is demonstrated that gender, disease, using head fixation device is statistically very useful factors. Especially, head fixation device is a main key minimizing repeated scan.
Purpose : Susceptibility-weighted magnetic resonance (MR) sequence is three-dimensional (3D), spoiled gradient-echo pulse sequences that provide a high sensitivity for the detection of blood degradation products, calcifications, and iron deposits. This pictorial review is aimed at illustrating and discussing its main clinical applications. Materials and Methods: SWI is based on high-resolution, 3D, fully velocity-compensated gradient-echo sequences using both magnitude and phase images. To enhance the visibility of the venous structures, the magnitude images are multiplied with a phase mask generated from the filtered phase data, which are displayed at best after post-processing of the 3D dataset with the minimal intensity projection algorithm. A total of 200 patients underwent MR examinations that included SWI on a 3 tesla MR imager were enrolled. Results: SWI is very useful in detecting multiple brain disorders. Among the 200 patients, 80 showed developmental venous anomaly, 22 showed cavernous malformation, 12 showed calcifications in various conditions, 21 showed cerebrovascular accident with susceptibility vessel sign or microbleeds, 52 showed brain tumors, 2 showed diffuse axonal injury, 3 showed arteriovenous malformation, 5 showed dural arteriovenous fistula, 1 showed moyamoya disease, and 2 showed Parkinson's disease. Conclusion: SWI is useful in detecting occult low flow vascular lesions, calcification and microbleed and characterising diverse brain disorders.
Objective : Cerebral hyperperfusion syndrome (CHS) manifests as a collection of symptoms brought on by heightened focal cerebral blood flow (CBF), afflicting nearly 30% of patients who have undergone superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. The aim of this study was to investigate whether the amalgamation of magnetic resonance imaging (MRI) fluid-attenuated inversion recovery (FLAIR) and apparent diffusion coefficient (ADC) imaging via MRI can discern cerebral hyperemia after STA-MCA anastomosis surgery. Methods : A retrospective study was performed of patients who underwent STA-MCA anastomosis due to Moyamoya disease or atherosclerotic steno-occlusive disease. A protocol aimed at preventing CHS was instituted, leveraging the use of MRI FLAIR. Patients underwent MRI diffusion with FLAIR imaging 24 hours after STA-MCA anastomosis. A high signal on FLAIR images signified the presence of hyperemia at the bypass site, triggering a protocol of hyperemia care. All patients underwent hemodynamic evaluations, including perfusion MRI, single-photon emission computed tomography (SPECT), and digital subtraction angiography, both before and after the surgery. If a high signal intensity is observed on MRI FLAIR within 24 hours of the surgery, a repeat MRI is performed to confirm the presence of hyperemia. Patients with confirmed hyperemia are managed according to a protocol aimed at preventing further progression. Results : Out of a total of 162 patients, 24 individuals (comprising 16 women and 8 men) exhibited hyperemia on their MRI FLAIR scans following the procedure. SPECT was conducted on 23 patients, and 11 of them yielded positive results. All 24 patients underwent perfusion MRI, but nine of them showed no significant findings. Among the patients, 10 displayed elevations in both CBF and cerebral blood volume (CBV), three only showed elevation in CBF, and two only showed elevation in CBV. Follow-up MRI FLAIR scans conducted 6 months later on these patients revealed complete normalization of the previously observed high signal intensity, with no evidence of ischemic injury. Conclusion : The study determined that the use of MRI FLAIR and ADC mapping is a competent means of early detection of hyperemia after STA-MCA anastomosis surgery. The protocol established can be adopted by other neurosurgical institutions to enhance patient outcomes and mitigate the hazard of permanent cerebral injury caused by cerebral hyperemia.
Purpose: Transient neurological deterioration (TND) is one of the complications after extracranial-intracranial bypass surgery, and it has been assumed to be caused by postoperative transient hyperperfusion. This study was performed to evaluate the relationship between TND and preoperative and postoperative cerebral perfusion status on brain perfusion SPECT following superficial temporal artery - middle cerebral artery (STA-MCA) anastomosis surgery. Materials and Methods: A total of 60 STA-MCA anastomosis surgeries of 56 patients (mean age: $50{\pm}16$ yrs; M:F=29:27; atherosclerotic disease: 33, moyamoya disease: 27) which were done between September 2003 and July 2006 were enrolled. The resting cerebral perfusion and cerebral vascular reserve (CVR) after acetazolamide challenge were measured before and 10 days after surgery using 99mTc-ethylcysteinate dimer (ECD) SPECT. Moreover, the cerebral perfusion was measured on the third postoperative day. With the use of the statistical parametric mapping and probabilistic brain atlas, the counts for the middle cerebral artery (MCA) territory were calculated for each image, and statistical analyses were performed. Results: In 6 of 60 cases (10%), TND occurred after surgery. In all patients, the preoperative cerebral perfusion of affected MCA territory was significantly lower than that of contralateral side (p=0.002). The cerebral perfusion on the third and tenth day after surgery was significantly higher than preoperative cerebral perfusion (p=0.001, p=0.02). In TND patients, basal cerebral perfusion and CVR on preoperative SPECT were significantly lower than those of non-TND patients (p=0.01, p=0.05). Further, the increases in cerebral perfusion on the third day after surgery were significant higher than those in other patients (p=0.008). In patients with TND, the cerebral perfusion ratio of affected side to contralateral side on third postoperative day was significantly higher than that of other patients (p=0.002). However, there was no significant difference of the cerebral perfusion ratio on preoperative and tenth postoperative day between patients with TND and other patients. Conclusion: In patients with TND, relative and moderate hyperperfusion was observed in affected side after bypass surgery. These finding may help to understand the pathophysiology of TND.
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