Journal of neuroimaging : official journal of the American Society of Neuroimaging
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The Circle of Willis (COW) is the main collateral system between the bilateral carotid systems and the posterior circulation. COW normal variants are encountered in up to 62% of subjects. We hypothesize that, in patients with carotid artery stenosis, the presence of COW variants is a risk factor for leukoaraiosis. ⋯ The presence and the number of COW variants are associated with a higher leukoaraiosis volume in patients with significant internal carotid artery stenosis.
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Parturitional injuries refer to injuries sustained during and secondary to fetal delivery. The skull, brain, and head and neck regions are frequently involved. ⋯ In addition, a short discussion of the most common head and neck, facial, and spinal lesions is included. Various mimickers and risk factors are also presented.
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Case Reports
Low endogenous recanalization in embolic central retinal artery occlusion--the retrobulbar "spot sign".
Central retinal artery occlusion (CRAO) is most often indirectly diagnosed by lack of retinal perfusion. Direct embolus characterization may help to understand the natural course and low response to treatment. In a previous study we identified a hyperechoic signal within the optic nerve and in the central retinal artery ("spot sign"). ⋯ The hyperechoic spot sign may be an important predictive prognostic marker for persistent loss of vision. Its persistence may indicate calcified or cholesterol emboli and may explain the low therapeutic success rate to thrombolysis. Further studies on their origin and significance in atherosclerotic disease are warranted.
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Hypertrophic olivary degeneration (HOD) is an uncommon type of transneuronal degeneration. Case reports and case series described in the literature provide a foundation of our current knowledge of HOD. These reports have described HOD most frequently to be unilateral and occurring in association with lesions in the dentato-rubro-olivary pathway. Our purpose was to evaluate the rate of bilateral versus unilateral HOD in a large case series. ⋯ This study demonstrates that HOD is frequently bilateral. In slightly over 50% of patients with HOD, a lesion can be identified. In just under 50% patients with HOD, a lesion could not be identified and in these cases HOD was present bilaterally in the majority.
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Clinical Trial
Monitoring of cortical activity postreperfusion. A powerful tool for predicting clinical response immediately after recanalization.
In acute ischemic stroke, although early recanalization predicts rapid neurological recovery, in some cases early reperfusion does not immediately correlate to clinical improvement as "stunned brain" patients. The cortical activity monitoring in stroke patients is usually performed to evaluate epileptic activity through electroencephalogram. Bispectral index (BIS) monitor the cortical activity by fronto-temporal electrodes and is currently used for monitoring level of conscious on sedo-analgesia patients. Some studies have shown certain sensibility to detect cerebrovascular events during carotid revascularization. We aimed to evaluate the impact of BIS monitoring before and shortly after reperfusion on early and delayed clinical improvement on stroke patients. ⋯ BIS value is associated with clinical and radiological variables in acute stroke patients. The final BIS value is a powerful independent predictor of further clinical improvement. Larger studies are needed to assess the value of post reperfusion cortical activity measured by BIS.