Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Stroke-like symptoms can be associated with the invasive evaluation and surgical resection of epileptic foci in patients with intractable epilepsy. Neurological deficits following surgical procedures for epilepsy are not uncommon, but most are relatively minor and transient. The authors investigated the neuroimaging patterns of cerebral tissue insults in patients suffering neurological deficits directly related to procedures performed to evaluate and treat intractable epilepsy. They attempted to discern potential secondary vascular insults from the not unexpected tissue loss that can be associated with various epilepsy procedures. ⋯ It is important to distinguish the not unexpected neurological deficits associated with inadvertent trauma to normal brain tissue during procedures associated with epilepsy surgery from vascular insults. Postoperative neuroimaging can be useful in this endeavor.
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To identify the prevalence and characteristics of aortic atherosclerotic plaque disease and its association with cerebrovascular risk factors in patients with cerebral ischemic events. ⋯ One third of TAA plaques are severe and complex in nature and more frequently present in the descending aorta and the arch of the aorta than in the ascending aorta. TEE should be considered for the early detection and treatment of TAA in patients without identified causes of stroke.
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Case Reports
Endovascular treatment of a left carotid artery "bowtie" pseudoaneurysm with a covered Wallgraft stent.
The authors present an unusual case of a young male patient with a large left common carotid artery pseudoaneurysm in a shape similar to that of a bowtie treated with a covered Wallgraft. The Wallgraft is a covered stent originally designed to be used in the treatment of tracheobronchial fistula and peripheral arterial applications. The favorable outcome of this case illustrates its endovascular application in nonsurgical traumatic injuries of the carotid artery.
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To assess the magnetic resonance (MR) imaging characteristics of spinal intramedullary ependymomas. ⋯ Ependymomas occur most often at the upper cord rather than in the conus medullaris and filum terminale. Of the cervical and thoracic ependymomas, most were cellular or epithelial types. Papillary ependymomas occurred exclusively in the conus medullaris and filum terminale. Rostral and caudal cysts are frequently associated with intramedullary ependymomas. Clear tumor margins, more uniform enhancement, and central locations can help differentiate ependymomas from other intramedullary spinal cord tumors.
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Transcranial Doppler (TCD) ultrasound with the intravenous injection of agitated saline as contrast (cTCD) is an effective method for detecting right-to-left intracardiac and extracardiac shunt (RLS); however, the sensitivity of cTCD in the diagnosis of RLS remains slightly less than that of transesophageal echocardiography, even in patients with adequate transtemporal ultrasonic bone windows. The authors present a case with cTCD underestimating RLS because of jugular valve incompetence in a 42-year-old man presenting with an episode of transient aphasia. Three weeks after transcatheter closure of a patent foramen ovale associated with an atrial septal aneurysm, he experienced 2 episodes of amaurosis fugax. ⋯ A single microbubble (MB) was detected in the left MCA in only 1 of 5 studies; the remaining runs all failed to detect an RLS. Significant MB reflux was noted in the left internal jugular vein because of jugular valve incompetence. The authors conclude that incompetence of the jugular vein valve can result in a false negative cTCD study for RLS detection.