Cerebral autoregulation(CA)is the mechanism that maintains stable cerebral blood flow(CBF)despite fluctuations in systemic blood pressure,crucial for brain homeostasis.Recent evidence highlights distinct regional vari...Cerebral autoregulation(CA)is the mechanism that maintains stable cerebral blood flow(CBF)despite fluctuations in systemic blood pressure,crucial for brain homeostasis.Recent evidence highlights distinct regional variations in CA between the anterior(carotid)and posterior(vertebrobasilar)circulations.Noninvasive neuromonitoring techniques,such as transcranial Doppler,transfer function analysis,and near-infrared spectroscopy,facilitate the dynamic assessment of CBF and autoregulation.Studies indicate a robust autoregulatory capacity in the anterior circulation,characterized by rapid adjustments in vascular resistance.On the contrary,the posterior circulation,mainly supplied by the vertebral arteries,may have a lower autoregulatory capacity.in acute brain injuries such as intracerebral and subarachnoid hemorrhage,and traumatic brain injuries,dynamic CA can be significantly altered in the posterior circulation.Proposed physiological mechanisms of impaired CA in the posterior circulation include:(1)Decreased sympathetic innervation of the vasculature impairing compensatory vasoreactivity;(2)Endothelial dysfunction;(3)Increased cerebral metabolic rate of oxygen consumption within the visual cortex causing CBFmetabolism(i.e.,neurovascular)uncoupling;and(4)Impaired blood-brain barrier integrity leading to impaired astrocytic mediated release of vasoactive substances(e.g.nitric oxide,potassium,and calcium ions).Furthermore,more research is needed on the effects of collateral circulation,as well as the circle of Willis variants,such as the fetal-type posterior cerebral artery,on dynamic CA.Improving our understanding of these mechanisms is crucial to improving the diagnosis,prognosis,and management of various cerebrovascular disorders.展开更多
BACKGROUND Lobulated intracranial aneurysm is a special type of aneurysm with at least one additional cyst in the neck or body of the aneurysm.Lobulated intracranial aneurysm is a complex aneurysm with complex morphol...BACKGROUND Lobulated intracranial aneurysm is a special type of aneurysm with at least one additional cyst in the neck or body of the aneurysm.Lobulated intracranial aneurysm is a complex aneurysm with complex morphology and structure and weak tumor wall,which is an independent risk factor for rupture and hemorrhage.Lobular aneurysms located in the anterior communicating artery complex account for 36.9%of all intracranial lobular aneurysms.Due to its special anatomical structure,both craniotomy and endovascular treatment are more difficult.Compared with single-capsule aneurysms,craniotomy for lobular intracranial aneurysms has a higher risk and complication rate.AIM To investigate the efficacy and safety of endovascular treatment for ruptured lobulated anterior communicating artery aneurysm(ACoAA).METHODS Patients with ruptured lobulated ACoAA received endovascular treatment in Sanming First Hospital Affiliated to Fujian Medical University from June 2020 to June 2022 were retrospectively included.Their demographic,clinical and imaging characteristics,endovascular treatment methods and follow-up results were collected.RESULTS A total of 24 patients with ruptured lobulated ACoAA were included,including 9 males(37.5%)and 15 females(62.5%).Their age was 56.2±8.9 years old(range 39-74).The time from rupture to endovascular treatment was 10.9±12.5 h.The maximum diameter of the aneurysms was 5.1±1.0 mm and neck width were 3.0±0.7 mm.Nineteen patients(79.2%)were double-lobed and 5(20.8%)were multilobed.Fisher's grade:Grade 2 in 16 cases(66.7%),grade 3 in 6 cases(25%),and grade 4 in 2 cases(8.3%).Hunt-Hess grade:Grade 0-2 in 5 cases(20.8%),grade 3-5 in 19 cases(79.2%).Glasgow Coma Scale score:9-12 in 14 cases(58.3%),13-15 in 10 cases(41.7%).Immediately postprocedural Raymond-Roy grade:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Raymond-Roy grade in imaging follow-up for 2 wk to 3 months:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Followup for 2 to 12 months showed that 21 patients(87.5%)had good functional outcomes(modified Rankin Scale score≤2),and there were no deaths.CONCLUSION Endovascular treatment is a safe and effective treatment for ruptured lobulated AcoAA.展开更多
Intracranial arterial occlusion is rarely encountered in association with head injury.Only six cases of traumatic occlusion of the anterior cerebral artery(ACA) have previously been reported.In this paper,the authors ...Intracranial arterial occlusion is rarely encountered in association with head injury.Only six cases of traumatic occlusion of the anterior cerebral artery(ACA) have previously been reported.In this paper,the authors describe a case of a posttraumatic occlusion of ACA.A 35-year-old male presented to the emergency room with severe head injury.Computed tomography(CT) scan displayed diffuse brain swelling with multiple skull fractures.Follow up CT scan showed extensive cerebral infarction in the territory of ACA.The patient underwent CT angiography that demonstrated occlusion of the ACA by a fracture of the anterior fossa.He died after 3 d.ACA traumatic occlusion is a rare condition,with poor prognosis.In this case,fracture was responsible for dissection and direct obstruction of the artery.展开更多
Anterior cerebral artery is the smaller terminal branch of the internal carotid artery. It is one of the arteries involved in the formation of the arterial circle of Willis at the base of the brain. Its hypoplasia or ...Anterior cerebral artery is the smaller terminal branch of the internal carotid artery. It is one of the arteries involved in the formation of the arterial circle of Willis at the base of the brain. Its hypoplasia or absence can cause serious problems during neurosurgery or in the vascular dynamics of the brain. We found a rare variation of the right anterior cerebral artery during the dissection of the brain. The initial segment of the artery was hypoplastic and plexiform. The anterior communicating artery was absent. The right and left anterior cerebral arteries fused with each other for a distance of about 1 cm. The course, size and distribution of the distal part of the right anterior cerebral artery were normal. This case may be of special importance to neurosurgeonsand radiologists. Obstructionor rupture of the left anterior cerebral artery in such cases might result in infarct of the medial surfaces of both cerebral hemispheres.展开更多
A 51-year-old man presented with subarachnoid haemorrhage with mild hydrocephaly. Digital substraction angiography and 3-D Computerised Angiogram (CT) revealed a saccular aneurysm at bifurcation of azygos anterior cer...A 51-year-old man presented with subarachnoid haemorrhage with mild hydrocephaly. Digital substraction angiography and 3-D Computerised Angiogram (CT) revealed a saccular aneurysm at bifurcation of azygos anterior cerebral artery (ACA) and other vascular variations such as vertebral artery fenestration and hypoplasia in one anterior cerebral artery. We performed aneurysmal neck clipping with good outcome and postoperative 3-D CT angiogram showed complet obliteration of aneurysm. Although azygos arteries are rare in healthy population, aneurysms of azygos ASA are not rare due to increased haemodynamic stress. We wanted to point out to better visualisation of anatomical variations at 3-D CT angiogram comparing DSA in patients with intracranial aneurysm.展开更多
Objective To report the clinical diagnosis and microsurgical treatment of ruptured distal anterior cerebral artery aneurysm (DACAA) patients treated over the last 3 years. Methods 9 consecutive cases of ruptured DACAA...Objective To report the clinical diagnosis and microsurgical treatment of ruptured distal anterior cerebral artery aneurysm (DACAA) patients treated over the last 3 years. Methods 9 consecutive cases of ruptured DACAA operated from October 2007 to March 2010 were reviewed and followed up. Results 11 aneurysms were clipped展开更多
The association between stroke and meningioma is rarely reported in the data. In most etiology classification, there is no compressive cause. The association between meningioma and stroke is increasingly reported. We ...The association between stroke and meningioma is rarely reported in the data. In most etiology classification, there is no compressive cause. The association between meningioma and stroke is increasingly reported. We report a case of 52-year-old woman, previously healthy, presented with sudden right hemiplegia with some transient mood disorders. The CT-scan revealed acute left anterior cerebral artery infarction associated with fronto-basale meningioma infiltrating both anterior cerebral arteries. She was treated by corticosteroid and rehabilitation, with partial recovery. No stroke prevention was used before surgical treatment.展开更多
BACKGROUND Cerebral infarction is an extremely rare postoperative complication of anterior cervical discectomy and fusion(ACDF),particularly in the delayed setting.We present a case who had a sudden stroke on day 18 a...BACKGROUND Cerebral infarction is an extremely rare postoperative complication of anterior cervical discectomy and fusion(ACDF),particularly in the delayed setting.We present a case who had a sudden stroke on day 18 after surgery.By sharing our experience with this case,we hope to provide new information about stroke after anterior cervical surgery.CASE SUMMARY We present the case of a 61-year-old man with more than 20 years of hypertension and 14 years of coronary heart disease who had suffered a stroke 11 years ago.The patient was admitted for a multiple ACDF due to symptoms of cervical spondylotic myelopathy and had a sudden stroke on day 18 after surgery.Imaging findings showed a large-area infarct of his left cerebral hemisphere and thrombosis in his left common carotid artery.With the consent of his family,the thrombus was removed and a vascular stent was implanted through an interventional operation.Forty days later,the patient was transferred to a rehabilitation hospital for further treatment.He had normal consciousness but slurred speech at the 1-year follow-up evaluation.The motor and sensory functions of his hemiplegic limbs partially recovered.CONCLUSION This case illustrated that a postoperative stroke related to anterior cervical surgery may be attributed to prolonged carotid retraction and might have a long silent period.Preventive measures include careful preoperative and postoperative examination for high-risk patients as well as gentle and intermittent retraction of carotid artery sheath during operation.展开更多
Variations of the anterior cerebral artery(ACA)-anterior communicating artery(ACo A) complex are commonly observed when associated with a symptomatic intracranial aneurysm. We report an asymptomatic ACo A aneurysm ass...Variations of the anterior cerebral artery(ACA)-anterior communicating artery(ACo A) complex are commonly observed when associated with a symptomatic intracranial aneurysm. We report an asymptomatic ACo A aneurysm associated with duplicated hypoplastic A1 segment of the right ACA, observed in a 70-year-old female cadaver. Furthermore, the aneurysm, practically substituting the ACo A, caused a remarkable depression on the internal surface of the right frontal lobe, anterior to the optic chiasm. Aneurysms and other anomalies of the ACA and ACo A are common and their microvascular surgical management requires sound knowledge of the normal and variant vascular anatomy. Persistence of some embryonic vessels that normally disappear, disappearance of vessels that would normally persist or sprouting of new vessels due to hemodynamic and genetic factors are the usual causes for such anomalies. The high incidence of coexisting vascular anomalies and aneurysm suggests that such abnormalities predispose to aneurysm formation due to changes in the regional blood flow. A1 segment duplication has been reported to occur in 4% of subjects in cadaveric studies and in up to 0.5%-9.7% of cases of ACo A aneurysm surgery. Angiographic hypoplasias and aplasias of the A1 seg-ment have been also correlated with ACo A aneurysm patients.展开更多
文摘Cerebral autoregulation(CA)is the mechanism that maintains stable cerebral blood flow(CBF)despite fluctuations in systemic blood pressure,crucial for brain homeostasis.Recent evidence highlights distinct regional variations in CA between the anterior(carotid)and posterior(vertebrobasilar)circulations.Noninvasive neuromonitoring techniques,such as transcranial Doppler,transfer function analysis,and near-infrared spectroscopy,facilitate the dynamic assessment of CBF and autoregulation.Studies indicate a robust autoregulatory capacity in the anterior circulation,characterized by rapid adjustments in vascular resistance.On the contrary,the posterior circulation,mainly supplied by the vertebral arteries,may have a lower autoregulatory capacity.in acute brain injuries such as intracerebral and subarachnoid hemorrhage,and traumatic brain injuries,dynamic CA can be significantly altered in the posterior circulation.Proposed physiological mechanisms of impaired CA in the posterior circulation include:(1)Decreased sympathetic innervation of the vasculature impairing compensatory vasoreactivity;(2)Endothelial dysfunction;(3)Increased cerebral metabolic rate of oxygen consumption within the visual cortex causing CBFmetabolism(i.e.,neurovascular)uncoupling;and(4)Impaired blood-brain barrier integrity leading to impaired astrocytic mediated release of vasoactive substances(e.g.nitric oxide,potassium,and calcium ions).Furthermore,more research is needed on the effects of collateral circulation,as well as the circle of Willis variants,such as the fetal-type posterior cerebral artery,on dynamic CA.Improving our understanding of these mechanisms is crucial to improving the diagnosis,prognosis,and management of various cerebrovascular disorders.
基金Supported by Fujian Province Health Young and Middle-aged Backbone Personnel Training Project,No.2021GGB022Fujian Medical University Sailing Fund,No.2019QH1262.
文摘BACKGROUND Lobulated intracranial aneurysm is a special type of aneurysm with at least one additional cyst in the neck or body of the aneurysm.Lobulated intracranial aneurysm is a complex aneurysm with complex morphology and structure and weak tumor wall,which is an independent risk factor for rupture and hemorrhage.Lobular aneurysms located in the anterior communicating artery complex account for 36.9%of all intracranial lobular aneurysms.Due to its special anatomical structure,both craniotomy and endovascular treatment are more difficult.Compared with single-capsule aneurysms,craniotomy for lobular intracranial aneurysms has a higher risk and complication rate.AIM To investigate the efficacy and safety of endovascular treatment for ruptured lobulated anterior communicating artery aneurysm(ACoAA).METHODS Patients with ruptured lobulated ACoAA received endovascular treatment in Sanming First Hospital Affiliated to Fujian Medical University from June 2020 to June 2022 were retrospectively included.Their demographic,clinical and imaging characteristics,endovascular treatment methods and follow-up results were collected.RESULTS A total of 24 patients with ruptured lobulated ACoAA were included,including 9 males(37.5%)and 15 females(62.5%).Their age was 56.2±8.9 years old(range 39-74).The time from rupture to endovascular treatment was 10.9±12.5 h.The maximum diameter of the aneurysms was 5.1±1.0 mm and neck width were 3.0±0.7 mm.Nineteen patients(79.2%)were double-lobed and 5(20.8%)were multilobed.Fisher's grade:Grade 2 in 16 cases(66.7%),grade 3 in 6 cases(25%),and grade 4 in 2 cases(8.3%).Hunt-Hess grade:Grade 0-2 in 5 cases(20.8%),grade 3-5 in 19 cases(79.2%).Glasgow Coma Scale score:9-12 in 14 cases(58.3%),13-15 in 10 cases(41.7%).Immediately postprocedural Raymond-Roy grade:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Raymond-Roy grade in imaging follow-up for 2 wk to 3 months:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Followup for 2 to 12 months showed that 21 patients(87.5%)had good functional outcomes(modified Rankin Scale score≤2),and there were no deaths.CONCLUSION Endovascular treatment is a safe and effective treatment for ruptured lobulated AcoAA.
文摘Intracranial arterial occlusion is rarely encountered in association with head injury.Only six cases of traumatic occlusion of the anterior cerebral artery(ACA) have previously been reported.In this paper,the authors describe a case of a posttraumatic occlusion of ACA.A 35-year-old male presented to the emergency room with severe head injury.Computed tomography(CT) scan displayed diffuse brain swelling with multiple skull fractures.Follow up CT scan showed extensive cerebral infarction in the territory of ACA.The patient underwent CT angiography that demonstrated occlusion of the ACA by a fracture of the anterior fossa.He died after 3 d.ACA traumatic occlusion is a rare condition,with poor prognosis.In this case,fracture was responsible for dissection and direct obstruction of the artery.
文摘Anterior cerebral artery is the smaller terminal branch of the internal carotid artery. It is one of the arteries involved in the formation of the arterial circle of Willis at the base of the brain. Its hypoplasia or absence can cause serious problems during neurosurgery or in the vascular dynamics of the brain. We found a rare variation of the right anterior cerebral artery during the dissection of the brain. The initial segment of the artery was hypoplastic and plexiform. The anterior communicating artery was absent. The right and left anterior cerebral arteries fused with each other for a distance of about 1 cm. The course, size and distribution of the distal part of the right anterior cerebral artery were normal. This case may be of special importance to neurosurgeonsand radiologists. Obstructionor rupture of the left anterior cerebral artery in such cases might result in infarct of the medial surfaces of both cerebral hemispheres.
文摘A 51-year-old man presented with subarachnoid haemorrhage with mild hydrocephaly. Digital substraction angiography and 3-D Computerised Angiogram (CT) revealed a saccular aneurysm at bifurcation of azygos anterior cerebral artery (ACA) and other vascular variations such as vertebral artery fenestration and hypoplasia in one anterior cerebral artery. We performed aneurysmal neck clipping with good outcome and postoperative 3-D CT angiogram showed complet obliteration of aneurysm. Although azygos arteries are rare in healthy population, aneurysms of azygos ASA are not rare due to increased haemodynamic stress. We wanted to point out to better visualisation of anatomical variations at 3-D CT angiogram comparing DSA in patients with intracranial aneurysm.
文摘Objective To report the clinical diagnosis and microsurgical treatment of ruptured distal anterior cerebral artery aneurysm (DACAA) patients treated over the last 3 years. Methods 9 consecutive cases of ruptured DACAA operated from October 2007 to March 2010 were reviewed and followed up. Results 11 aneurysms were clipped
文摘The association between stroke and meningioma is rarely reported in the data. In most etiology classification, there is no compressive cause. The association between meningioma and stroke is increasingly reported. We report a case of 52-year-old woman, previously healthy, presented with sudden right hemiplegia with some transient mood disorders. The CT-scan revealed acute left anterior cerebral artery infarction associated with fronto-basale meningioma infiltrating both anterior cerebral arteries. She was treated by corticosteroid and rehabilitation, with partial recovery. No stroke prevention was used before surgical treatment.
基金Capital’s Funds for Health Improvement and Research,No.2020-2-4091.
文摘BACKGROUND Cerebral infarction is an extremely rare postoperative complication of anterior cervical discectomy and fusion(ACDF),particularly in the delayed setting.We present a case who had a sudden stroke on day 18 after surgery.By sharing our experience with this case,we hope to provide new information about stroke after anterior cervical surgery.CASE SUMMARY We present the case of a 61-year-old man with more than 20 years of hypertension and 14 years of coronary heart disease who had suffered a stroke 11 years ago.The patient was admitted for a multiple ACDF due to symptoms of cervical spondylotic myelopathy and had a sudden stroke on day 18 after surgery.Imaging findings showed a large-area infarct of his left cerebral hemisphere and thrombosis in his left common carotid artery.With the consent of his family,the thrombus was removed and a vascular stent was implanted through an interventional operation.Forty days later,the patient was transferred to a rehabilitation hospital for further treatment.He had normal consciousness but slurred speech at the 1-year follow-up evaluation.The motor and sensory functions of his hemiplegic limbs partially recovered.CONCLUSION This case illustrated that a postoperative stroke related to anterior cervical surgery may be attributed to prolonged carotid retraction and might have a long silent period.Preventive measures include careful preoperative and postoperative examination for high-risk patients as well as gentle and intermittent retraction of carotid artery sheath during operation.
文摘Variations of the anterior cerebral artery(ACA)-anterior communicating artery(ACo A) complex are commonly observed when associated with a symptomatic intracranial aneurysm. We report an asymptomatic ACo A aneurysm associated with duplicated hypoplastic A1 segment of the right ACA, observed in a 70-year-old female cadaver. Furthermore, the aneurysm, practically substituting the ACo A, caused a remarkable depression on the internal surface of the right frontal lobe, anterior to the optic chiasm. Aneurysms and other anomalies of the ACA and ACo A are common and their microvascular surgical management requires sound knowledge of the normal and variant vascular anatomy. Persistence of some embryonic vessels that normally disappear, disappearance of vessels that would normally persist or sprouting of new vessels due to hemodynamic and genetic factors are the usual causes for such anomalies. The high incidence of coexisting vascular anomalies and aneurysm suggests that such abnormalities predispose to aneurysm formation due to changes in the regional blood flow. A1 segment duplication has been reported to occur in 4% of subjects in cadaveric studies and in up to 0.5%-9.7% of cases of ACo A aneurysm surgery. Angiographic hypoplasias and aplasias of the A1 seg-ment have been also correlated with ACo A aneurysm patients.
文摘目的探讨益肾通脉膏方在肾虚血瘀痰阻证脉络膜前动脉(anterior choroidal artery,AchA)区脑梗死患者中的应用效果。方法选取2021年12月—2023年9月泰安市中医医院收治的80例肾虚血瘀痰阻证AchA区脑梗死患者为研究对象,以治疗方法的不同分为两组,各40例。对照组行阿司匹林肠溶片治疗,观察组在对照组基础上增加益肾通脉膏方治疗。对比两组临床疗效、神经功能、日常生活能力、血清脑源性神经营养因子(brain derived neurotrophic factor,BDNF)水平及不良反应发生情况。结果观察组治疗总有效率为92.50%(37/40),高于对照组的75.00%(30/40),差异有统计学意义(χ^(2)=4.501,P<0.05)。治疗前,两组美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、Barthel指数(Barthel Index,BI)、改良Rankin量表(Modified Rankin Scale,mRS)评分、BDNF水平比较,差异无统计学意义(P均>0.05)。治疗后,观察组NIHSS评分、mRS评分、BI、BDNF水平均优于对照组,差异有统计学意义(P均<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论益肾通脉膏方能够减轻肾血瘀痰阻证AchA区脑梗死患者的神经功能损伤,提升日常生活能力,调节血清BDNF水平,且无严重不良反应。
