Temporal Characteristics of CSF-Venous Fistulas on Digital Subtraction Myelography

BACKGROUND AND PURPOSE

CSF-venous fistula can be diagnosed with multiple myelographic techniques; however, no prior work has characterized the time to contrast opacification and the duration of visualization. The purpose of our study was to evaluate the temporal characteristics of CSF-venous fistula on digital subtraction myelography.

MATERIALS AND METHODS

We reviewed the digital subtraction myelography images of 26 patients with CSF-venous fistulas. We evaluated how long the CSF-venous fistula took to opacify after contrast reached the spinal level of interest and how long it remained opacified. Patient demographics, CSF-venous fistula treatment, brain MR imaging findings, CSF-venous fistula spinal level, and CSF-venous fistula laterality were recorded.

RESULTS

Eight of the 26 CSF-venous fistulas were seen on both the upper- and lower-FOV digital subtraction myelography, for a total of 34 CSF-venous fistula views evaluated on digital subtraction myelography. The mean time to appearance was 9.1 seconds (range, 0-30 seconds). Twenty-two (84.6%) of the CSF-venous fistulas were on the right. The highest fistula level was C7, while the lowest was T13 (13 rib-bearing vertebral bodies). The most common CSF-venous fistula levels were T6 (4 patients) followed by T8, T10, and T11 (3 patients each). The mean age was 58.3 years (range, 31.7-87.6 years). Sixteen patients were women (61.5%).

CONCLUSIONS

This is the first study to report the temporal characteristics of CSF-venous fistulas using digital subtraction myelography. We found that on average, the CSF-venous fistula appeared 9.1 seconds (range, 0-30 seconds) after intrathecal contrast reached the spinal level.

Differential Contribution of ASPECTS Regions to Clinical Outcome after Thrombectomy for Acute Ischemic Stroke

BACKGROUND AND PURPOSE

Ischemic stroke is the leading cause of long-term disability in adults, but our ability to prognosticate from baseline imaging data is limited. The ASPECTS measures ischemic change in the middle cerebral artery territory on noncontrast CT based on 10 anatomic regions. Here, we investigated whether infarction in particular regions was associated with worse long-term outcome.

MATERIALS AND METHODS

We identified consecutive patients receiving mechanical thrombectomy for ICA/MCA occlusion at 2 comprehensive stroke centers. Pretreatment ASPECTS was assessed by 2 blinded reviewers. Clinical data including demographics, baseline NIHSS score, and 90-day mRS were collected. The relationship between individual ASPECTS regions and the mRS score (0-2 versus 3-6) was assessed using multivariable logistic regression.

RESULTS

Three hundred fifty-three patients were included (mean age, 70 years; 46% men), of whom 214 had poor outcome (mRS = 3-6). Caudate (OR = 3.26; 95% CI, 1.33-8.82), M4 region (OR = 2.94; 95% CI, 1.09-9.46), and insula (OR = 1.75; 95% CI, 1.08-2.85) infarcts were associated with significantly greater odds of poor outcome, whereas M1 region infarction reduced the odds of poor outcome (OR = 0.38; 95% CI, 0.14-0.99). This finding remained unchanged when restricted to only patients with good recanalization. No significant associations were found by laterality. Similarly, no region was predictive of neurologic improvement during the first 24 hours or of symptomatic intracerebral hemorrhage.

CONCLUSIONS

Our results indicate that ASPECTS regions are not equal in their contribution to functional outcome. This finding suggests that patient selection based on total ASPECTS alone might be insufficient, and infarct topography should be considered when deciding eligibility for thrombectomy.

Effects of BDNF and NT-3 on hair cell survival in guinea pig cochlea damaged by kanamycin treatment

The aim of this study was to determine whether neurotrophic factors such as brain derived neurotrophic factor (BDNF) and neurotrophin 3 (NT-3) would protect auditory hair cells from ototoxicity by aminoglycoside antibiotic. Twenty-seven Wistar guinea pigs were divided into three groups of nine animals each. BDNF and NT-3 (100 microg/ml) were delivered into the right scala tympani of guinea pig cochlea through a cannula-osmotic pump device. Artificial perilymph (AP) was used as control. Immediately after implantation of the device, each animal was given five successive doses of kanamycin (400 mg/kg). At 15, 30 and 60 days after infusion, surviving inner and outer hair cells were counted at each turn of every cochlea with a Philips 515 scanning electron microscope. Multiple comparison tests were carried out among the groups, using ANOVA and Dunnett T3/Tukey HSD. Protective effects of NT-3 on hair cells were observed at 30 and 60 days after kanamycin injection. BDNF had no protective effect on hair cells at 15 and 60 days, but some at 30 days. This study suggests that NT-3 and BDNF may protect against cochlear hair cell damage caused by kanamycin treatment. Possible mechanisms for the otoprotective effects were discussed. No single mechanism postulated can explain fully the results seen in this study. It is possible that the mechanisms act in concert to produce the observed effects, or there are as yet undiscovered mechanisms or secondary messengers responsible for the otoprotective effects.

[Immune tolerance in Masugi nephritis]

Induction of immunotolerance was studied in the autologous phase of experimental rabbit glomerulonephritis. The glomerulonephritis was induced by intravenous injection of duck anti-rabbit glomerular basement membrane globulin into rabbits. One single intravenous injection of that nephrotoxis immunoglobulin (20 mg/kg body weight) into rabbits was followed by glomerulonephritis with glomerular hypercellularity and proteinuria. Another group of rabbits was pretreated on their first day of age, using 1.5 mg/animal of immunoglobulin from duck. Nephritis did not grow manifest when the animals received another injection (20 mg/kg body weight), after eight weeks. Passive (intracutaneous) Arthus reaction (triggered by duck immunoglobulin) was recordable with equal intensity from either group.

The effect of cyclosporin A on rabbit nephrotoxic glomerulonephritis

The effect of cyclosporin A on the development of the autologous phase of experimental rabbit glomerulonephritis was assessed. The glomerulonephritis was induced by a single intravenous injection of duck anti-rabbit glomerular basement membrane globulin (molecular weight: 115 kDa) into adult rabbits. After 5-7 days, diffuse proliferative glomerulonephritis with proteinuria was observed in all the animals not treated with cyclosporin A (control group). The cyclosporin A treatment was started simultaneously with the injection of duck globulin. This attenuated the glomerular lesion, resulting in a normal urinary protein excretion. The serum level of autologous anti-duck IgG was reduced. In the group of rabbits which received an injection of duck anti-rabbit glomerular basement membrane globulin, cyclosporin A treatment and an additional high dose rabbit anti-duck globulin 8 days later again no glomerulonephritis was observed. However, cyclosporin A treatment had no effect on the observed duck immunoglobulin-induced passive Arthus phenomenon.

Viral hepatitis among parenteral drug addicts attending a Danish addiction clinic

100 parenteral drug abusers attending an addiction clinic were studied for past or present infection with hepatitis A and B virus (HAV and HBV) by sensitive serological assays for hepatitis B surface and e-antigen and antibodies to HBsAg, HBeAg, HBcAg and HAV. 44% of the individuals had past HAV infection, which is 4 times as high compared to the general population in Denmark. 83% had evidence of past or present HBV infection with no difference between men and women. This is 30 times higher than in the general population in Denmark. 18% of the subjects studied were positive for HBsAg and/or anti-HBc alone, but only 3 of these were positive for HBeAg (3%). Serum transaminase values were often elevated but this finding could not differentiate between patients with or without HBV infection. Infection with HBV appeared to take place during the first year of the drug addict's career, and to eliminate this major reservoir of HBV infection the main objective will be to prevent new susceptible individuals in getting addicted.

The newborn addict, ante- and postnatal care

An investigation is presented of 87 Danish infants born to 62 drug-addicted mothers who had been pregnant altogether 145 times. In Denmark all pregnant women are offered prophylactic examinations, sometimes by their family doctor, sometimes by the midwife and in special cases by the obstetric clinic. Despite the fact that this antenatal care is considered especially important, not least for the addicted, pregnant woman, these offers were only poorly utilised. There were four perinatal deaths, of which two were stillbirths, further 3 infants died later as a result of abuse or neglect. After discharge from hospital only 43 infants lived at home with their mothers. The rest were either voluntarily or compulsorily placed with the mothers' parents, in family care, or in a childrens home. Only 2 infants were adopted. After their return home from the labour wards the mothers took little advantage of the prophylactic paediatric examinations and the vaccination program which are offered free by the family doctor to all children of pre-school age. The same was true regarding domiciliary visits by the health visitor.