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García-Pérez D, Parra-Serrano J, Panero I, Moreno LM, Campollo J, Alén JF. Transient cortical blindness secondary to contrast-induced encephalopathy following diagnostic cerebral angiography: report of 2 cases. Acta Neurol Belg 2021; 121:585-589. [PMID: 33123949 DOI: 10.1007/s13760-020-01532-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain.
| | - Javier Parra-Serrano
- Department of Neurology, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Irene Panero
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Luis Miguel Moreno
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Jorge Campollo
- Division of Neuroradiology, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - José F Alén
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
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Rodríguez-Pardo J, Fuentes B, Alonso de Leciñana M, Campollo J, Calleja Castaño P, Carneado Ruiz J, Egido Herrero J, García Leal R, Gil Núñez A, Gómez Cerezo J, Martín Martínez A, Masjuán Vallejo J, Palomino Aguado B, Riera López N, Simón de las Heras R, Vivancos Mora J, Díez Tejedor E. Acute stroke care during the COVID-19 pandemic. Ictus Madrid Program recommendations. Neurología (English Edition) 2020. [PMCID: PMC7211680 DOI: 10.1016/j.nrleng.2020.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction The COVID-19 pandemic has resulted in complete saturation of healthcare capacities, making it necessary to reorganise healthcare systems. In this context, we must guarantee the provision of acute stroke care and optimise code stroke protocols to reduce the risk of SARS-CoV-2 infection and rationalise the use of hospital resources. The Madrid Stroke multidisciplinary group presents a series of recommendations to achieve these goals. Methods We conducted a non-systematic literature search using the keywords “stroke” and “COVID-19” or “coronavirus” or “SARS-CoV-2.” Our literature review also included other relevant studies known to the authors. Based on this literature review, a series of consensus recommendations were established by the Madrid Stroke multidisciplinary group and its neurology committee. Results These recommendations address 5 main objectives: (1) coordination of action protocols to ensure access to hospital care for stroke patients; (2) recognition of potentially COVID-19-positive stroke patients; (3) organisation of patient management to prevent SARS-CoV-2 infection among healthcare professionals; (4) avoidance of unnecessary neuroimaging studies and other procedures that may increase the risk of infection; and (5) safe, early discharge and follow-up to ensure bed availability. This management protocol has been called CORONA (Coordinate, Recognise, Organise, Neuroimaging, At home). Conclusions The recommendations presented here may assist in the organisation of acute stroke care and the optimisation of healthcare resources, while ensuring the safety of healthcare professionals.
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Rodríguez-Pardo J, Fuentes B, Alonso de Leciñana M, Campollo J, Calleja Castaño P, Carneado Ruiz J, Egido Herrero J, García Leal R, Gil Núñez A, Gómez Cerezo JF, Martín Martínez A, Masjuán Vallejo J, Palomino Aguado B, Riera López N, Simón de Las Heras R, Vivancos Mora J, Díez Tejedor E. Acute stroke care during the COVID-19 pandemic. Ictus Madrid Program recommendations. Neurologia 2020; 35:258-263. [PMID: 32364127 PMCID: PMC7180371 DOI: 10.1016/j.nrl.2020.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/22/2022] Open
Abstract
Introducción La pandemia por COVID-19 ha obligado a una reorganización de los sistemas sanitarios y ha comportado una saturación excepcional de sus recursos. En este contexto es vital asegurar la atención al ictus agudo y optimizar los procesos asistenciales del código ictus para reducir el riesgo de contagios y racionalizar el uso de recursos hospitalarios. Para ello, desde el Grupo Multidisciplinar Ictus Madrid proponemos una serie de recomendaciones. Métodos Revisión bibliográfica no sistemática de las publicaciones disponibles con los términos «stroke» y «COVID-19» o «coronavirus» o «SARS-CoV-2», así como otras conocidas por los autores. En base a esta se redacta un documento de recomendaciones que es sometido a consenso por el Grupo Multidisciplinar Ictus Madrid y su Comité de Neurología. Resultados Las recomendaciones se estructuran en cinco líneas fundamentales: 1) coordinar la actuación para garantizar el acceso a la asistencia hospitalaria de los pacientes con ictus; 2) reconocer a los pacientes con ictus potencialmente infectados por COVID-19, 3) organización adecuada para garantizar la protección de los profesionales sanitarios frente al riesgo de contagio por COVID-19, 4) en la realización de neuroimagen y otros procedimientos que conlleven contactos de riesgo de infección COVID-19 hay que procurar reducirlos y asegurar la protección, y 5) alta y seguimiento seguros procurando optimizar la ocupación hospitalaria. Resumimos el procedimiento de forma esquemática con el acrónimo CORONA (COordinar, Reconocer, Organizar, Neuroimagen, Alta). Conclusiones Estas recomendaciones pueden servir de apoyo para la organización del sistema sanitario en la atención al ictus agudo y la optimización de sus recursos, garantizando la protección de sus profesionales.
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Affiliation(s)
- J Rodríguez-Pardo
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPaz, Madrid, España.
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPaz, Madrid, España
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPaz, Madrid, España
| | - J Campollo
- Servicio de Radiología (Sección de Neurorradiología), Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - P Calleja Castaño
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Carneado Ruiz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, España
| | - J Egido Herrero
- Servicio de Neurología, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, Madrid, España
| | - R García Leal
- Servicio de Neurocirugía, Hospital Universitario Gregorio Marañón, Universidad Autónoma de Madrid, Madrid, España
| | - A Gil Núñez
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Universidad Autónoma de Madrid, Madrid, España
| | - J F Gómez Cerezo
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, Madrid, España
| | - A Martín Martínez
- Servicio de Urgencias Hospitalarias, Hospital Severo Ochoa, Madrid, España
| | - J Masjuán Vallejo
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | - B Palomino Aguado
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | - N Riera López
- Servicio de Urgencias Médicas de Madrid, SUMMA-112, Madrid, España
| | - R Simón de Las Heras
- Servicio de Neurología (Sección Neuropediatría), Hospital Universitario 12 de Octubre, Madrid, España
| | - J Vivancos Mora
- Servicio de Neurología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - E Díez Tejedor
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPaz, Madrid, España.
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Munarriz PM, Castaño-Leon AM, Cepeda S, Campollo J, Alén JF, Lagares A. Endovascular treatment of a true posterior communicating artery aneurysm. Surg Neurol Int 2014; 5:S447-50. [PMID: 25422786 PMCID: PMC4235117 DOI: 10.4103/2152-7806.143273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/22/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Posterior communicating artery (PCoA) aneurysms are most commonly located at the junction of the internal carotid artery and the PCoA. "True" PCoA aneurysms, which originate from the PCoA itself, are rarely encountered. Most previously reported cases were treated surgically mainly before the endovascular option became available. CASE DESCRIPTION A 53-year-old male presented with sudden onset of right hemiparesis and aphasia. Left middle cerebral artery stroke was diagnosed. Further studies revealed a 3 mm left PCoA aneurysm arising from the PCoA itself, attached to neither the internal carotid artery nor the posterior cerebral artery. Endovascular treatment was performed and the aneurysm was coiled completely. CONCLUSION Technical advances in endovascular interventional technology have permitted an additional approach to these lesions. The possible endovascular significance of the treatment of true PCoA aneurysms is discussed.
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Affiliation(s)
- Pablo M Munarriz
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Ana M Castaño-Leon
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Santiago Cepeda
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Jorge Campollo
- Division of Neuroradiology, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Jose F Alén
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain ; Division of Neuroradiology, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
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5
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Guerrero AM, Sierra-Hidalgo F, Calleja P, Navia P, Campollo J, Díaz-Guzmán J. Intracranial Internal Carotid Artery Angioplasthy and Stenting in Giant Cell Arteritis. J Neuroimaging 2014; 25:307-309. [DOI: 10.1111/jon.12116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 02/05/2014] [Accepted: 03/02/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Fernando Sierra-Hidalgo
- Stroke Unit, Department of Neurology; Hospital Universitario 12 de Octubre; Madrid Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12); Madrid Spain
| | - Patricia Calleja
- Stroke Unit, Department of Neurology; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Pedro Navia
- Interventional Neuroradiology Unit; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Jorge Campollo
- Interventional Neuroradiology Unit; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Jaime Díaz-Guzmán
- Stroke Unit, Department of Neurology; Hospital Universitario 12 de Octubre; Madrid Spain
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6
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Alén JF, Lagares A, Paredes I, Campollo J, Navia P, Ramos A, Lobato RD. Cerebral microarteriovenous malformations: a series of 28 cases. J Neurosurg 2013; 119:594-602. [DOI: 10.3171/2013.4.jns121740] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Microarteriovenous malformations (micro-AVMs) are a rare subgroup of brain AVMs characterized by a nidus smaller than 1 cm. The authors' purpose in this study was to assess the clinical presentation, radiological features, therapeutic management, and outcome of these lesions.
Methods
All angiography studies performed at the authors' institution since 2000 for the diagnosis of AVM were retrospectively reviewed. Clinicoradiological findings, therapeutic management, and outcome were evaluated.
Results
Twenty-eight patients had presented with AVMs having a nidus diameter smaller than 1 cm or no clearly identifiable nidus but an early draining vein. All patients, except 2, presented with intracranial hemorrhage, and 12 patients had a focal deficit. Supratentorial hematomas were large (mean volume 25 ml), and in 8 patients hematomas were evacuated urgently. In 6 patients cerebral digital subtraction angiography studies were normal. Magnetic resonance imaging and dynamic MR angiography revealed an AVM in 4 of these 6 patients. Treatment of the AVM consisted of surgery in 16 cases, radiosurgery in 6, and endovascular embolization in 2, and there were no posttreatment deficits. Four patients received no treatment because of their poor condition. The AVM was occluded at the follow-up in all patients treated with surgery or embolization and in 4 of the 6 patients treated with radiosurgery. The Glasgow Outcome Scale (GOS) score was good (GOS 4–5) in 23 patients (82%) and poor (GOS 3–2) in 5 (18%).
Conclusions
Patients with micro-AVMs generally present with large intracranial hemorrhages and neurological deficits. If the initial angiography is negative, then delayed or superselective angiography is recommended. Magnetic resonance imaging may reveal the existence of these lesions. Surgery is the treatment of choice for superficial micro-AVMs, and radiosurgery or embolization can be considered for deep lesions.
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Affiliation(s)
| | | | | | - Jorge Campollo
- 2Division of Neuroradiology, Hospital 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Pedro Navia
- 2Division of Neuroradiology, Hospital 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Ana Ramos
- 2Division of Neuroradiology, Hospital 12 de Octubre, Universidad Complutense de Madrid, Spain
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7
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Paredes I, Martinez-Perez R, Munarriz PM, Castaño-Leon AM, Campollo J, Alén JF, Lobato RD, Lagares A. [Intracranial dural arteriovenous fistulae. Experience after 81 cases and literature review]. Neurocirugia (Astur) 2013; 24:141-51. [PMID: 23582488 DOI: 10.1016/j.neucir.2013.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/25/2013] [Accepted: 02/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To analyse the clinical, radiological and therapeutic variables of intracranial dural arteriovenous fistulae (DAVF) treated at our institution, and to assess the validity of the Borden and Cognard classifications and their correlation with the presenting symptoms. MATERIAL AND METHODS The DAVF identified were retrospectively analysed. They were classified according to their location, drainage pattern and the Borden and Cognard classifications. We recorded the different treatments, their complications and efficacy. RESULTS There were 81DAVF identified between 1975 and 2012. The cavernous sinus (CS) location was the most frequent one. The Borden and Cognard classifications showed an interobserver Kappa index of 0.72 and 0.76 respectively. The odds ratio of aggressive presentation in the presence of cortical venous drainage (CVD) was 19.3 (2.8-132.4). No location, once adjusted by venous drainage pattern, showed significant association with an aggressive presentation. Endovascular transarterial treatment of cavernous sinus DAVF achieved symptomatic improvement of 78%, with a complication rate of 5%. The DAVF of non-CS locations, with CVD, treated surgically were angiographically shown cured in 100% of the cases, with no treatment-related complications. CONCLUSIONS The presence of CVD was significantly associated with aggressive presentations. The Borden and Cognard classifications showed little interobserver variability. Endovascular treatment for CS DAVF is safe and relatively effective. Surgical treatment of non-CS DAVF with CVD is safe, effective and the first choice treatment in our environment.
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Affiliation(s)
- Igor Paredes
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Madrid, España.
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8
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Arrese Regańón I, Alday R, González PA, Campollo J, Ramos A, Domínguez P, Fernández-Letón JP, Pérez-Núñez A, Lobato RD. [Hyperintensity on T2 MRI and size as predictors of obliteration in radiosurgically treated arteriovenous malformations]. Neurocirugia (Astur) 2009; 20:97-102. [PMID: 19448953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The aim of this study was to determine which factors were statistically related to radiological and clinical outcomes following radiosurgical treatment of arteriovenous malformations (AVMs). METHODS The data of 59 patients receiving radiosurgical treatment at our department were retrospectivelly reviewed. Different clinical and biological data, including Spetzler-Martin grade, the presentation of symptoms, radiation dose, number of isocenters and both radiological and clinical outcome, were subjected to multivariate analysis. RESULTS AVM obliteration was achieved in 77% of patients, the majority of them occurring between 3-5 years after treatment. Ten patients (17%) showed either acute or delayed complications. Only one patient died due tor hemorrhage during the follow-up after radiosurgery. A multivariate analysis showed that, hyperintensity on T2 MRI and a nidus smaller than 3 cm were the only factors statistically related to oclusion of the AVM (p=0.03 and p=0.05, respectively). CONCLUSION The nidus size and the development of hyperintensity on T2 MRI after the treatment were the strongest predictive factors of obliteration in our series of AVMs radiosurgically treated. Moreover, given that many AVMs showed complete obliteration between 3-5 years after treatment, we recommend to wait untill 5 years after treatment before considering a new terapeuthic approach in patients showing small residual nidus at control imaging.
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Arrese I, Alday R, González P, Campollo J, Ramos A, Dominguez P, Fernández-Letón J, Pérez-Núñez A, Lobato RD. Hiperintensidad en secuencias T2 y tamaño como factores pronósticos de obliteración en malformaciones arteriovenosas tratadas mediante radiocirugía. Neurocirugia (Astur) 2009. [DOI: 10.4321/s1130-14732009000200001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Arrese I, Alday R, González P, Fernández-Letón J, Pérez-Núñez A, Lobato R, Campollo J, Ramos A, Dominguez P. Hiperintensidad en secuencias T2 y tamaño como factores pronósticos de obliteración en malformaciones arteriovenosas tratadas mediante radiocirugía. Neurocirugia (Astur) 2009. [DOI: 10.1016/s1130-1473(09)70174-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Alén JF, Lagares A, Campollo J, Ballenilla F, Kaen A, Núñez ÁP, Lobato RD. IDIOPATHIC SUBARACHNOID HEMORRHAGE AND VENOUS DRAINAGE. Neurosurgery 2008; 63:1106-11; discussion 1111-2. [DOI: 10.1227/01.neu.0000335777.14055.71] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- José F. Alén
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Jorge Campollo
- Section of Neuroradiology, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Ariel Kaen
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Ángel P. Núñez
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Ramiro D. Lobato
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
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12
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Alén JF, Campollo J, Rivas JJ, Lagares A, Pascual B, Jiménez-Roldán L, Lobato RD. [Embolization of indirect carotid-cavernous sinus fistula through the ophthalmic vein]. Neurocirugia (Astur) 2008; 19:338-342. [PMID: 18726044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Indirect or dural carotid cavernous fistulas are abnormal connections between the cavernous sinus and meningeal branches of the external and/or internal carotid arteries. Most of them are idiopathic and occurs spontaneously. Symptoms vary from a tiny episcleral injection to a severe visual loss. Conservative therapy is recomended in cases with few symptoms and no leptomeningeal drainage, as spontaneous resolution is not infrequent. Whenever symptoms worsen, treatment of the fistula should be prescribed. Nowadays, transvenous endovascular treatment consisting of packing the cavernous sinus is the first choice. In most cases, cavernous sinus can be approached through the inferior petrosal sinus. However, sometimes that is not possible, and an approach directly through the superior ophthalmic vein could be necessary. We report a case of a patient with a dural carotid cavernous fistula treated with embolization of the cavernous sinus through the ophthalmic vein.
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Affiliation(s)
- J F Alén
- Servicio de Neurocirugía, Hospital 12 de Octubre, Madrid
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13
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Alén J, Campollo J, Rivas J, Lagares A, Pascual B, Jiménez-Roldán L, Lobato R. Embolización de fístula carótido cavernosa indirecta a través de la vena oftálmica superior. Neurocirugia (Astur) 2008. [DOI: 10.4321/s1130-14732008000400004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lagares A, Fernández-Alén JA, Porto J, Campollo J, Ramos A, Jiménez-Roldán L, Lobato RD. [Subarachnoid hemorrhage caused by a dissecting carotid artery aneurysm]. Neurocirugia (Astur) 2007; 18:414-419. [PMID: 18008015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Dissecting aneurysms of the carotid artery as a cause of subarachnoid hemorrhage are rare. However, the association of arterial dissection with the etiology of some aneurysms of the dorsal or anterior wall of the carotid artery, carotid trunk or "blister-like" aneurysms has increased the interest in the description of dissecting aneurysms, as they are difficult to treat and require non-habitual surgical techniques. We present the case of a patient that presented with a poor grade subarachnoid hemorrhage secondary to a right carotid artery dissecting aneurysm characterised in angiography by a carotid artery stenosis accompanied by a post-stenotic dilatation and the finding of a saccular aneurysm that increased in size in the follow-up study. A carotid occlusion test showed an asymmetry in the opacification of the venous phase indicating the need for a revascularization procedure prior to arterial sacrifice. A high flow EC-IC bypass was performed using a saphenous vein graft prior to right carotid artery occlusion without morbidity. Eight months after the procedure the patient is free of neurological deficit. Control image studies demonstrate the resolution of the carotid lesion and the bypass permeability. We discuss the difficulties in the diagnosis of these aneurysms, their clinical and imaging characteristics and the problems related to their treatment as they often require arterial sacrifice with or without prior cerebral revascularization.
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Affiliation(s)
- A Lagares
- Servicios de Neurocirugía, Hospital 12 de Octubre, Madrid, Spain
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15
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Lagares A, Fernández-Alén J, Porto J, Campollo J, Ramos A, Jiménez-Roldán L, Lobato R. Hemorragia subaracnoidea como forma de presentación de aneurisma disecante carotídeo. Neurocirugia (Astur) 2007. [DOI: 10.4321/s1130-14732007000500005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pascual B, Lagares A, Miranda P, Pérez-Núñez A, Arrese I, Lobato RD, Campollo J. [Spontaneous regression of cerebral arteriovenous malformations: case report and review of the literature]. Neurocirugia (Astur) 2007; 18:326-9. [PMID: 17882340 DOI: 10.4321/s1130-14732007000400006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Spontaneous regression of intracranial arteriovenous malformations (AVMs) is a rare phenomenon. Such an event is more likely to occur with small AVMs that present with intracranial hemorrhage, which are fed by a unique artery and drained through a single vein. The factors responsible for AVMs regression remain unclear. Thrombosis of the AVM secondary to intracranial hemorrhage ha been the most commonly associated factor. Other possible causes are the gliosis around the clot secondary to repeated frequent microbleedings or occlusion of the feeding arteries by small emboli. We report a new case of spontaneous regression of a AVM and review the literature related to this entity.
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Affiliation(s)
- B Pascual
- Servicios de Neurocirugía, Hospital Universitario 12 de Octubre, Madrid
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Lagares A, Perez-Nuñez A, Alday R, Ramos A, Campollo J, Lobato RD. Dural arteriovenous fistula presenting as brainstem ischaemia. Acta Neurochir (Wien) 2007; 149:965-7; discussion 967. [PMID: 17659371 DOI: 10.1007/s00701-007-1250-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 06/21/2007] [Indexed: 11/24/2022]
Abstract
Dural arteriovenous fistulas presenting with ascending myelopathy are characterised by the presence of an abnormal retrograde drainage through spinal veins. The authors present a case of cranial dural arteriovenous fistula causing brainstem dysfunction secondary to venous hypertension, treated by surgical interruption of the pial venous drainage which resulted in complete clinical and radiological resolution of the brainstem lesion.
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Affiliation(s)
- A Lagares
- Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain.
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Pascual B, Lagares A, Miranda P, Pérez-Núñez A, Arrese I, Lobato R, Campollo J. Regresión espontánea de las malformaciones arteriovenosas cerebrales: presentación de un caso y revisión de la literatura. Neurocirugia (Astur) 2007. [DOI: 10.1016/s1130-1473(07)70277-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Palomino JC, Lobato RD, Campollo J, Fernández-Alen J, Lagares A. Unruptured dural arteriovenous malformation of the transverse-sigmoid sinus presenting with focal symptoms and coma. Neurocirugia (Astur) 2005; 15:458-67. [PMID: 15558203 DOI: 10.1016/s1130-1473(04)70458-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We are presenting the case of a 63 year-old man with a dural arteriovenous malformation of the transverse sigmoid sinus who developed focal deficits followed by less localized symptoms such a disorientation, lethargy and eventually comatose status. Initial cerebral angiography showed retrograde filling of the cortical and deep cerebral venous system with marked delay in venous empting. Following embolization clinical symptoms completely cleared at the time that control angiography showed retrograde venous flow turning anterograde. Patient's symptoms recurred four months later when there was a relapse of retrograde cerebral venous drainage at the time he developed thrombosis of the superior longitudinal and right transverse sinuses. Sinus thrombosis and thrombosis of the central retinal artery were coincidental with hypercoagulability related to hyperhomocysteinemia. Since control angiography still showed persistence of the AV shunting radical excision of the involved dural sinuses was performed. The final outcome was excellent. The physiopathological mechanism responsible for neurological deficits in our patient most likely was ischemia of venous origin secondary to venous hypertension resulting from retrograde cerebral venous drainage. The clinical and angiographic presentation in few similar cases reported in the literature is reviewed.
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Affiliation(s)
- J C Palomino
- Service of Neurosurgery and Section of Neuroradiology, Hospital Doce de Octubre, Faculty of Medicine, University Complutense, Madrid, Spain
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Lagares A, Gómez PA, Alen JF, Lobato RD, Rivas JJ, Alday R, Campollo J, de la Camara AG. A comparison of different grading scales for predicting outcome after subarachnoid haemorrhage. Acta Neurochir (Wien) 2005; 147:5-16; discussion 16. [PMID: 15565480 DOI: 10.1007/s00701-004-0417-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Most scales used to assess prognosis after subarachnoid haemorrhage (SAH) are based on the level of consciousness of the patient. Based on information from a logistic regression model, Ogilvy et al. developed a new grading scheme (Massachussetts General Hospital (MGH) Scale) which applied a simple scoring method to each prognostic factor considered relevant such as level of consciousness, age, quantity of blood in the first CT scan and size of the aneurysm. The purpose of this study is to introduce a modified version of the MGH scale, built up using factors applicable to every patient suffering SAH, and compare this new scale to the World Federation of Neurological Surgeons scale (WFNS), the Glasgow Coma Scale (GCS) scale for SAH and the MGH scale. METHOD A series of 442 patients consecutively admitted to Hospital 12 de Octubre between January 1990 and September 2001 with the diagnosis of spontaneous SAH were retrospectively reviewed. Outcome was assessed by means of the Glasgow Outcome Scale measured six months after hospital discharge. Differences between grades of the WFNS, the GCS scale for SAH, the MGH scale and the new scale were computed by chi2 statistics. ROC curves were plotted for the different scales and their areas compared. FINDINGS Both WFNS and GCS scales fail to present significant differences between most of their grades, while the proposed scale shows a constant inter-grade significant difference in predicting outcome. The proposed scale presents a significantly higher prognostic efficacy in the whole series of patients suffering spontaneous SAH, patients with idiopathic subarachnoid haemorrhage (ISAH) and patients with confirmed aneurysmal SAH. The MGH scale is not applicable to some groups of patients suffering SAH. INTERPRETATION Grading scales including additional factors to the level of consciousness show higher prognostic efficacy. The proposed modification of the MGH scale makes it applicable to every patient suffering SAH without losing its prediction capability.
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Affiliation(s)
- A Lagares
- Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain.
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Berbel-Garcia A, Martinez-Salio A, Porta-Etessam J, Saiz-Diaz R, Gonzalez-León P, Ramos A, Campollo J. Venous Angioma Associated With Atypical Ophthalmoplegic Migraine. Headache 2004; 44:440-2. [PMID: 15147253 DOI: 10.1111/j.1526-4610.2004.04097.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ophthalmoplegic migraine is a rare syndrome in which episodic headaches are associated with ophthalmoplegia. Several recent reports emphasize the possibility, especially in atypical cases, of a heterogeneous type of ophthalmoplegic migraine. METHODS We describe the case of an 18-year-old woman with recurrent episodic headache accompanied by binocular diplopia due to left third cranial nerve palsy. The symptoms resolve in hours. A diagnosis of atypical ophthalmoplegic migraine was established. RESULTS Digital angiography revealed a venous angioma draining into the left cavernous sinus. CONCLUSIONS This case reveals the importance of differential diagnosis in atypical migraine in which the symptomatology could be secondary to intracranial lesions. We propose venous stasis as a cause of symptoms.
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Alvarez-Linera J, Benito-León J, Escribano J, Campollo J, Gesto R. Prospective evaluation of carotid artery stenosis: elliptic centric contrast-enhanced MR angiography and spiral CT angiography compared with digital subtraction angiography. AJNR Am J Neuroradiol 2003; 24:1012-9. [PMID: 12748115 PMCID: PMC7975781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND AND PURPOSE Although digital subtraction angiography (DSA) is the reference standard for assessing carotid arteries, it is uncomfortable for patients and has a small risk of disabling stroke and death. These problems have fueled the use of spiral CT angiography and MR angiography. We prospectively compared elliptic centric contrast-enhanced MR angiography and spiral CT angiography with conventional DSA for detecting carotid artery stenosis. METHODS Eighty carotid arteries (in 40 symptomatic patients) were assessed. Elliptic centric MR and spiral CT angiographic data were reconstructed with maximum intensity projection and multiplanar reconstruction techniques. All patients had been referred for DSA evaluation on the basis of findings at Doppler sonography, which served as a screening method (degree of stenosis > or = 70% or inconclusive results). Degree of carotid stenosis estimated by using the three modalities was compared. RESULTS Significant correlation with DSA was found for stenosis degree for both elliptic centric MR and spiral CT angiography; however, the correlation coefficient was higher for MR than for CT angiography (r = 0.98 vs r = 0.86). Underestimation of stenoses of 70-99% occurred in one case with elliptic centric MR angiography (a 70% stenosis was underestimated as 65%) and in nine cases with spiral CT angiography, in comparison to DSA findings. Overestimation occurred in two cases with MR angiography (stenoses of 65-67% were overestimated as 70-75%). With CT, overestimation occurred in seven cases; a stenosis of 60% in one case was overestimated as 70%. Both techniques confirmed the three cases of carotid occlusion. With elliptic centric MR angiography, carotid stenoses of 70% or greater were detected with high sensitivity, 97.1%; specificity, 95.2%; likelihood ratio (LR) for a positive test result, 20.4; and ratio of LR(+) to LR(-), -0.3. With spiral CT angiography, sensitivity, specificity, LR(+), and LR(+):LR(-) were 74.3%, 97.6%, 31.2, and 0.3, respectively. CONCLUSION Elliptic centric contrast-enhanced MR angiography is more accurate than spiral CT angiography to adequately evaluate carotid stenosis. Furthermore, elliptic centric contrast-enhanced MR angiography appears to be adequate to replace conventional DSA in most patients examined.
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Lagares A, Lobato RD, Ricoy JR, Campollo J. Embolization of arteriovenous malformations with Onyx: clinicopathological experience in 23 patients. Neurosurgery 2002; 51:1525-6. [PMID: 12484347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
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Lobato RD, Campollo J, Lagares A, Gómez PA, Ramos A, Alday R, Alen JF. [Arteriovenous malformation of the middle and posterior third section of the corpus callosum treated with embolization and surgery]. Neurocirugia (Astur) 2002; 13:209-15. [PMID: 12148165 DOI: 10.1016/s1130-1473(02)70619-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We are presenting the case of a 58 year-old woman with an arteriovenous malformation (AVM) of the middle and posterior thirds of the corpus callosum which had produced two episodes of bleeding before admission to our Department, when the patient was neurologically intact. The nidus was fed by the anterior and posterior pericallosal arteries draining through the left medial atrial vein to the vein of Galen, by parasagittal cortical veins to the superior sagittal sinus and by right temporal veins to the sphenoparietal sinus. The patient underwent embolization of the anterior and posterior feeders in two sessions separated by a week interval, and then the AVM was removed through a left paramedial parietooccipital craniotomy in a single stage. The patient showed transient mild short term memory deficit, but the final outcome was excellent.
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Affiliation(s)
- R D Lobato
- Servicio de Neurocirugía y Sección de Neurorradiología, Hospital 12 de Octubre, Madrid
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Lagares A, Gómez PA, Lobato RD, Alén JF, Alday R, Campollo J, González P, de la Lama A, Palomino JC, Miranda P. [Idiopathic subarachnoid hemorrhage; comparison of different bleeding patterns and long-term outcome]. Neurocirugia (Astur) 2002; 13:110-9. [PMID: 12058602 DOI: 10.1016/s1130-1473(02)70630-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Idiopathic subarachnoid haemorrhage (ISAH) represents approximately 15-30% of all subarachnoid haemorrhages. On the basis of the diagnostic CT and depending on the location of the subarachnoid bleeding, patients with ISAH may be classified into three groups: a) Patients with normal CT and diagnosis made by lumbar puncture (ISAHNCT); b) patients with a pure perimesencephalic pattern (ISAHPM) and c) patients with a bleeding pattern resembling that of aneurismatic rupture (ISAHA). This classification could permit the establishment of differences in the management and prognosis. OBJECTIVES To describe the clinical and radiological characteristics of these three classes of patients and analyse their medium and long term outcome and moreover, compare these with those observed in patients suffering aneurysmal subarachnoid haemorrhage (ASAH). MATERIAL AND METHODS A series of 122 patients consecutively admitted to Hospital 12 de Octubre Madrid between 1990 and 2000 with the diagnosis of ISAH were retrospectively reviewed. Patients were considered to have suffered ISAH when the first complete four vessel angiography did not show the presence of any aneurysm or vascular lesion responsible for the bleeding. Patients were classified depending on the pattern of bleeding into ISAHNCT, ISAHPM as described by Van Gijn et al., and ISAHA. The angiography study was repeated when: a) the first study was incomplete or had poor quality, b) vasospasm was present, c) in those patients who had an aneurysmal pattern of bleeding in the initial CT. Different clinical and radiological characteristics were recorded as well as complications that occurred during the hospital stay. Final outcome was evaluated by means of the Glasgow Outcome Score (GOS). With the purpose of comparing these clinical and radiological characteristics and the outcome of patients with ISAH with those suffering aneurysmal subarachnoid haemorrhage (ASAH), 294 patients diagnosed with ASAH during the same study period were also reviewed. RESULTS 27% of patients admitted to our hospital with the diagnosis of non-traumatic subarachnoid hemorrhaged were diagnosed as ISAH. Of these, 41% presented with a ISAHA pattern, 39% ISAHPM and 20% ISAHNCT. The average age was similar in the different subgroups of SAH, being around 55 years. There was a greater frequency of male patients in the ISAHNCT and ISAHPM groups. In comparison with ASAH, ISAH characterises by patients presenting with less frequency a bad clinical grade and also loss of consciousness at stroke. There are fewer complications in patients with ISAH than ASAH, with a frequency of rebleeding and ischemia much less (5 and 6% respectively). Within the ISAH group, patients with ISAHA pattern of bleeding present more complications. Outcome is excellent for patients with ISAHNCT and ISAHPM, and rather worse for patients with ISAHA (median followup 5.8 years). CONCLUSIONS This study confirms that the frequency of ISAH in our environment reaches the higher limit of that shown previously in the literature, replicating the results previously published by our group. Patients with ISAH have a better prognosis and a smaller risk of complications than patients with ASAH, the prognosis of patients with ISAHCTN and ISAHPM being particularly good. Patients with ISAHA present initially with a severe clinical situation, probably related to the bigger amount of bleeding, as well as a higher frequency of systemic complications, cerebral ischemia and hydrocephalus. However, if the absence of vascular lesions is confirmed, the long term prognosis is similar to that of the other subgroups of ISAH.
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Affiliation(s)
- A Lagares
- Servicio de Neurocirugía, Hospital 12 de Octubre, Madrid
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Lobato RD, Gómez PA, Lagares A, Campollo J, González P, Boto GR, de la Lama A, Alén JF, Palomino JC. [Parasplenial arteriovenous malformations. Report of 15 surgically treated cases]. Neurocirugia (Astur) 2002; 13:15-21. [PMID: 11939088 DOI: 10.1016/s1130-1473(02)70643-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Yasargil called paraesplenial those AVMs located at the confluence of the hippocampus, the isthmus of the cingulate girus and the girus occipitotemporalis medialis. Large AVMs at this location are among the most difficult to delineate and to treat. OBJECTIVE Analyze the clinical presentation, the findings in the imaging studies, the surgical management and the final outcome in 15 patients with paraesplenial AVMs treated with embolization (the last 4 cases), and microsurgical removal. RESULTS Nine patients (60%) were female and 6 males of ages between 15 and 39 years (mean = 24 yrs). Eleven (75%) presented with hemorrhage, (intraventricular in most cases) and the remaining with epilepsy. The Spetzler-Martin grade was II in one Case, III in 5 cases, IV in 8 cases and V in one case. Preoperative embolization clearly improved surgical management. All the patients had complete resection of the lesion, 13 in a single stage and 2 in two stages. The final outcome was good but four patients developed defects of the visual field not seen preoperatively. CONCLUSIONS The authors comment the peculiarities of paraesplenial AVMs which can be safely and completely removed with microsurgery and the aid of preoperative embolization.
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Affiliation(s)
- R D Lobato
- Servicio de Neurocirugía y Sección de Neurorradiología, Hospital 12 de Octubre, Madrid
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Lagares A, Gómez PA, Lobato RD, Alén JF, Alday R, Campollo J. Prognostic factors on hospital admission after spontaneous subarachnoid haemorrhage. Acta Neurochir (Wien) 2002; 143:665-72. [PMID: 11534686 DOI: 10.1007/s007010170044] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Factors related to prognosis after subarachnoid haemorrhage (SAH) have been mainly extracted from surgical series, and only few authors have considered these factors in total management or population series. Though the level of consciousness is a major determinant of outcome after subarachnoid haemorrhage, there is not a consensus about which classification should be used to define it. The objective of this study was twofold. Firstly to find which factors recorded on hospital admission relate to outcome determining their relative importance in a non-selected series of patients suffering from aneurysmal SAH admitted to our centre, and secondly to assess the validity of the WFNS clinical scale for predicting the final result. METHODS A series of 294 patients consecutively admitted to Hospital 12 de Octubre Madrid between January 1990 and June 2000 with the diagnosis of aneurysmal SAH were retrospectively reviewed. All factors possibly related to prognosis were recorded on hospital admission. Outcome was measured by means of the Glasgow Outcome Scale measured one month after hospital discharge. Relationship between factors and outcome was evaluated by univariate and logistic regression multivariate analysis. RESULTS Although several factors, appeared related to prognosis in the univariate analysis, only the age. the level of consciousness defined by the WFNS scale and the presence of global brain hypodensity on the initial CT scan had a significant prognostic influence in the logistic regression model. Global brain hypodensity was strongly related to mortality. Since a number of factors associated with poor outcome in the univariate analysis are related to age, their influence could be explained by the difficulty of recovery of the ageing brain. The WFNS grading scale failed to predict significant differences in outcome between some of its grades. CONCLUSIONS Age and clinical grade on admission are the most important factors influencing the final outcome of patients suffering aneurysmal SAH. A reappraisal of the WFNS grading scale should be considered as no significant differences in outcome were found between some of its grades.
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Affiliation(s)
- A Lagares
- Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain
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Gómez PA, Campollo J, Lobato RD, Lagares A, Alén JF. [Subarachnoid hemorrhage secondary to dissecting aneurysms of the vertebral artery. Description of 2 cases and review of the literature]. Neurocirugia (Astur) 2001; 12:499-508. [PMID: 11787398 DOI: 10.1016/s1130-1473(01)70665-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED OBJECTIVES AND INTRODUCTION: The pathogenesis and natural history of intracranial vertebral artery dissection remain uncertain up to now due in part to its relative rarity. In this article we review the state of the art of this process and remark the good outcome obtained with embolization using Guglielmi detachable coiling (GDC). METHODS Two cases with subarachnoid hemorrhage secondary to rupture of a vertebral dissection aneurysms are described. The first patient initially suffered brain stem infarction, followed by a subarachnoid hemorrhage a year later. The second patient who had a severe subarachnoid hemorrhage with two early rebleedings was successfully treated with embolization using GDC. CONCLUSIONS Subarachnoid hemorrhage due to rupture of vertebral dissecting aneurysm is a relatively unknown disease with some important aspects that should be known. The high incidence of early rebleeding (up to 60%), makes early diagnosis and treatment important goals. Classically the preferred treatment has been proximal vertebral artery occlusion. However, the recent introduction of embolization with GDC has made possible the occlusion of the dissection with very good final outcome.
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Affiliation(s)
- P A Gómez
- Servicio de Neurocirugía, Hospital 12 de Octubre, Madrid
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Muñoz A, Campollo J, Vergas J. Bilateral internal carotid aneurysms presenting as a nonpulsatile parapharyngeal mass: complementary diagnosis by CT, MR imaging, and digital subtraction angiography. AJNR Am J Neuroradiol 2001; 22:864-6. [PMID: 11337329 PMCID: PMC8174935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
SUMMARY We report fusiform aneurysms in both internal carotid arteries in a 74-year-old man who presented with a nonpulsatile retropharyngeal mass. Both helical CT and MR imaging disclosed the nature of the lesions. Arteriography, required for therapeutic decisions, confirmed the diagnosis. Because of the rarity of this condition and the potential for misdiagnosis, we describe the findings on complementary radiologic examinations.
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Affiliation(s)
- A Muñoz
- Section of Neuroradiology, Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Lobato R, Palomino J, Campollo J, de la Lama A, Lagares A, Ramos A. 7. Malformación A-V dural del seno transverso manifestada por isquemia cerebral global y coma. Neurocirugia (Astur) 2001. [DOI: 10.1016/s1130-1473(01)70916-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Roda J, Conesa G, Diez Lobato R, Garcia Allut A, Gomez Lopez P, Gonzalez Darder J, Lagares A, Ley Garcia A, Lloret J, Martinez Rumbo R, Prada J, de la Riva A, Ruiz F, Soto M, Campollo J. Hemorragia subaracnoidea aneurismática. Introducción a algunos de los aspectos más importantes de esta enfermedad. Neurocirugia (Astur) 2000. [DOI: 10.1016/s1130-1473(00)70954-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lobato R, Porto J, Gómez P, Campollo J, Alday R, González P, Rodríguez Boto G, de la Lama A. Aneurisma en ampolla (blister-like) de la carótida asociado a aneurismas múltiples y malformación arteriovenosa cerebral tratado con oclusión carotidea y bypass de alto flujo. Neurocirugia (Astur) 2000. [DOI: 10.1016/s1130-1473(00)70726-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lagares A, Gómez PA, Lobato RD, Alén JF, Campollo J, Benito-León J. Cerebral aneurysm rupture after r-TPA thrombolysis for acute myocardial infarction. Surg Neurol 1999; 52:623-6. [PMID: 10660031 DOI: 10.1016/s0090-3019(99)00147-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intracranial hemorrhage is the most dreaded risk of thrombolytic therapy for acute myocardial infarction because of the high mortality and disability rates associated with this complication. Brain structural lesions may predispose a patient to bleeding. To date, aneurysm rupture has not been described as a complication of such therapy. CASE DESCRIPTION A 66-year-old hypertensive woman was admitted because of chest pain. Myocardial infarction was diagnosed and fibrinolytic therapy with recombinant tissue plasminogen activator (r-TPA) was initiated. Eight hours after admission she became unconscious. Brain computed tomography scan showed subarachnoid hemorrhage, and a cerebral arteriography showed an anterior communicating artery aneurysm. Because of her poor clinical condition treatment was postponed. Death occurred 7 days later because of multiorgan failure. CONCLUSIONS Cerebral aneurysms should be considered as a possible contributing factor to intracranial bleeding after thrombolytic therapy.
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Affiliation(s)
- A Lagares
- Neurosurgical Service, Hospital 12 de Octubre, Madrid, Spain
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Campollo J, Boto G, Lobato R, Rivas J. Malformaciones arteriovenosas durales del seno longitudinal superior y la hoz cerebral. Presentación de cinco casos. Neurocirugia (Astur) 1998. [DOI: 10.1016/s1130-1473(98)70806-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lobato R, Romance A, Sánchez Aniceto G, Cabrera A, Rivera B, Campollo J. La translocación facial ampliada en la resección de tumores de la base craneal. Nuestra experiencia con tres casos. Neurocirugia (Astur) 1997. [DOI: 10.1016/s1130-1473(97)70731-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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