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Caproni S, Ottavi P, Borghetti V, Taddei G, Conti C, Riva A, Di Schino C, Costantini F, Colosimo C. Transient ischemic attack and minor stroke as "surgeons affairs": a narrative review. Neurol Sci 2023; 44:4233-4245. [PMID: 37542547 DOI: 10.1007/s10072-023-06985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE The scope of this paper is to review the subtypes of transient ischemic attack (TIA) and minor stroke (mS) in which a surgical treatment is needed, discussing the importance and the timing of a multidisciplinary approach, in order to achieve an optimized management and prevent major strokes or other critical complications. MATERIALS AND METHODS The keywords "transient ischemic attack," "minor stroke," "surgical treatment," "vascular surgery," "heart surgery," "neurosurgery," and "multidisciplinary" were searched using MEDLINE, EMBASE, and Scopus. Relevant search results were discussed by the authors for references inclusion. RESULTS Notwithstanding that best medical therapy is usually the first choice for the most part of cases, there are specific but recurrent etiologies that must be properly recognized because of a potential surgical approach, even in urgency. In fact, symptomatic carotid stenosis, or particular cases of hemodynamic cerebrovascular events, should be promptly referred to vascular surgeon, since increasing evidences highlighted a benefit from an early artery revascularization. In addition, beyond arrhythmic causes, cardioembolic events due to bacterial endocarditis and atrial myxoma should be quickly diagnosed, possibly in emergency department, because they are a presumptive urgency for heart surgery. In addition to the above-mentioned conditions, in patients suffering from vertebrobasilar TIA or mS, clinicians should keep in mind the Bow Hunter disease, because surgical artery decompression can represent the only suitable treatment in selected cases. CONCLUSIONS TIA and mS require a multidisciplinary in order to discuss therapeutic options, comparing risks and benefits and determining the best timing for an optimized management.
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Affiliation(s)
- S Caproni
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - P Ottavi
- Vascular Surgery, Cardio-Thoraco-Vascular Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - V Borghetti
- Heart Surgery, Cardio-Thoraco-Vascular Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - G Taddei
- Neurosurgery, Surgery Department, "S. Maria Goretti" Hospital, Via Lucia Scaravelli, 04100, Latina, Italy
| | - C Conti
- Neurosurgery, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - A Riva
- Neurology, Medicine Department, "Università Politecnica delle Marche", Via Conca 71, 60126, Ancona, Italy
| | - Chiara Di Schino
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - F Costantini
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - C Colosimo
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
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Rumbiak ALE, Sani AF, Kurniawan D, Ahadiyati I. Bilateral gradual cortical blindness due to hemodynamic stroke: A case report. Radiol Case Rep 2023; 18:1657-1661. [PMID: 36873042 PMCID: PMC9982439 DOI: 10.1016/j.radcr.2023.01.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/17/2023] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/27/2023] Open
Abstract
Cortical blindness refers to the loss of vision caused by a lesion affecting the geniculate calcarine visual pathway. Bilateral occipital lobe infarctions in the vascular territory of the posterior cerebral arteries are the most common cause of cortical blindness. However, bilateral cortical blindness gradual is rarely reported. Gradual bilateral blindness usually occurs in lesions other than stroke, such as tumors. We report a case of a patient with gradual cortical blindness caused by a nonocclusive stroke caused by hemodynamic compromise. A 54-year-old man diagnosed with bilateral cerebral ischemia after complaining of bilateral gradual vision loss and headache for 1 month. Initially, he only complained of blurred vision with >2/60 vision. However, his visual acuity worsened until he could only see hand movements and only light perception later on (with visual acuity of 1/∼). A computed tomography scan of the head revealed a bilateral occipital infarction, and cerebral angiography revealed multiple stenoses and near-total occlusion of the left vertebral artery ostium, underwent angioplasty and stenting. He has received dual antiplatelet and antihypertensive treatment. He got visual improvement with visual acuity 2/300 after 3 months of the treatment and procedure. Gradual cortical blindness caused by hemodynamic stroke is rare. The most common cause of posterior cerebral arteries infarction is embolism from the heart or vertebrobasilar circulation. With proper management and focusing on treating the etiology of these patients, vision improvements can be obtained in these patients.
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Affiliation(s)
- Adelheid Loraine Erensina Rumbiak
- Department Neurology, Faculty of Medicine, Airlangga University, Surabaya 60286, East Java, Indonesia.,Dr Soetomo General Hospital, Surabaya 60286, East Java, Indonesia
| | - Achmad Firdaus Sani
- Department Neurology, Faculty of Medicine, Airlangga University, Surabaya 60286, East Java, Indonesia.,Dr Soetomo General Hospital, Surabaya 60286, East Java, Indonesia
| | - Dedy Kurniawan
- Department Neurology, Faculty of Medicine, Airlangga University, Surabaya 60286, East Java, Indonesia.,Dr Soetomo General Hospital, Surabaya 60286, East Java, Indonesia
| | - Ida Ahadiyati
- Department Neurology, Faculty of Medicine, Airlangga University, Surabaya 60286, East Java, Indonesia.,Dr Soetomo General Hospital, Surabaya 60286, East Java, Indonesia
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Abstract
Some neurological diseases are accompanied by autonomic dysfunction. Postprandial hypotension (PPH) is one disorder accompanied by autonomic dysfunction. Although the major symptoms of PPH are fall and syncope, PPH is sometimes overlooked because of its non-specific symptoms, such as dizziness, nausea, and light-headedness. Because PPH could result in decreased cerebral perfusion pressure accompanied by a decrease in blood pressure, PPH may be linked to the risk of hemodynamic stroke or transient ischemic events, especially in patients with chronic cerebral large vessel occlusion/stenosis. Whether chronic cerebral large vessel occlusion or stenosis causes symptomatic ischemic events depends on the patient's compensatory collateral circulation and cerebral vasoreactivity. Therefore, we hypothesized that cerebral blood flow assessment could be essential for stratifying patients at high risk of postprandial cerebral infarction. However, there have been few reports on the association between cerebral blood flow and the occurrence of postprandial cerebral infarction. In a literature review, we identified seven cases of postprandial cerebral infarction. Postprandial cerebral infarction occurs in patients with chronic cerebral large vessel occlusion/stenosis accompanied by cerebral blood flow reduction. Non-pharmacotherapeutic and pharmacotherapeutic approaches could improve postprandial cerebral infarction; however, one patient with poor compensatory collateral circulation and reduced cerebral vasoreactivity experienced recurrent symptomatic episodes even with sufficient medical treatment and needed extracranial-intracranial bypass surgery. Physicians should be aware of PPH as it can complicate neurological disorders. Long-term blood pressure monitoring for the detection of PPH and cerebral blood flow assessment is needed in patients with cerebral large vessel occlusion/stenosis to prevent postprandial cerebral infarction.
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Affiliation(s)
- Hajime Ikenouchi
- Department of Neurology, National Cerebral and Cardiovascular Center, Japan
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Japan.
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Hackenberg A, Battilana B, Hebeisen M, Steinfeld R, Khan N. Preoperative clinical symptomatology and stroke burden in pediatric moyamoya angiopathy: Defining associated risk variables. Eur J Paediatr Neurol 2021; 35:130-136. [PMID: 34715507 DOI: 10.1016/j.ejpn.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the preoperative clinical and magnetic resonance imaging and angiography (MRI-MRA) characteristics in pediatric moyamoya patients. METHODS Analysis included 100 children with moyamoya angiopathy referred to our moyamoya center for preoperative evaluation. Clinical symptoms, neurological status using Pediatric Stroke Outcome Measurement (PSOM) and degree of disability on modified Rankin scale score (mRS) were evaluated. MRI-MRA evaluation included the assessment of ischemic lesions and involvement of posterior circulation. Data were analyzed for moyamoya disease (MMD), moyamoya syndrome (MMS) and age at disease onset. RESULTS Stroke was a common presentation in both MMD and MMS patients. TIAs and headaches/migraine were more frequent in MMD. There was no evidence of a difference in stroke burden on MRI as well as in PCA involvement between the two subgroups. Children <2 years had higher odds of having a stroke (OR 15.5, 95% CI 3.8-62.4, p < 0.001), recurrent stroke (OR 11.8, 95%CI 2.9-46.7, p < 0.001) and unfavorable mRS (≥2) (OR 4.2, 95% CI 1.3-13.7, p = 0.01) when compared to those >5 years of age. There was some evidence of association of PCA involvement with recurrent strokes (OR 3.1, CI 1.0-9.6, p = 0.05), a poor PSOM (OR 3.0, 95% CI 1.1-8.2, p = 0.04) and mRS (OR 3.1, 95% CI 1.2-8.3, p = 0.02). CONCLUSION Stroke seems to be a common presentation in both MMD and MMS patients. Early age at symptom onset and involvement of posterior circulation seem to be important risk factors for a high stroke burden and an unfavorable PSOM and mRS.
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Affiliation(s)
- Annette Hackenberg
- Department of Pediatric Neurology, University Children's Hospital, University of Zurich, Switzerland; Moyamoya Center, University Children's Hospital, University of Zurich, Switzerland.
| | - Bianca Battilana
- Moyamoya Center, University Children's Hospital, University of Zurich, Switzerland
| | - Monika Hebeisen
- Moyamoya Center, University Children's Hospital, University of Zurich, Switzerland; Department of Biostatistics, Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Switzerland
| | - Robert Steinfeld
- Department of Pediatric Neurology, University Children's Hospital, University of Zurich, Switzerland
| | - Nadia Khan
- Moyamoya Center, University Children's Hospital, University of Zurich, Switzerland
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Hecht N, Wessels L, Fekonja L, von Weitzel-Mudersbach P, Vajkoczy P. Bypass strategies for common carotid artery occlusion. Acta Neurochir (Wien) 2019; 161:1993-2002. [PMID: 31377956 DOI: 10.1007/s00701-019-04001-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Common carotid artery occlusion (CCA-occlusion) is a rare condition where standard revascularization is not feasible. Here, we analyzed our experience with surgical revascularization of CCA-occlusion to develop an algorithm for selection of the most suitable bypass strategy according to the Riles classification. METHODS During a 10-year period, 16 out of 288 patients with cerebrovascular disease and compromised hemodynamic reserve underwent revascularization for unilateral CCA-occlusion. The utilized bypass strategies included (1) a saphenous vein graft from the subclavian artery (SA) to the internal carotid artery (ICA), (2) a radial artery graft from the V3 segment of the vertebral artery (VA) to a superficial branch of the middle cerebral artery (MCA), or (3) a saphenous vein graft from the SA to a deep branch of the MCA. RESULTS In CCA-occlusion with maintained external carotid artery (ECA)/ICA patency (Riles type 1A), an SA-ICA bypass was performed (25%). In cases without ECA/ICA patency (Riles type 1B or 2) but suitable VA, a VA-MCA bypass was grafted (31%). In cases with unsuitable VA, a long SA-MCA interposition bypass was performed (38%). Transient postoperative neurological deficits occurred in 5 patients (31%) with 1 patient (6%) suffering permanent neurological worsening and 1 mortality (6%). Overall, no difference was found between the median preoperative mRS (2; range, 1-4) and the mRS at the time point of the last follow-up (2; range, 1-6; p = 0.75). The long-term graft patency was 94%. CONCLUSIONS Although surgical revascularization for CCA-occlusion is feasible, it is associated with a higher risk than standard bypass grafting. Considering the poor natural history of CCA-occlusion, however, this risk may be justified in carefully selected patients.
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Affiliation(s)
- Nils Hecht
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Wessels
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lucius Fekonja
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Peter Vajkoczy
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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