جستجوی مقالات مرتبط با کلیدواژه « intracranial » در نشریات گروه « پزشکی »

In around 10-20% of angiofibroma cases, the tumor penetrates the skull base to involve intracranial structures, posing difficulty in treating them surgically. Today, advancement in skull base surgery has brought about a paradigm shift, and extensive angiofibroma tumors with intracranial extension are approached surgically today with minimal morbidity.
This study was a retrospective analysis of angiofibroma with significant intracranial extension Radkowski staging IIIb from 2011 to 2021 who came to our center. There were seven children of angiofibroma with significant intracranial extension Radkowski staging IIIb, out of whom, four patients had undergone surgical resection at our center. Three patients underwent surgery by pre-auricular lateral subtemporal approach and one patient by maxillary swing approach. Preoperative embolization was done in all the patients one day before the day of operation.
Gross total removal of the tumor was achieved in all three patients who had undergone pre-auricular lateral subtemporal approach with no permanent complication. All three patients had a minimum follow-up of one year with no recurrence.
The pre-auricular lateral subtemporal approach provides the shortest shallow route to the affected skull base with direct visualization of the tumor base. Hence recommended for angiofibroma with Radkowski staging IIIb.

Propofol is a commonly used medication for sedation during surgery; however, it must be used with precaution in neurologic patients because of the subsequent adverse effects of cardiovascular and neurologic. An 83-year-old male patient with acute subdural hemorrhage was referred with a two-year history of falling and a recent occurrence of imbalance; the patient underwent urgent surgery under general anesthesia, using 100 μg fentanyl for premedication, 50 mg Propofol for induction, and Isoflurane gas and fentanyl drip for maintenance. During transmission of the patient for postsurgical computed tomography, two ccs Propofol 1% were mistakenly injected into the patient's radial artery and managed appropriately by the master. Following this management, the patient represented no alteration in his vital signs and was discharged in a favorable condition. Here, we report how this case could be managed successfully. Robust data regarding the complications of accidental administration of Propofol through an artery are lacking, and the presented results remain controversial. The authors have herby drawn attention to the unique management of an accidental intra-arterial injection of Propofol. Further studies are warranted to establish definite conclusions.

Large vessel occlusion (LVO) strokes are associated with worse functional outcomes and higher mortality rates. In the present systematic review and meta-analysis, we evaluated the diagnostic yield of the Cincinnati Prehospital Stroke Scale (CPSS) in detecting LVO.

We performed an extensive systematic search among online databases including Medline, Embase, Web of Science, and Scopus, until July 31st, 2023. We also conducted a manual search on Google and Google scholar, along with citation tracking to supplement the systematic search in retrieving all studies that evaluated the diagnostic accuracy of the CPSS in detecting LVO among patients suspected to stroke.

Fourteen studies were included in the present meta-analysis. CPSS showed the sensitivity of 97% (95% CI: 87%–99%) and the specificity of 17% (95% CI: 4%–54%) at the cut-off point of ≥1. The optimal threshold was determined to be ≥2, with a sensitivity of 82% (95% CI: 74%–88%) and specificity of 62% (95% CI: 48%–74%) in detecting LVO. At the highest cut-off point of ≥3, the CPSS had the lowest sensitivity of 60% (95% CI: 51%–69%) and the highest specificity of 81% (95% CI: 71%–88%). Sensitivity analyses showed the robustness of the results regardless of study population, inclusion of hemorrhagic stroke patients, pre-hospital or in-hospital settings, and the definition of LVO.

A very low level of evidence demonstrated that CPSS, with a threshold set at ≥2, is a useful tool for identifying LVO stroke and directing patients to CSCs, both in prehospital and in-hospital settings.

This study aimed to investigate the frequency of asymptomatic intracranial and extracranial artery stenosis in healthy volunteers in Kerman, Iran, in 2019 using Doppler ultrasound imaging. This cross-sectional study was conducted on healthy volunteers in Kerman in 2019 following a public elicitation. After the general examination, 138 healthy volunteers who had no history of any disease and were not treated with any medication underwent cerebrovascular evaluation with Doppler ultrasound. Demographic information, history of addiction, and sonographic findings were recorded in a checklist and then analyzed using SPSS 22. Stenosis was found in 14.4% of volunteers. The mean age of participants was 45.8±10.12 years, and 74 (54%) of them were male. In volunteers with stenosis, a significant correlation was found between age (P = 0.03) and addiction (P = 0.04) with the involved artery. There was also a significant correlation between addiction and intracranial and extracranial artery stenosis (P = 0.04). Logistic regression analysis showed a significant relationship between being female, addiction, and age with stenosis, as well as between addiction and intracranial artery stenosis (P <0.05). The majority of healthy residents of Kerman have asymptomatic cerebrovascular stenosis, and this is more prevalent in the elderly, addicts, and women.

Primary inflammatory pseudotumor of the central nervous system is extremely rare. These lesions may be intra-axial, extra-axial, or a mix of them. We report a case of intracranial inflammatory pseudotumor involving both brain parenchyma and dura.

Malignant triton tumor (MTT) is a rare, aggressive type of tumor that commonly originates from mesenchymal tissue and is mainly found in adults. Herein, we report a single case of a 12-year-old boy diagnosed with intracranial MTT. This report presents the clinical features and imaging findings of MTT. The 12-year-old patient consulted the hospital due to intermittent dizziness and headache. Computed tomography (CT) showed low-density space-occupying lesion in the left parietal fossa. Magnetic resonance imaging (MRI) showed a mass shadow with slightly long T1 and long T2 signal intensity in the same area. Contrast enhanced MRI (CE-MRI) showed obvious enhancement of the lesion. He was diagnosed with meningioma and underwent surgery. Postoperative histopathological examination diagnosed the lesion as MTT. Two months after the operation, CT examination showed tumor recurrence. He then underwent local radiotherapy and chemotherapy, and unfortunately, died six months later. Intracranial MTT should be considered as one of the differential diagnoses of intracranial meningiomas. CT and MRI are of great significance in the identification of lesion location, invasion range, and degree of malignancy. Final diagnosis of intracranial MTT requires histopathological examination. MTT has a poor prognosis, and surgical resection of the tumor is the preferred treatment. Intervention after early diagnosis is the key to improve the outcome of patients.

Diabetes is an important risk factor of extra and intracranial stenosis and hence can cause cerebrovascular stroke. In Egypt, prevalence of asymptomatic extra and intracranial blood vessels stenosis in diabetic patients is still unknown.

To estimate the prevalence of asymptomatic extra and intracranial vessels stenosis.

100 Patients with Type-2 Diabetes (T2D) were recruited consecutively from diabetes clinic of the department of internal medicine at Assiut University Hospitals in the period from 1st January 2016 to 31st January 2017. A detailed history was obtained for all participant. As well, thorough-out physical and neurologic examination were carried out for patients. All patients underwent extra cranial and transcranial colour coded ultrasound by two independent investigators. Patients with history of cerebrovascular stroke and transient ischemic attacks were excluded.

36% of patients had increased IMT, 6% had stenosis 50-69% and 2% had stenosis ≥ 70%. There was a positive correlation between age and increased IMT (r = 0.272) (P = 0.006) and between uncontrolled DM and increased IMT (r = 0.211) (P = 0.035). 26% of patients had stenosis of < 50% in vertebral artery (21% in V0 segment, 5% in V1 segment); being male and uncontrolled diabetes escalate the stenosis risk. MCA pulsatility index was found to be higher among old diabetics in comparison to younger diabetics and control group (r = -0.225) (P = -0.025). Also, the longer the time since T2D onset, the higher was MCA PSV (r = 0.244) (P = 0.014).

The cerebral blood vessels atherosclerotic changes (mainly extracranial) are higher among diabetics in comparison to healthy controls.

 Cerebral venous thrombosis (CVT) is a relatively common disorder of the cerebral venous system accounting for less than 1% of all strokes with a higher prevalence in Iran. Despite the considerable advances in recent years, the diagnosis and treatment of CVT are still challenging predominantly in the emergency setting. Therefore, the present study sought to provide an update on the diagnosis and treatment of CVT.

 PubMed, Web of Science, Google Scholar, Scopus, Elsevier, and Iranian domestic scientific databases were searched within January 1, 2000, to July 1, 2020. In all the electronic databases, the keywords (in the title/abstract) of “cerebral vein thrombosis” OR “CVT” OR “Cerebral venous sinus thrombosis” OR “CVST” AND “risk factor”, “diagnosis”, “treatment”, and “prognosis” were searched. The unrelated articles, studies not concerning humans or pediatric population, and case reports were excluded from the study. In addition, the articles related to CVT in association with coronavirus disease 2019 infection were excluded from the present review.

 According to the findings of the present study, the diagnosis of CVT might be delayed due to a wide range of clinical manifestations from a subacute headache with or without the signs of intracranial hypertension to the acute focal neurologic deficit and even loss of consciousness. Although the diagnosis is typically based on brain magnetic resonance imaging and magnetic resonance venography, there has been evidence suggesting that the plain computed tomography markers with an attenuation value of > 60.4 Hounsfield unit (HU) and Hounsfield-hematocrit (H: H) ratio of > 1.42 are specific enough for the diagnosis regardless of confirmatory imaging, such as venography. Additionally, the usefulness of D-dimer is still debatable, and an unacceptable false-negative rate of up to 26% has been illustrated. In terms of therapeutic aspects, although warfarin is still the mainstay of treatment, there has been increasing interest in new oral anticoagulants with promising results in both thrombus recanalization and excellent functional recovery. Balloon angioplasty and mechanical thrombectomy might also be considered in severely progressive cases without response to conventional treatments. It is worth mentioning that even for those achieving favorable outcomes, CVT can remain a disabling condition leading to at least neuropsychiatric complaints.

 The CVT is a rare and important cause of stroke accounting for less than 5% of all strokes mainly affecting young females. With regard to the rarity of the disease and novelty of the therapeutic approaches, there is a long way to fully identify the best diagnostic and therapeutic approaches to the disease.

Isolated intracranial Rosai-Dorfman disease (RDD) is an extremely rare, idiopathic histo-proliferative disorder. RDD is associated with the proliferation of histiocytes and emperipolesis.

we report a case with isolated intracranial RDD. A 47-year- old man presented with a dizziness, falling, and then secondary generalized seizure, hemiparesis and right hemisensory deficit. This case preoperatively was misdiagnosed with meningioma. Histopathological examination revealed pale histiocytes displaying emperipolesis which were positive for S-100 and CD68 proteins and negative for CD1a marker. BRAF V600E mutation was negative.

In this case, total resection was performed and clinical symptoms were regressed completely.

Intracranial Arachnoid Cysts (IAC) are suitable choices for endoscopic procedure to avoid craniotomy or shunt placement. Our main objective is to study the outcome of endoscopic procedure in IAC treatment. Methods and Materials/Patients: In this descriptive and retrospective study, we report our experience of 27 symptomatic patients with IAC who underwent endoscopic surgery at National Institute of Neurosciences Hospital and Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2009 to December 2016. The recorded data of patients’ management including operations, outcomes, and follow up were studied retrospectively. The diagnosis was confirmed by neuroimaging, surgery and histopathological examination. Patients were postoperatively followed up on regular basis. Size of the IAC decreased (significant to minimal) in all cases. Even where size reduction was minimal, patients’ symptoms improved significantly. No IAC increased in size after endoscopic procedure. There was no recurrence of symptoms in the follow up period. There was no postoperative mortality or major morbidity related to the surgery. Based on our results, most of symptomatic IAC cases can be managed by endoscopic procedure which seems to be a safe and effective method.

Intraorbital foreign body with intracranial extension is a potentially devastating condition leading to blindness and even death in certain circumstances. Lot of controversies still exist regarding the most appropriate approach for removal of orbital foreign body with intracranial extension. In this paper we have discussed a series of 3 cases where the foreign body was removed through the anterior (transorbital) approach.

Cerebral venous sinus thrombosis (CVST) with cerebral hemorrhage is relatively rare but may result in a catastrophic outcome. Antithrombin III deficiency is an inherited disease that contributes to an increase in the occurrence of thromboembolic events during pregnancy.
A nulliparous, 34-year-old Chinese woman at 9 weeks of pregnancy with underlying antithrombin III deficiency was under treatment with low dose molecular weight heparin. She presented with a frontal headache and projectile vomiting. A plain computed tomography (CT) scan and magnetic resonance angiography and venography (MRAV) of the brain showed features suggestive of CVST involving superior sagittal sinus with venous infarct and right frontal and left parietal intraparenchymal hemorrhage. During admission, she developed episodes of fainting and loss of consciousness. A repeated brain CT scan showed worsening intraparenchymal hemorrhages with midline shift, subfalcine herniation and cerebral edema. An emergency bilateral craniectomy was performed to relieve the intracranial pressure. Despite the surgery and supportive measures, the patient succumbed to death.
Due to the highly hypercoagulable state of pregnancy with concomitant antithrombin III deficiency, preconception counselling including optimization of anticoagulant dosage is crucial. In addition, the administration of antithrombin III concentrate should be considered during pregnancy for women with antithrombin deficiency.

This study aimed at analyzing the demographic characteristics of the patients with non-traumatic intracranial hemorrhage, their angiographic results and the correlation between computed tomography (CT) scan and angiography findings.
Methods and Materials/Patients: In a descriptive study, we retrospectively reviewed the records of the patients with non-traumatic intracranial hemorrhage based on their brain CT or lumbar puncture findings from 2011 to 2017. For all patients, four vessel catheter angiography via the femoral approach was performed in the Medical Imaging Center of Kermanshah University of Medical Sciences, Iran.
We investigated 143 cases with non-traumatic intracranial hemorrhage which was indicated in CT findings (91.61%) or lumbar puncture (8.39%). Of 143 patients, 64 (44.8%) were men and 79 (55.2%) women (mean age 53.7±12.1 years old). Moreover, 104(72.7%) patients had Subarachnoid Hemorrhage (SAH), 19(13.3%) of them had Intracranial Hemorrhage (ICH), 8(5.6%) ones had Intraventricular Hemorrhage (IVH) and 12(8.4%) patients had normal brain CT. There were 100 cases of aneurysm (69.93%), 13 cases of Arteriovenous Malformations (AVM) (9.09%), 28 cases with negative angiograms (19.58%), and 2 cases with other pathologies (1.4%). Seven (4.89%) cases of multiple aneurysms were also recorded. Of 13 patients with AVM, 8(61.5%) patients had AVM in parieto-occipital region, 2(15.4%) in temporal, 1(7.7%) in frontal region and 2(15.4%) had deep AVM. Two (1.4%) patients with SAH had dural AVF. Twenty-eight (19.6%) patients had negative angiogram, 22 cases of them had second angiography after one to two weeks. The most common positive finding in the second angiogram was Acom aneurysm (18.18%).
Aneurysms and AVMs are the most common causes of non-traumatic intracranial hemorrhage. The most common site of intracranial aneurysms is the circle of Willis. A second angiogram after one to two weeks is necessary in most patients with negative results in first angiography after non-traumatic intracranial hemorrhage.

Background and Importance: This interesting case is about the presence of normal pressure hydrocephalus and a large pseudomeningocele at the same time after 13 months of posterior fossa surgery. Although the occurrence of a pseudomeningocele following posterior fossa surgery is not so rare, such a late large pseudomeningocele development with signs and symptoms of NPH after 13 months of surgery is rather peculiar.
A 59-year-old man referred to our clinic for a cerebellopontine angle tumor. The patient presented with right hearing loss and mild facial palsy. We operated the patient with retrosigmoid approach, and we discharged him after five days. After about 13 months, the patient referred to our center again with complaint of progressive bulging of previous surgical region and gait apraxia, urinary incontinence and dementia. A large pseudomeningocele in the site of previous surgery was seen.
The authors presented a case report on late development (13 months) of a huge pseudomeningocele following vestibular schwannoma surgery with signs and symptoms of normal pressure hydrocephalus. Such a late big pseudomeningocele presentation with signs and symptoms of normal pressure hydrocephalus after posterior fossa surgery is peculiar.

In a recent study of 5360 deceased records′ within a local teaching hospital in Isfahan/Iran, neurological disorders′ ranked as the main cause of mortality among others. Additionally based on previous global reports, it seems that approximately 150000 individuals die within hospital every day. Therefore the current study aims to provide an atlas for the major causes of death correlated to neurologic disorders′ in a local hospital in Isfahan/Iran.
A retrospective survey of 1036 deceased individuals due to neurologic disorders′ (comprised of n = 607 males and n = 429 females), was carried out from the years 2011 to 2014. The study was conducted to Isfahan Kidney Transplantation Research Center (IKTRC). Death reported data such as age, gender, final code of death, date of admission, and duration of hospital stay were noted in Excel. The statistical analyses of d-Base were performed using SPSS (version 20) for windows. Descriptive statistics such as mean, minimum, maximum was reported for variables of interest.
Out of total population studied 59% were males. Age related death in the 79% was between 31 to 96 years old of life. Location of disorders that caused death were ranked as brain (n = 89%) > both brain and spinal cord (n = 5%) > spinal cord (n = 4%). Ranked reasons of death due to brain disorders resulted as: unspecified intracranial hemorrhage (n = 283; 41%) > stroke (n = 224; 32%) > traumatic intracranial injuries (n = 186; 27%) and other reasons (n = 24%). With a minimum of 1 and a maximum of 162 days, the mean hospital stay in this group was 11.9 days. In the 52% of deceased population due to spinal cord injuries, age at death was under 15 years old of life. The average hospital stay within this group of deceased before death was 15.3 days with a minimum of 1 to a maximum of 74 days. There were 7 reported deaths due to multiple sclerosis at the minimum and maximum age of 22 and 66 years old.
The evaluation based on clinical research maps from this study could help upcoming investigation for inserting the new strategy of the multi-dimensional difference of main reasons of death due to neurological disorders in Isfahan/Iran. Finally in order to achieve for improved clinical, pharmacological or surgical performance and management, or a more profitable founding of health incomes, further study in this direction recommended.

Ollier’s syndrome, a variant of multiple enchondromatosis, is a rare disease with an estimated prevalence of 1/100,000, characterized by multiple enchondromas, asymmetrically involving small bones of the hands and feet, especially the proximal phalanges. Intracranial enchondromas, such as those arising from the skull base are extremely rare. Herein, we report a 25-year-old female, known case of Ollier’s disease, presenting with right eyelid ptosis and visual disturbance. Brain MRI revealed a skull base tumour suspicious to enchondroma followed by trans-sphenoidal resection. Histologic examination of the excisional biopsy sample confirmed the diagnosis of enchondroma.

Management of intracranial aneurysms has made debates about the best treatment modality in recent years. The aim of this study was to compare the interventional outcomes between two groups of patients, one treated with endovascular coiling and the other treated with surgical clipping. This prospective study included 48 patients with intracranial aneurysms who underwent endovascular coiling (27 patients) or surgical clipping (21 patients) from July 2011 to August 2013. A neurologist examined patients in admission and followed them by phone call 1-year after intervention. Mean modified Rankin Scale (MRS) score at the time of admission in endovascular group was 2.86 ± 0.974 whereas it was 3.81 ± 1.078 in surgical clipping group (P = 0.0040). Focal neurologic signs were higher in clipping during procedures (P = 0.0310). Of 37 patients who followed up for a year, 19 were in endovascular group and 18 in surgical clipping group. At 1 year follow-up, MRS improvement was statistically significant in coiling group (P = 0.0090), but not in clipping group (P = 0.8750). Mean difference of MRS score at the time of admission and at one year later, was 0.947 ± 1.224 in endovascular group and 0.111 ± 2.083 in surgical group (P = 0.3000). There was no statistically significant difference at 1 year outcome between two groups. We recommend further interventional studies with larger sample sizes for better evaluation of the modalities.

Cerebral venous sinus thrombosis (CVST) is a frequent cause of cerebrovascular disease in Iran.. In this study, we report cumulative data of published Iranian studies in a systematic manner with critically appraisal and presenting future directions.. The authors systematically searched the ISI web of knowledge, Pubmed, Scopus, EBESCO and iranmedex for keywords attributed to cerebral venous sinus thrombosis. The methodological and demographic characteristics, etiology, site of involvement and clinical manifestations of the patients with CVST were investigated.. Seven eligible series with 465 patients were found. Age of the patients were between 29.5-43.8 in these series. The ratio of Female to male was 2.79. The Mortality rate was 11.4%. Oral contraceptive pills the single most common risk factor in the all series(40-71% of female patients). Headache(80-97%), sensori/motor deficits(39-64%) and seizure(20-62%) were the most common clinical presentations. Hemorrhagic transformation was seen in 11-58% of the patients. All included studies have substantial shortcomings. Majority of the studies were retrospective and only one study was population based. Despite the ethnic heterogeneity in Iran, none of these studies reported ethnic information. Detailed methodology was missing in all studies. The extent of investigation for hematologicalor neoplastic disorders was not clear methods. Only one study reported a subgroup with multifactorialetiology. Neither Barthel index nor modified Rankin scale were reported in any studies. The mortality was reported only in the three studies. The analysis of prognostic factors was not done in any study.. To overcome theses hortcomings, more well-structured epidemiologic studies should be conducted in Iran as a CVST-raising country..