Hyuk Won Chang

Leptomeningeal collaterals are associated with modifiable metabolic risk factors.

We sought to identify potentially modifiable determinants associated with variability in leptomeningeal collateral status in patients with acute ischemic stroke.

Intra-arterial tirofiban infusion for thromboembolism during endovascular treatment of intracranial aneurysms.

OBJECTIVEThromboembolism is one of the most common and serious complications associated with the endovascular embolization of intracranial aneurysms. We report our clinical experiences with intra-arterial tirofiban infusion during aneurysm embolization. METHODSThe clinical, radiological, and laboratory data of 24 patients harboring 25 aneurysms (25 procedures) who underwent intra-arterial tirofiban infusion for thromboembolism during the endovascular treatment of intracranial aneurysms were reviewed retrospectively. Thrombi or emboli were resolved by superselective intra-arterial tirofiban infusion via a microcatheter. RESULTSThe study cohort comprised 14 unruptured and 11 ruptured aneurysms. Intra-arterially infused tirofiban doses ranged from 0.2 to 1.0 mg (mean ± standard deviation, 0.64 ± 0.25 mg). Thromboemboli were resolved, and arteries were recanalized on all occasions except one: a case of distal middle cerebral artery embolism. No hemorrhagic complications related to intra-arterial tirofiban infusion occurred. CONCLUSIONIntra-arterial tirofiban delivery appears to be a safe and effective treatment modality when thromboembolism is encountered during the endovascular treatment of intracranial aneurysms.

Anti-inflammatory effect of quetiapine on collagen-induced arthritis of mouse

Quetiapine is an atypical antipsychotic and has also been used in the treatment of depression. Since anti-inflammatory effects of antidepressants are well established, we hypothesized that quetiapine may also exert anti-inflammatory effects. Thus this study was designed to examine the anti-inflammatory effect of quetiapine in murine collagen-induced arthritis. Mice were immunized with collagen type II for the induction of arthritis and treated with quetiapine (10mg/kg) daily for 2weeks. Mice were divided into 3 groups: control, CIA, and CIA+quetiapine treatment. Arthritic index and paw thickness were used to compare severity of arthritis. In additions, radiological and histological assessments were employed. Anti-type II collagen-specific antibody, interleukin-6 (IL-6), interleukin-17 (IL-17), and prostaglandin E(2) (PGE(2)) were evaluated at the end of the treatment period. Both arthritic index and paw thickness were markedly improved in CIA+quetiapine treatment group compared with those in CIA groups (arthritic index; P<0.01, paw thickness; P<0.05). Radiologic assessment revealed decreased cartilage damage and bone erosion in CIA+quetiapine treatment group compared with those in CIA groups. Articular cartilage destruction observed in CIA group was not found in CIA+quetiapine group. The concentrations of anti-type II collagen-specific antibody, IL-6, IL-17, and PGE(2) in CIA+quetiapine group were significantly lower than those in CIA groups (P<0.05). Weight gain which is commonly observed with the treatment of antipsychotics was not observed. Taken together, these results suggest that quetiapine shows anti-inflammatory effects in murine collagen-induced arthritis.

Coil-based endovascular treatment of single-hole cerebral arteriovenous fistulae: experiences in 11 patients

BACKGROUND An SHF is rare pial arteriovenous shunt with no nidal component, of which the feeder drains directly into a single venous channel. Casting with NBCA was described previously, but its control demands operator to accumulate a considerable learning curve. We are to present our experiences of coil-based endovascular treatment of SHF. METHODS Eleven patients harbored 12 SHFs (5 men, 6 women; mean age, 28.4 years; age range, 4-73 years), and they presented with hemorrhage, seizure, collapse, orbital mass, and as an incidental lesion. The location was frontal for 3, temporal for 5, parietal in 2, and occipital in 2 patients. The angioarchitectures, the methods of endovascular treatment, and outcomes were analyzed. RESULTS Fifteen feeders arose from 4 anterior, 8 middle, and 3 posterior cerebral arteries. The coil framework was constructed at the fistula before the penetration of a low concentrated NBCA. Nine fistulae were occluded completely, and 3 fistulae were occluded to near-completion with micro-AVM. There was no recanalization of SHF, either growth of a micro-AVM during follow-up period (mean, 48.3 months; range, 6-120 months). One patient with postprocedure hemorrhage developed hemiplegia, but 1 patient with seizure and the other 9 asymptomatic patients were uneventful. CONCLUSIONS The coil-based endovascular treatment can achieve safe and stable occlusion of SHF, and the preventions against venous thrombosis and perfusion breakthrough should be essential.

T2 Relaxometry Using 3.0-Tesla Magnetic Resonance Imaging of the Brain in Early- and Late-Onset Restless Legs Syndrome

Background and Purpose Previous T2 relaxometry studies have provided evidence for regional brain iron deficiency in patients with restless legs syndrome (RLS). Measurement of the iron content in several brain regions, and in particular the substantia nigra (SN), in early- and late-onset RLS patients using T2 relaxometry have yielded inconsistent results. In this study the regional iron content was assessed in patients with early- and late-onset RLS using magnetic resonance imaging (MRI), and compared the results with those in controls. Methods Thirty-seven patients with idiopathic RLS (20 with early onset and 17 with late onset) and 40 control subjects were studied using a 3.0-tesla MRI with a gradient-echo sampling of free induction decay and echo pulse sequence. The regions of interest in the brain were measured independently by two trained analysts using software known as medical image processing, analysis, and visualization. The results were compared and a correlation analysis was conducted to investigate which brain areas were related to RLS clinical variables. Results The iron index in the SN was significantly lower in patients with late-onset RLS than in controls (p=0.034), while in patients with early-onset RLS there was no significant difference. There was no significant correlation between the SN iron index of the late-onset RLS group and clinical variables such as disease severity. Conclusions Late-onset RLS is associated with decreased iron content in the SN. This finding supports the hypothesis that regional brain iron deficiency plays a role in the pathophysiology of late-onset RLS.

Cribriform neuroepithelial tumor in the third ventricle: A case report and literature review

Cribriform neuroepithelial tumor (CRINET) is a very rare and recently described entity of INI1‐deficient intraventricular neuroepithelial tumor of primitive non‐rhabdoid cells with distinct cribriform formation and has a relatively favorable prognosis. A 14‐month‐old boy had presented with gait imbalance and was crawling for the last 2 weeks. MRI revealed a large, complex solid and cystic mass with dimensions of 55 × 55 × 50 mm in the vicinity of the third ventricle. Histopathologically, the tumor was composed of relatively small undifferentiated neuroepithelial cells arranged in a cribriform pattern and intervening solid sheets with true rosettes. Immunohistochemically, the tumor cells showed complete loss of nuclear INI1 expression and distinct expression of epithelial membrane antigen (EMA) along the luminal borders of the tubules or glands. The typical rhabdoid feature of tumor cells was absent. Ultrastructurally, the tumor cells were neuroepithelial cells that contained short linear rough endoplasmic reticula and distinct intercellular junctions. Here, we describe a new case of CRINET and also discuss its clinicopathological, immunohistochemical, and ultrastructural features.

Gray matter alteration in patients with restless legs syndrome: a voxel-based morphometry study

The purpose of this study was to demonstrate whether or not restless legs syndrome (RLS) is associated with any morphological change in gray matter. Forty-six RLS subjects and 46 controls were enrolled. We performed voxel-based morphometry analysis and compared the results of the two groups. The RLS subjects showed significant regional decreases of gray matter volume in the left hippocampal gyrus, both parietal lobes, medial frontal areas and cerebellum (uncorrected, P<.001). We found that RLS patients showed structural alteration in the brain and alterations in certain parts of the brain in RLS patients are relevant to RLS.

Altered white matter integrity in primary restless legs syndrome patients: diffusion tensor imaging study

Abstract Objectives: A prior diffusion tensor imaging (DTI) of restless legs syndrome (RLS) subjects found alterations in brain white matter (WM). The aim of this study was to explore the possible mechanism of altered integrity of brain WM in RLS patients. Methods: The DTI measurement was performed in 22 subjects with RLS and 22 age-matched control subjects. Using a voxel-based analysis, fractional anisotropy (FA) and axial and radial diffusivities (AD and RD) were compared between RLS and control subjects with a two-sample t-test, and correlation analysis was performed in RLS subjects. Results: RLS subjects demonstrated decreased FA in the genu of the corpus callosum and frontal WM adjacent to the inferior frontal gyrus compared with the control subjects. For areas of decreased FA, both the AD and RD were higher than that in the control subjects. Discussion: Our findings suggest that loss of axonal density and myelin may account for WM changes seen in a prior study of RLS subjects.

Intracranial aneurysm perforation during endosaccular coiling: impact on clinical outcome, initial occlusion, and recanalization rates.

OBJECTIVEThe aim of this study was to evaluate the acute and follow-up outcomes of cerebral aneurysms that perforated during endovascular treatment. METHODSNine hundred ten patients harboring 1056 intracranial aneurysms received 1164 endovascular treatments over 11 years at our institution. Intraprocedural aneurysm perforation occurred in 20 cases (1.7%). Thirteen cases (mean size, 6.2 mm) demonstrated contrast leakage, whereas the other 7 cases (mean size, 5.3 mm) showed only nonleak coil extrusion from the aneurysms. Results of follow-up magnetic resonance angiography or catheter angiography at least 6 months after embolization were available in 11 contrast leak and 6 nonleak cases. Acute and follow-up results were reviewed. RESULTSNew neurological deficits directly associated with aneurysm perforation were identified at discharge in only 4 contrast leak patients (20%). Their respective modified Rankin Scale scores were 1, 2, 3, and 5. Respective acute results in the contrast leak and nonleak groups were as follows: complete occlusion in 7 (54%) and 3 (43%), neck remnant in 3 (23%) and 4 (57%), and incomplete occlusion in 3 (23%) and 0. Respective follow-up results were as follows: major recanalization in 3 (27%) and 1 (17%), minor recanalization in 3 (27%) and 1 (17%), and stable occlusion in 5 (46%) and 4 (67%). CONCLUSIONIntraprocedural aneurysm perforation with leakage of contrast appears to be associated with relatively high rates of incomplete acute results and major recanalizations during follow-up, although perforation frequently occurs in small aneurysms. Nonleak perforation may also lead to major recanalization through the potentially weak point of initial coil extrusion.

Rare variant of persistent primitive hypoglossal artery in magnetic resonance angiography

We present an extremely rare case of a variant of persistent primitive hypoglossal artery, which was found incidentally in magnetic resonance angiography during an examination for dizziness. This anastomotic vessel arose from the external carotid artery (ECA), not internal carotid artery, and entered the hypoglossal canal to basilar artery. To our knowledge, this is the fourth reported case of the persistent hypoglossal artery arising from the ECA. The possible clinical implications of this anomalous vessel are discussed.