Lia Lucas Neto

Delayed leukoencephalopathy after acute carbon monoxide intoxication

Delayed leukoencephalopathy is an uncommon complication of hypoxic-ischemic events of different etiologies, including carbon monoxide intoxication. We present a case of a 40-year-old male patient who was admitted with rapidly progressive neurocognitive and behavioral deficits. There was a history of accidental carbon monoxide intoxication one month before, presenting with loss of consciousness and short hospitalization, followed by a complete clinical recovery. The imaging studies in the delayed phase depicted confluent, symmetric supra-tentorial white matter lesions in keeping with diffuse demyelinization. Restricted diffusion and metabolite abnormalities in magnetic resonance proton spectroscopy were also seen. The diagnosis of CO-mediated delayed post-hypoxic leukoencephalopathy was assumed after exclusion of other mimickers. Hyperbaric oxygen therapy was tentatively performed and the patient had a favorable clinical and radiological evolution.

Recanalization in Cerebral Venous Thrombosis: A Systematic Review and Meta-Analysis

Background and Purpose— The role of recanalization of the occluded dural sinus or vein in the outcome of patients with cerebral venous thrombosis (CVT) is not established. We aimed to systematically review, in patients with CVT, (1) the recanalization rate and its association with (2) clinical outcome and (3) CVT recurrence. Methods— Systematic search in MEDLINE (Medical Literature Analysis and Retrieval System Online), Cochrane Library, and clinicaltrials.gov (inception to September 2017). We considered cohort studies reporting the recanalization rate in adult patients with CVT treated with anticoagulation. Reported rates of venous recanalization at the last follow-up, functional outcome defined using the modified Rankin scale at last follow-up dichotomized for favorable (0–1) and unfavorable (2–6) outcome, and recurrence rate of CVT according to recanalization status were extracted independently by 2 authors. Meta-analyses of proportions were performed using Freeman-Tukey double arcsine transformation. Functional outcomes according to the recanalization status were compared using meta-analysis and ordinal logistic regression. We conducted sensitivity analyses for time to assessment of recanalization and study quality. Results— Four hundred sixty-eight studies were identified, and 19 studies were included. (1) We found report of 694 patients with recanalization in the follow-up among 818 cases of CVT. The overall pooled proportion of patients achieving recanalization was 85% (95% confidence interval, 80–89; I2=58%). In studies with higher methodological quality, the recanalization rate was 77% (95% confidence interval, 70–82; I2=0%). (2) There was a significant increase in the chance of favorable outcome (modified Rankin scale, 0–1) in patients with recanalization with a pooled odds ratio of 3.3 (95% confidence interval, 1.2–8.9; I2=32%) in the random effects meta-analysis and a common odds ratio of 3.3 (95% confidence interval, 1.7–6.3) in the ordinal logistic regression. (3) Data on CVT recurrence according to recanalization was scarce. Conclusions— The overall rate of recanalization in patients receiving anticoagulation was 85%, but exclusion of severe patients from follow-up imaging is a plausible source of bias. Lack of venous recanalization was associated with worse clinical outcome.

Posterior cerebral artery dissecting aneurysm: another cause of perimesencephalic pattern of subarachnoid haemorrhage

Perimesencephalic subarachnoid haemorrhage is a distinct radiographic and clinical entity of uncertain aetiology. This syndrome is diagnosed by the characteristic pattern of extravasated blood on brain CT in combination with a negative cerebral angiography.1 Current practice requires digital subtraction angiography (DSA) to exclude an aneurysm in patients with a perimesencephalic pattern of subarachnoid haemorrhage (SAH). Although up to 96% of patients with this pattern of SAH do not have an aneurysm, and will undergo an uneventful clinical course with invariably good outcome,1 about 4% of patients might have a vertebrobasilar aneurysm requiring emergent treatment.1 We present a patient with a perimesencephalic pattern of SAH caused by rupture of dissecting posterior cerebral artery (PCA) aneurysm. To our knowledge, this is the first reported case of perimesencephalic pattern of SAH caused by a dissecting aneurysm in such a location. A 62-year-old man presented at the emergency department because of severe headache, nausea and vomiting. The headache, initially located on the right fronto-temporal side, had developed over the course of a few minutes, while …