Sergio A. Vargas

Endovascular Treatment of Traumatic Injuries of the Vertebral Artery

BACKGROUND AND PURPOSE: There are a few reports regarding the treatment of traumatic vertebral arteriovenous fistulas and pseudoaneurysms. Our aim was to describe the clinical and angiographic results of endovascular therapy for traumatic injuries of the vertebral artery. MATERIALS AND METHODS: The clinical and angiographic features of 18 traumatic injuries of the vertebral artery during an 8-year period were reviewed. There were 14 male (78%) and 4 female patients (22%). The average age was 28 years (range, 11–49 years). Of the 18 lesions of the vertebral artery, 17 (95%) were the result of penetrating trauma (gunshot or stab wound injury) and 1 (5%) was iatrogenic (jugular vein catheter). In 16 (89%) instances, the injury resulted in an arteriovenous fistula, and in the other 2 (11%), in a pseudoaneurysm. All patients were treated with an endovascular approach by using different techniques (balloon occlusion, coil embolization, and/or stent deployment). RESULTS: Endovascular therapy resulted in immediate lesion total occlusion in 16 (89%) patients. Delayed total occlusion was demonstrated angiographically during follow-up in the 2 remaining patients. Clinical improvement was documented in all patients, and there were no clinically symptomatic complications. CONCLUSION: In this small series, endovascular techniques were a safe and effective method of treatment and were not associated with significant morbidity or mortality.

Endovascular Treatment of Penetrating Traumatic Injuries of the Extracranial Carotid Artery

PURPOSE To describe the clinical and angiographic results of endovascular therapy for traumatic injuries of the extracranial carotid artery. MATERIALS AND METHODS The clinical and angiographic features of 36 traumatic injuries of the carotid artery during a 12-year period were reviewed. There were 35 male patients (97.2%) and 1 female patient (2.8%) with an average age of 28.8 years (range 13-60 years). Of the 36 lesions of the carotid artery, 29 (80.6%) were the result of gunshot injury, and 7 (19.4%) were secondary to stab wounds. In 24 (66.7%) instances, the injury resulted in a pseudoaneurysm; in 7 (19.4%), in an arteriovenous fistula (AVF); in 4 (11.1%), in a dissection; and in 1 (2.8%), in inactive bleeding. All patients were treated with an endovascular approach using different techniques (balloon occlusion, embolization, or stent deployment). RESULTS Endovascular therapy resulted in documented lesion occlusion in 34 (94.4%) patients. Two patients declined any follow-up postprocedural imaging; however, they have remained asymptomatic. Clinical improvement was documented in 35 (97.2%) patients, and there was one procedure-related complication with fatal consequences. CONCLUSIONS In this series, endovascular techniques were an effective method of treatment. It was possible to use different endovascular reconstructive techniques or parent artery occlusion depending on the degree of vessel damage, with resolution of clinical symptoms and avoidance of surgery in most cases.

Intracranial Aneurysms in Children: The Role of Stenting and Flow‐Diversion

To report a single‐center experience in the endovascular management of cerebral aneurysms in children with stenting and flow‐diversion techniques.

Traumatic carotid-cavernous fistula with pontomesencephalic and cervical cord venous drainage presenting as tetraparesis.

A 27‐year‐old male presented with progressive ascending myelopathy leading to tetraparesis. Magnetic resonance imaging of the cervical spine showed dilated perimedullary veins and spinal cord edema. Catheter angiography demonstrated a direct carotid‐cavernous fistula (CCF) with prominent pontomesencephalic and perimedullary venous drainage. Successful coil embolization of the fistula was performed with improvement of the patients symptoms. To our knowledge, no case of a direct CCF with perimedullary drainage has been previously reported.

Characteristic brain MRI findings in ataxia-neuropathy spectrum related to POLG mutation:

Patients with mutations in the polymerase gamma gene (POLG) may present with progressive ataxia and in such situations neuroimaging findings may suggest the diagnosis. Herein we report a patient with a POLG gene W748S homozygous mutation and characteristic lesions in the thalamus, cerebellum and inferior olivary nucleus seen on magnetic resonance imaging.

Clinical application of diffusion tensor imaging and tractography in a child with holoprosencephaly

Diffusion tensor imaging and fiber tracking can be methods used for the study of congenital brain malformations associated to white matter bundle abnormalities.Their use is illustrated in a child with semilobar holoprosencephaly in whom diffusion tensor imaging and tractography showed diencephalic ventral induction failure and abnormal white matter fascicles in brain and brainstem.

Neurocisticercosis racemosa (sic), diagnóstico orientado por neuroimágenes

Neurocysticercosis is the leading cause of parasitosis of the central nervous system and acquired epilepsy in developing countries. The clinical manifestations of neurocysticercosis, especially its racemose variant, are pleomorphic and unspecific, characteristics that hinder the diagnosis and make it a challenge for the clinician.The objective of this report was to describe two cases of racemose neurocysticercosis in which neuroimaging led to the definitive diagnosis. The first case involved a patient with persistent headache and focal neurological signs. She required multiple paraclinical tests that led to the definitive diagnosis of racemose neurocysticercosis with secondary cerebral vasculitis. Despite medical and surgical treatment the patient died after multiple complications.The second case involved a patient with a history of neurocysticercosis, who consulted for chronic intractable vomiting. She required multiple paraclinical tests that led to the diagnosis of vomiting of central origin secondary to racemose neurocysticercosis and entrapment of the fourth ventricle. After medical and surgical treatment the patient showed slight improvement. In these two cases it was evident how proper interpretation of neuroimages is essential for the diagnosis of racemose neurocysticercosis.

Congenital and Acquired Conditions of the Mesial Temporal Lobe: A Pictorial Essay

Purpose Our goal is to pictorially review a wide spectrum of congenital and acquired conditions affecting the medial aspect of the temporal lobe. Conclusion After completing this article, the reader will have knowledge of the imaging appearance of diverse developmental, malformative, and acquired lesions of the mesial temporal lobe, which will be useful when evaluating pathology in this location.

Alzheimer’s Disease: Initial Clinical Implementation of Automated Volumetry

Alzheimer’s disease (AD) is a chronic, progressive, and degenerative brain disease. Mild cognitive impairment (MCI) may represent a transitional predementia state between normal aging and AD dementia. Noninvasive diagnostic methods are necessary to identify asymptomatic individuals and MCI subjects with high-risk genetic factors who are candidates for early preventive or therapeutic intervention. Structural MRI methods allow visualization of macroscopic cerebral atrophy secondary to AD cellular changes. To be a diagnostic biomarker, MRI should be able to detect and quantify essential characteristics in high-risk patients (e.g., amnestic MCI individuals or asymptomatic carriers of a high-risk genetic factor with familial AD history) and in patients with clinical AD diagnosis. It is also important to accurately differentiate between healthy control (HC) subjects and AD dementia andMCI individuals. Manually defined MRI regions of interest or automated methods can be used to identify AD and MCI individuals. Image analysis algorithms have allowed the development of MRI-based tools to quantify atrophy in various anatomical regions by automatic segmentation. In 2009, Desikan and colleagues described the use of an automated volumetry tool for AD diagnosis with excellent clinical and neuropsychological correlation (specificity, 91%; sensitivity, 90%). Our goal was to explore the possible implementation of this tool and its usefulness in patients with clinical and neuropsychological diagnosis of MCI and AD dementia.