Vascular Neurology Notes

Notes and Clinical Pearls gathered while reading articles and books covering Vascular Neurology, Neuroanatomy, and Neurointervention • Fellow run

[Vascular Neurology Notes @vascularnotes]

A great reference to keep close-at-hand by @JeremyHeitMDPHD

[Vascular Neurology Notes @vascularnotes]

Large vessel occlusion stroke patients should be taken for thrombectomy within 7 hours, even if imaging doesn’t look favorable…

[Tudor G. Jovin, MD @TudorGJovin]

Honored to present LASTE results @slice_inr together with @CostalatV @CarolineArquiz1 @lapergue6. Strong benefit of thrombectomy within 7 hrs in unlimitedly large core.NNT 4.Equal benefit in ASPECTS 0-2 vs 3-5 & lower mortality.
No more reasons to exclude pts based on imaging !!

[Vascular Neurology Notes @vascularnotes]

They are limited and are only used to assist in decision making but important to be familiar with them.

Clinical Scales in Aneurysm Rupture Prediction | Stroke: Vascular and Interventional Neurology https://t.co/4SQMbgl21R

[Vascular Neurology Notes @vascularnotes]

Workflow for patients with symptoms concerning for aSAH.

https://t.co/wIKeHlOIwM

[Vascular Neurology Notes @vascularnotes]

13% of patients will die in the hospital of aneurysmal subarachnoid hemorrhage, and up to 26% will die before arriving at the hospital.

If ≥2 first-degree relatives with cerebral aneurysms -> you have a 12% chance of having one

https://t.co/wIKeHlOIwM

[Giana Dawod, MD @gdawod1]

1/

CTA. DSA. MRA. CFD. VWI.
So many letters, so many ❓❓❓
& so the discussion ensues - which imaging are YOU going to use for intracranial aneurysm dx + mgt?

Luckily, Beaman et. al go thru +/- of imaging modalities - both old + new🧠

Let's begin! 👇

[Vascular Neurology Notes @vascularnotes]

One caveat is that mRS is unlikely to be a great assessment tool for isolated PCA infarcts. A trial should assess visual fields.

[Vascular Neurology Notes @vascularnotes]

Interesting results comparing medical management to med + thrombectomy for isolated PCA strokes.

Notes:
-Multicenter observational
-Higher symptomatic ICH and END in thrombectomy patients
-mRS not better for thrombectomy patients

RCT may be warranted

https://t.co/ucTvgrG3d8

[Vascular Neurology Notes @vascularnotes]

Important arterial connections at the skull base. Be careful with embolizations of the middle meningeal artery that may cause facial paralysis or hearing loss.

https://t.co/AZcYQCngbh

[Vascular Neurology Notes @vascularnotes]

It appears that clots should be removed even when the core infarct is large, 2 new studies in NEJM:
#thrombectomy for all

https://t.co/kWjHgf8YHd

https://t.co/82P8RGUVAG

[Vascular Neurology Notes @vascularnotes]

Sturge-Weber Syndrome patients may present to the hospital with stroke like episodes that often fully resolve over a period of days, weeks, or months.

MRI rarely shows diffusion restriction, but impaired venous drainage is common on perfusion imaging.

https://t.co/NLWX8Sde82

[Vascular Neurology Notes @vascularnotes]

A new method for ischemic stroke treatment? “Molecularly self‐fueled nano-penetrator for nonpharmaceutical treatment of thrombosis and ischemic stroke”

https://t.co/rWiq3LWwTp

[Vascular Neurology Notes @vascularnotes]

The thalamostriate vein does not drain the thalamus

[Vascular Neurology Notes @vascularnotes]

Thrombectomy beyond 24 hours from last known well? This study demonstrated worse outcomes overall (as one might expect), but similar hemorrhages/complications compared to the 6–24 hours group. Study by @ashabanmd et al.

https://t.co/XHIuZxMPt9

[Vascular Neurology Notes @vascularnotes]

Are you at the SVIN conference in LA?! @svinsociety great opportunity to meet leaders/friends in the field

[Vascular Neurology Notes @vascularnotes]

Which component of Wallenberg Syndrome is the most disabling? Tough disease for such a small infarct... Most occur with V4 segment occlusion, remainder with PICA occlusion or lateral medullary arteries.

[Vascular Neurology Notes @vascularnotes]

The U.S. neuroendovascular workforce in 2013 and 2019, respectively, was as follows: radiologists (46% vs 44%), neurosurgeons (45% vs 35%), and neurologists (9% vs 21%).

https://t.co/qNhu51obSr

[Vascular Neurology Notes @vascularnotes]

New CASSISS study from China compares medical management to medicine + Wingspan stenting in patients with ICAD.

->No significant difference
->Relatively low stroke rates in both groups (see SAMMPRIS)
->Question remains:why do some patients still fail?

https://t.co/eQ8Zuoczoh

[Vascular Neurology Notes @vascularnotes]

Cinematic rendering reconstruction of intracranial arteries showing right paraclinoid aneurysm

Read More: https://t.co/IU67CYXVW0

[Vascular Neurology Notes @vascularnotes]

The era of TNK begins! 0.25 mg/kg

https://t.co/YMLRM5Eu28

[Vascular Neurology Notes @vascularnotes]

“The M1 segment of the middle cerebral artery precedes by a few hundred million years the appearance of the M2 segment.” -Lasjaunias, Berenstein, and Ter Brugge