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Endovascular Stenting of Vertebral Artery Dissection in Acute Ischemic Stroke
Mehrnoush Gorjian,
Scott B. Raymond,
Matthew Koch,
Aman B. Patel
Issue:
Volume 3, Issue 4, December 2019
Pages:
74-76
Received:
1 July 2019
Accepted:
3 August 2019
Published:
11 October 2019
Abstract: Background: Vertebral artery (VA) dissection causing acute stroke is commonly treated with anticoagulation and rarely requires stenting. While stenting for atherosclerotic stenosis of VA is an established and efficient treatment option, the safety of stenting for VA dissection has not been studied. Case information: We report the technical challenges associated with stenting of a proximal VA dissection in a 74 year-old male with NIHSSS > 20 outside of the time window for thrombolytic therapy presenting with acute basilar artery thrombus and a hypoplastic contralateral VA. Methods: A coronary Drug-Eluting Stent (DES) was implemented in right VA following balloon angioplasty and basilar artery thrombolysis to maintain the patency of the dissected area in proximal VA. Results: The procedure was completed without complication. Postoperative Digital Subtraction Angiography (DSA) confirmed the patency of the vertebrobasilar system. There was no evidence of significant residual stenosis in the right vertebral artery on the follow up Computed Tomography Angiography (CTA) 2 months after the stent placement. Conclusion: Endovascular stenting of proximal VA dissection in the setting of acute ischemic stroke is relatively safe and feasible. It could be particularly considered in patients ineligible for IV thrombolysis with a hypoplastic contralateral VA. Further studies are needed to evaluate the long-term safety and efficacy of stenting for VA dissection.
Abstract: Background: Vertebral artery (VA) dissection causing acute stroke is commonly treated with anticoagulation and rarely requires stenting. While stenting for atherosclerotic stenosis of VA is an established and efficient treatment option, the safety of stenting for VA dissection has not been studied. Case information: We report the technical challeng...
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Optimal Times of Carrying Out of Operative Treatment of Patients with Hypertensive Hemorrhagic Stroke
Mitalip Mamytov,
Keneshbek Yrysov
Issue:
Volume 3, Issue 4, December 2019
Pages:
77-83
Received:
1 October 2019
Accepted:
29 October 2019
Published:
4 November 2019
Abstract: Background: Until now, nobody has arrived at a general consensus on the timing of operative treatment intervention, depending on the hemorrhage nature, localization and volume and the severity of patient's condition. Objective: To assess the results of operative treatment of patients with hypertension-induced hemorrhagic stroke (HS) in order to determine the optimal times of surgical interventions, thereby improving the results of operative treatment. Methods: The treatment outcome analysis has been performed regarding the patients with hypertensive hemorrhagic stroke (HHS), who underwent surgery operation at the neurosurgery and neurotraumatology departments of the National Hospital of the MH KR. The age of patients ranged from 43 to 76 years. The main etiological factor in all cases was hypertensive disease. Results: The mean age of postoperative patients was 60 years old (the youngest patient was 43 years old and the oldest was 76 years old). Out of the 90 (100%) postoperative patients 74 (82.2%) patients were discharged with improvement, and 16 (17.8%) patients with fatal outcome. And also the fatality rate analysis has been performed depending on the HHS volume and the midline structure dislocation degree. Among the deceased postoperative patients, the distribution by HHS volume was as follows: up to 60 cm3 - 11.5% of cases, from 61 to 80 cm3 - 9.52%, from 81 to 120 cm3 - 22.58% and above 121 cm3 - 33.3%. The deceased patient distribution by the midline structure dislocation degree was as follows: up to 2 mm - in 11.1% of cases, from 3 to 6 mm - in 21%, over 10 mm - in 40%. Also the fatality rate analysis has been performed, depending on the timing of operative treatment. Among the deceased postoperative patients, the distribution by operative treatment times was as follows: 1–3 days 23.7% of cases, 4–6 days 16.6%, 7–9 days 12.5%, 10 days and more - 11.1% (Table 6). Conclusions: The prognostic favorable times for operative treatment of patients having HHS with different localization and volumes (60 cm3-80 cm3), and with different dislocations of midlinebrain structures (from 2 to more than 6 mm) range from 3 days to 15-20 days. And the surgery operation is unjustified for the patients with supratentorial localization of than 120 cm3 in volume with midline structure dislocation of more than 10 mm, and in this case the watchful waiting must be applied.
Abstract: Background: Until now, nobody has arrived at a general consensus on the timing of operative treatment intervention, depending on the hemorrhage nature, localization and volume and the severity of patient's condition. Objective: To assess the results of operative treatment of patients with hypertension-induced hemorrhagic stroke (HS) in order to det...
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Factors Indicating on Differentiated Approach in Treatment of Severe Focal Brain Injures
Issue:
Volume 3, Issue 4, December 2019
Pages:
84-88
Received:
2 October 2019
Accepted:
8 November 2019
Published:
17 November 2019
Abstract: Background: Modern methods of complex diagnostics in neurotraumatology, in particular computed tomography (CT) and magnetic resonance imaging (MRI), enable neurosurgeons to make a differentiated approach to choosing the right method for treating traumatic and other brain injuries. Objective: To elaborate criteria for differentiated treatment of severe focal traumatic brain injuries. Methods: Results of treatment in 126 patients with severe craniocerebral injury have been examined, 74 of them were undergone to surgical methods of treatment, and 52 patients were treated conservatively. To all patients computed tomography and magnetic resonance imaging procedures of the brain were done. The results of treatment were assessed using Glasgow Outcome Scale. Criteria for selection of patients were fact of severe isolated craniocerebral injury, depth and time of loss of consciousness, availability of СТ and МRI of brain in dynamics, and operational findings. Results: It was determined а high degree of possibility of tomographic objectification and consecutive transformation of substrates of injured brain. It is noted, that the most frequent traumatization is observed for frontal (43.4%) and temporal (40.5%) brain lobes. Conclusions: Introduction of differentiated approach to using conservative and surgical methods of treatment for severe traumatic cerebral contusion and hematomas of brain, and preference of conservative treatment led to greater efficiency and adequacy of treatment of these patients.
Abstract: Background: Modern methods of complex diagnostics in neurotraumatology, in particular computed tomography (CT) and magnetic resonance imaging (MRI), enable neurosurgeons to make a differentiated approach to choosing the right method for treating traumatic and other brain injuries. Objective: To elaborate criteria for differentiated treatment of sev...
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Atypical Femur Fractures: A Case Report and Literature Review
Xiang Dian,
Yang Yuhao,
Lin Hongsheng
Issue:
Volume 3, Issue 4, December 2019
Pages:
89-92
Received:
9 November 2019
Accepted:
2 December 2019
Published:
10 December 2019
Abstract: With the aging of the global population, osteoporosis has become a widespread phenomenon in the society. With the rapid increase of the number of osteoporotic fractures, a huge social and economic pressure has been caused. At the same time, it has attracted extensive attention. Bisphosphonates (BPs) can effectively prevent bone loss, improve bone density, and effectively reduce the incidence of osteoporotic fracture in the vertebral body and hip, which is the first choice for the treatment of osteoporosis. However, after tens of thousands of people take bisphosphonates for a long time, there are more and more reports of atypical femoral fractures (AFFs) caused by bisphosphonates, which cause the concerns of patients and doctors. The long-term use of bisphosphonates can promote the apoptosis of osteoclasts, inhibit the osteoclast's dissolution and absorption of bone trabecula, then reduce bone turnover, inhibit bone remodeling, lead to the accumulation of bone micro damage, and finally lead to fracture AFFs. We present an 83 year old woman who has been taking bisphosphonates for more than 10 years. The images indicate that there is nonunion in the middle and upper segments of both femurs. She was diagnosed as bilateral AFFS and was treated with plate and screw internal fixation for the left femur fracture and temporary conservative treatment for the right femur fracture. She was treated with anti infection, analgesia and circulation improvement after operation and the symptoms were relieved obviously and the effect was satisfactory. The case was reported as follows and reviews the related literature.
Abstract: With the aging of the global population, osteoporosis has become a widespread phenomenon in the society. With the rapid increase of the number of osteoporotic fractures, a huge social and economic pressure has been caused. At the same time, it has attracted extensive attention. Bisphosphonates (BPs) can effectively prevent bone loss, improve bone d...
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Antiepileptic Drug Adherence and Associated Factors Among Adult Epileptic Patients Attending Neurology Referral Clinic in Adama Hospital Medical College, Ethiopia
Issue:
Volume 3, Issue 4, December 2019
Pages:
93-99
Received:
26 October 2019
Accepted:
28 November 2019
Published:
11 December 2019
Abstract: Background- Adherence to anti epileptic medication therapies is a primary determinant of treatment success. Non-adherence to the treatment attenuates most clinical benefits and therefore reduces the overall effectiveness of health systems. However, to our knowledge there is study conducted to what extent epileptic patients adhere to their treatment and factors which affects adherence. Hence, this study aimed to assess antiepileptic drug adherence and factors associated with it among Adult Epileptic Patients Attending Neurology Referral Clinic in Adama Hospital Medical College. Methods- We conducted a cross-sectional hospital based study on epileptic patients who are on antiepileptic medications from April 10 to July 10, 2019. Data were collected from patient above 18 years old. Adherence was measured using the four-item Morisky’s medication adherence scale. All consecutive patients coming to Neurology referral clinic during the study period were interviewed until the calculated sample size (322) was obtained. We collected patient demographics, clinical related, questions related to drug intake and adherence. Both Bivariate and multivariate analyses were performed to test for associations. Odds ratio was used to assess strength of association, and level of association determined by p. value <0.05%. Result- out of a total of 340 participants, 322 were willing to participate. Of the 194 participants, 109 (56.2%) were males. The mean age of the participants was 32.10 ± 7.37 years; range 18-56 years. The majority, 61.4% of the participants were taking a single antiepileptic drug. Over all 67.3% (95% CI: 62.9%, 71.9%) of the participants were adherent to their treatment. The most common reported reasons for non-adherence were financial or cost of drugs 39.01 followed by distance 38.5%. Factors which have significant association with adherence to antiepileptic treatment were: being female (AOR=2.04, 95% CI=1.07, 3.87), respondents in primary education (AOR= 2.74, 95% CI= 1.01, 7.46), married (AOR= 3.65, 95% CI= 1.34, 9.89) cost of drug 500 to 999 birr (AOR= 2.59, 95% CI= 1.03, 6.45) and one thousand and more (AOR= 5.14, 95% CI= 2.49, 10.61). Conclusion: Only 67.2% of the respondents were adhered to their treatment which is low when compared with more than 95% standard adherence may be necessary to adequately suppress the epileptic seizures.
Abstract: Background- Adherence to anti epileptic medication therapies is a primary determinant of treatment success. Non-adherence to the treatment attenuates most clinical benefits and therefore reduces the overall effectiveness of health systems. However, to our knowledge there is study conducted to what extent epileptic patients adhere to their treatment...
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