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Spinal vascular malformation consists of normal or enlarged arteries feeding into venous channels without passing throught capillaries. We present the case of a 50 years old man who was reffered to our clinic with a suspicion of spinal arteriovenous fistulae-(AVF) and a clinical course of progressive myelopathy. [ABSTRACT FROM AUTHOR]

Introduction. Atherosclerotic occlusive disease of the innominate artery (IA) represents a rare entity, comprising less than 2% of all extracranial causes of altered cerebral blood flow. This type of lesion is associated with adaptative hemodynamic changes increasing the risk of developing both cerebral and upper extremity ischaemia. Subclavian steal syndrome is a serious complication that may occur with occlusive lesions of the innominate artery and may represent an indication for revascularization. Case presentation. In the current paper we present the case of a patient who was admitted in our clinic for further investigations regarding episodes of dizziness and a difference of 30mmHg in the systolic blood pressure between his arms. On duplex ultrasonography scanning, an IA stenosis suspicion was raised, with associated retrograde flow through the right vertebral artery (VA) at light efforts of the right upper extremity. An angiographic evaluation confirmed the sub-occlusive lesion and reversed flow through the right VA. A decision was reached to undertake percutaneous transluminal angioplasty and stenting. There was no report of periprocedural complications, the intervention has been considered successful with no restenosis and no neurologic symptoms at 9 months follow-up. Discussion. Until recently, surgical treatment was the only option in the management of atherosclerotic disease of the IA, a procedure with high complication, morbidity and mortality rate. Therefore, endovascular treatment gained more ground and is considered today as the first line of treatment for this type of lesion. Conclusion. PTA and stenting of the IA still remains challenging mainly due to complex anatomy and the rarity of this pathology and we must keep in mind that the decision for the revascularization technique is personalized. This present case brings new evidence that percutaneous transluminal angioplasty is a safe and efficient method to manage an atherosclerotic lesion of the brachiocephalic artery. [ABSTRACT FROM AUTHOR]

Introduction. Non-saccular aneurysms are independent vascular entities, characterized by particular pathogenesis, localization, natural history and treatment. The fusiform subtype comprises an estimated tenth of all intracranial aneurysm, while the dolichoectatic subtype has different reported prevalence values, owing to several proposed diagnostic criteria (Smoker et al. criteria1 being the most widely used). The most frequent initial clinical presentations are ischemic stroke and transient ischemic attack, due to different hemodynamics and mechanism of formation. Prognosis is usually poor and progression can be demonstrated in almost half of ectatic vessels. Treatment can be either conservative in asymptomatic or ischemic presentations or by endovascular or microsurgical conduit in other cases. Case presentation. We report the case of a hypertensive 63-year old male patient with multiple intracranial vascular anomalies; he was initially admitted for ischemic stroke, with right hemiplegia and mixt aphasia. Non-contrast CT demonstrated a thrombosed left posterior cerebral artery aneurysm and contrast enhanced CT revealed a middle cerebral artery saccular aneurysm, two saccular and fusiform right PCA aneurysms and vertebrobasilar dolichoectasia. Cerebral angiography confi rmed the previous fi ndings and revealed lack of contrast at the level of the left PCA in the P2 segment. The patient was treated conservatively with aspirin and high-dose statins and had a favorable outcome, regaining part of his right-side function, object-naming and simple sentence construction capabilities. Conclusions. Upon ischemic presentation in the case of non-saccular aneurysms, a conservative attitude is recommended. These aneurysms commonly have an unfavorable prognosis, demanding periodic follow-up for detecting recurrent ischemic events, possible hemorrhage and progression. [ABSTRACT FROM AUTHOR]

Objectives. The carotid-cavernous fi stula (CCF) represents an abnormal communication developed between the internal and/or the external carotid artery (ICA, ECA) or their branches and the cavernous sinus (CS). We report this case in order to highlight the course and an alternative to treatment of a CCF. Material and methods. A 47-year old male patient with medical history of subarachnoid hemorrhage and cranio-facial comminuted fractures due to a motorcycle accident-induced craniofacial traumatism (4 months prior to admission) was referred to our clinic for further investigation regarding a potential CCF. Results. The cerebral digital substraction angiography showed a direct CCF type A. The Neurology and Interventional Radiology team opted for endovascular stent-grafting of the right ICA. Conclusions. This case is presented in order to highlight that angioplasty with stent-graft is a safe and effective procedure in selected cases of CCF. [ABSTRACT FROM AUTHOR]

Arteriovenous malformation is a frequent cause of hemorrhagic stroke in young adults and children, with not so many therapeutic options. We present the case of a 26-year-old woman who suffered from a hemorrhagic stroke from an arteriovenous malformation. She underwent radiosurgery three years after the acute event. Two years later, the malformation is excluded from the cerebral circulation. [ABSTRACT FROM AUTHOR]

Introduction: Nucleoplasty, the most advanced form of percutaneous discectomy developed to date, has important advantages as compared to other surgical methods: minimal tissue trauma, faster recovery time, local anesthetic, short duration and a painless rehabilitation period. Aim: Since the method is newly adopted in Romania, the aim of our study is to centralize the benefits and the side effects of the method in order to spread it on national level. Material and methods: A 12-month prospective, nonrandomized, human clinical study was started in the Neurology Department of the Emergency University Hospital, Bucharest, covering one year time interval (December 2006 - December 2007). The study included 60 patients presenting lumbar pathology at more than one level. The used method was the Dekompressor, a highly efficient method for removal of intervertebral disc nucleus pulposus under fluoroscopic control. Periprocedural the patients received antibiotics treatment. Results: Up to now there were no procedure related complications. 89% of patients reported improvement of the simptomatology with almost 60% the first 6 months postprocedural while 92% of patients were satisfied with results for 12 months, reporting the reduction of the analgesic intake. In 4% of cases no benefit was reported. The follow-up of the patients is still on-going. Conclusion: The results of our study confirm that nucleoplasty provides the therapeutic benefits of earlier percutaneous disc decompression techniques without many side effects. Clinical results are very promising when the inclusion criteria are strictly respected and therefore we encourage the patients to expect rapid and sustained pain reduction after the procedure. [ABSTRACT FROM AUTHOR]

The carotid stenosis treatment implies medical approaches or surgery treatment such as endarterectomy (CEA) or angioplasty/ stenting (CAS). In our paper we report the experience of the Neurology Clinics of the Emergency University Hospital in carotidian stenting. The study includes over 60 patients stented during a three years period of time (2005 - 2007) with good clinical outcome. As complications we registered only one case of contralateral ICA dissection and one case of restenosis. The results of our study are confirming the efficiency of CAS for patients with symptomatic over 70% ICA stenosis in the absence of CEA criteria. [ABSTRACT FROM AUTHOR]

Unruptured intracranial aneurysms are diagnosed with increased frequency as cerebral imaging techniques are more easily available. In spite of this, there is still no standardized approach to the patient with such pathology. We present the case of a 56 year-old woman presenting with ongoing headaches, who had a giant unruptured intracranial aneurysm of the left internal carotid artery. [ABSTRACT FROM AUTHOR]

The authors present two cases of subarachnoid hemorrhage, both women, middle aged who developed almost the whole spectrum of complications of this type of intracranial bleeding. We briefly review the management of the subarachnoid hemorrhage and we emphasize the importance of the interventional therapy (treatment of the aneurysm by endovascular coiling or intraarterial catheterization and administration of Nimodipine for vasospasm) for the good prognosis of the patients. [ABSTRACT FROM AUTHOR]