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Background Inferior petrosal sinus sampling (IPSS) is known as the gold standard to distinguish whether excessive adrenocorticotropin hormone (ACTH) production origins from the pituitary gland or an ectopic source. However, due to a number of factors, the value of IPSS for adenoma lateralization may be limited. Aim of this study was to evaluate the influence of parasellar venous drainage (VD) patterns on IPSS findings in predicting lateralization of pituitary microadenomas. Methods We retrospectively reviewed records of confirmed cases of Cushing's disease which were evaluated by IPSS prior to endoscopic tansnasal trans-sphenoidal surgery (ETSS) to assess the ability of IPSS to predict adenoma laterality. Results Seventeen patients with pathologically confirmed Cushing's disease were retrospectively reviewed. The median age of the included patients was 37 years. Laterality of parasellar VD perfectly associated with lateralization as measured by IPSS. Symmetrical VD was associated with symmetrical ACTH gradient on IPSS. However, lateralization measured by IPSS did not show any significant correlation with lateralization detected during ETSS. Conclusion Our study suggests that IPSS lateralization results strongly depend on parasellar VD pattern but show no significant correlation with the adenoma lateralization found during ETSS. Thus, IPSS does not appear to be an appropriate modality to predict adenoma lateralization., Anatomy; Neurology; Medical imaging; Endocrinology; Endocrine system; Clinical research; Inferior petrosal sinus sampling; Cushing's disease; Parasellar venous drainage; Lateralization of microadenoma

Objective The middle cerebral artery (MCA) is the third most common site for ruptured intracranial aneurysms. Aneurysms in this location are known to be challenging to treat endovascularly and are commonly treated with microsurgery. Although advances in endovascular treatment options for cerebral aneurysms have markedly reduced the need for surgery in recent years and decades, there is no compelling scientific evidence that endovascular treatments are superior to surgical treatment. The present study aimed to determine the appropriate treatment modality in ruptured MCA aneurysms. Methods We retrospectively evaluated and compared the treatment outcomes of 80 patients with ruptured MCA aneurysms who underwent either endovascular or microsurgical treatment in our center between 2011 and 2016. Post-treatment clinical and radiological outcomes were assessed in all patients. Furthermore, we compared intraoperative complications and the need for re-treatments between the two groups. Results According to our findings, complete aneurysm occlusion was achieved in 90.5% and 89.2% of the patients in the clipping and coil group, respectively (p = 0.850). Moreover, 14.3% of the patients in the clipping group and 15.8% of the subjects in the coil group developed intraoperative complications (p = 0.851), including 3 cases of intraoperative hemorrhage and 3 cases of ischemia in the clipping group as well as 2 cases of thromboembolism and 4 cases of vasospasm during endovascular treatment in the coil group. There was an improvement in the modified Rankin score (mRS) at six months, with no significant difference between the two groups (p = 0.916). Conclusion The results of coiling only with coil able MCA aneurysms were comparable to the results of clipping with difficult cases. Sufficient follow-up study of recurrence and retreatment are needed to determine the indication for coiling for ruptured MCA aneurysm.

Mondello, Stefania/0000-0002-8587-3614; Alizada, Orkhan/0000-0003-0942-9906; Ghorbani, Mohammad/0000-0002-7709-3095; Abedi, Vida/0000-0001-7689-933X WOS:000575454600010 PubMed ID: 32818804 Background: There is an increased attention to stroke following SARS-CoV-2. The goal of this study was to better depict the short-term risk of stroke and its associated factors among SARS-CoV-2 hospitalized patients. Methods: This multicentre, multinational observational study includes hospitalized SARS-CoV-2 patients from North and South America (United States, Canada, and Brazil), Europe (Greece, Italy, Finland, and Turkey), Asia (Lebanon, Iran, and India), and Oceania (New Zealand). The outcome was the risk of subsequent stroke. Centres were included by non-probability sampling. The counts and clinical characteristics including laboratory findings and imaging of the patients with and without a subsequent stroke were recorded according to a predefined protocol. Quality, risk of bias, and heterogeneity assessments were conducted according to ROBINS-E and Cochrane Q-test. The risk of subsequent stroke was estimated through meta-analyses with random effect models. Bivariate logistic regression was used to determine the parameters with predictive outcome value. The study was reported according to the STROBE, MOOSE, and EQUATOR guidelines. Findings: We received data from 26,175 hospitalized SARS-CoV-2 patients from 99 tertiary centres in 65 regions of 11 countries until May 1st, 2020. A total of 17,799 patients were included in meta-analyses. Among them, 156(0.9%) patients had a stroke-123(79%) ischaemic stroke, 27(17%) intracerebral/subarachnoid hemorrhage, and 6(4%) cerebral sinus thrombosis. Subsequent stroke risks calculated with meta-analyses, under low to moderate heterogeneity, were 0.5% among all centres in all countries, and 0.7% among countries with higher health expenditures. The need for mechanical ventilation (OR: 1.9, 95% CI:1.1-3.5, p = 0.03) and the presence of ischaemic heart disease (OR: 2.5, 95% CI:1.4-4.7, p = 0.006) were predictive of stroke. Interpretation: The results of this multi-national study on hospitalized patients with SARS-CoV-2 infection indicated an overall stroke risk of 0.5%(pooled risk: 0.9%). The need for mechanical ventilation and the history of ischaemic heart disease are the independent predictors of stroke among SARS-CoV-2 patients. (C) 2020 The Authors. Published by Elsevier B.V.

Introduction The risk and benefit of restarting oral anticoagulation (OAC) therapy among patients with atrial fibrillation or flutter (AF) and an episode of anticoagulation-associated intracerebral hemorrhage (ICH) remain unclear. Whether or not to resume OAC after an OAC-associated ICH will remain an unanswered clinical question until we have sufficient data through randomized clinical trials. Here, we analyzed the long-term outcome of patients with AF who did or did not resume OAC after an OAC-associated ICH. Patients and methods We studied consecutive patients with AF who were discharged from our institution after an OAC-associated ICH event between 2010 and 2017. Baseline characteristics of patients, past medical history, and history or OAC use were recorded. Outcome measures in our study included recurrent ICH, ischemic stroke or systemic emboli, and death. Results Out of 115 patients with AF and OAC-associated ICH, 93 patients (mean age 76.2 ± 10.3 years [44–91 years old], 54.3% men) were included in this study. Thirty-eight (40.9%) patients resumed OAC after the episode of OAC-associated ICH. More than 70% of patients had resumed OAC within two months of ICH (mean delay 56.0 ± 52.5 days). There was no significant difference between the group who resumed OAC and the group who did not in terms of mean follow-up duration (1.9 vs. 2.4 years), the type of initial ICH, as well as history of hypertension, diabetes, previous ischemic stroke, congestive heart failure, coronary artery disease, and tobacco use. There was no significant difference between the two groups considering the incidence rate of recurrent ICH (relative risk 2.9; 95% CI, 0.3–30.8). There was also no significant difference between the two groups regarding the incidence rate of ischemic stroke or systemic emboli (relative risk 0.9; 95% CI, 0.3–2.7). There was no significate difference between patients who did and did not resume OAC was 96 and 121 per 1000 patient-years, respectively (relative risk 0.8; 95% CI, 0.3–1.9). Conclusions We did not observe any significant difference between the group of patients who resumed OAC and the patients who did not in terms of recurrent ICH, ischemic stroke or systemic emboli, and death. However, there was a tendency toward a higher long-term risk of recurrent ICH among patients who resumed OAC., Highlights • Outcome of AF patients who did/did not resume OAC after an OAC-ICH was studied. • No significant difference between two groups in terms of recurrent ICH and death. • Tendency toward a higher long-term risk of recurrent ICH in patients who resumed OAC.

Purpose Ruptured blood blisters (BBA) and very small, wide necked aneurysms (VSA) remain challenging lesions to treat due to their small size, wide necks, and thin, fragile walls. In the present study, we reviewed our experience with these aneurysms treated by flow diversion. Methods A total of 18 patients with hemorrhage due to a ruptured BBAs and VSAs, treated with flow diversion between July 2014 and March 2016 were included in this study. We analyzed clinical and radiographic outcomes. Results A total of 12 (66.7%) VSAs and 6 (33.3%) BBAs were treated with flow diversion. Fifteen (83.3%) and three (16.7%) aneurysms were located on the internal carotid artery and the basilar artery, respectively. On admission, a GCS score of 15 and WFNS grade 1 were found in 14 (77.7%) patients, 3 patients had an admission GCS of 13 and WFNS grade 2, one had an admission GCS of 8 and WFNS of 4. Fisher CT grades 2, 3, and 4 were observed in 11 (61.1%), 1 (5.6%), and 6 (33.3%) patients, respectively. Flow diversion was performed on average 5.6 days after onset of hemorrhage. 6 months post-intervention angiography showed complete obliteration of the aneurysms in all patients. Conclusion Our findings indicate that flow diversion in the acute and subacute phase of hemorrhage is a reliable treatment for reducing complications in patients with BBAs and VSAs. In patients with poor clinical presentation it might be reasonable to delay treatment until the first signs of recovery become apparent.

Aneurysms of the communicating artery segment of the internal carotid artery comprise a significant portion of the anterior circulation aneurysms. In particular, knowledge of aneurysms of the posterior communicating artery is considered fundamental to neurosurgery and these aneurysms are generally amenable to both endovascular and surgical treatment. This chapter explores the fundamental natural history and anatomy relevant to dealing with this class of aneurysms and some specific considerations that are important for the practitioner faced with the task of deciding between modalities.

The cranial nerves receive their arterial supply from an intricate network of tributaries derived from the external carotid, internal carotid, and vertebrobasilar territories. This chapter provides a comprehensive review of the arterial supply of the cranial nerves.

Peripheral nerve injury has significant societal and economic impact. Current gold standard treatment for severe peripheral nerve injury is autografting, which requires the sacrifice of a donor nerve. Despite best practices, recovery from severe peripheral nerve injuries is often suboptimal. Pluripotent stem cells, bone marrow mesenchymal cells, adipose-derived stem cells, skin-derived precursor cells, and hair follicle pluripotent stem cells can be induced into Schwann cells and/or Schwann cell-like phenotypes; when administered in combination with artificial nerve graft conduits, these cells improve morphological and functional recovery in mouse, rat, and primate models of transecting peripheral nerve injury. Questions regarding survival, differentiation, and safety of cell-based therapy remain to be answered, and no cell-based therapies have yet translated to humans, but if current trends indicate potential, stem cell-based therapy is promising.

The vagus nerve has a larger distribution than any other cranial nerve. Originating in the medulla, the vagus nerve innervates structures in the neck, thorax, and abdomen and has influence over cardiac and digestive functions. As the vagus nerve travels from the brain stem to the abdomen, it gives off many branches. Two branches of great importance are the superior and recurrent laryngeal nerves. The vagus nerve carries five different fiber types: general somatic afferent, general visceral afferent, special visceral afferent, general visceral efferent, and special visceral efferent fibers. A neurological exam and, if necessary, imaging and electrophysiological testing, are useful in diagnosing and localizing pathology of the vagus nerve.