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37 results on '"Amit Herwadkar"'

1. Endovascular coiling in the treatment of patients with renal artery aneurysms

Author: Louise M. Finch, MBChB, MPhil, Harry V.M. Spiers, MBBS, BSc, Rajkumar Chinnadurai, MBBS, MRCP, PhD, Amit Herwadkar, MBBS, FRCR, Ganapathy Anantha-Krishnan, MBBS, FRCR, and Titus Augustine, MBBS, MS, FRCSEd
Subjects: Aneurysm, Case report, Endovascular, Renal artery, Solitary kidney, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Endovascular coiling is a percutaneous endovascular technique used in the management of arterial aneurysms with high success rates and minimal associated morbidity. We present a series of three patients with incidental renal artery aneurysms treated successfully with endovascular coiling, despite comorbidities. One patient had an aneurysm associated with a solitary kidney. The decision to use this technique becomes critical when the aneurysm involves a single functioning kidney. Each renal artery aneurysm was successfully coiled by combining vascular and neurointerventional techniques. The results from the present case series also highlight the challenges faced in therapeutic decision-making in complex situations with limited error margins.
Published: 2021
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2. Persistent Cryptococcal Brain Infection despite Prolonged Immunorecovery in an HIV-Positive Patient

Author: Tom Wingfield, Jo Baxter, Amit Herwadkar, Daniel du Plessis, Tom J. Blanchard, F. Javier Vilar, and Anoop Varma
Subjects: Neurology. Diseases of the nervous system, RC346-429
Abstract: Background. HIV-positive people starting combined antiretroviral therapy may develop immune reconstitution to latent or treated opportunistic infections. Immune reconstitution to cerebral Cryptococcus is poorly understood and can be fatal. Case Presentation. A 33-year-old Zimbabwean female presented with cryptococcal meningitis and newly diagnosed HIV with a CD4 count of 51 cells/μL (4%). She was treated with amphotericin and flucytosine. Combined antiretroviral therapy was started four weeks later and she showed early improvement. However, over the ensuing 18 months, her clinical course was marked by periodic worsening with symptoms resembling cryptococcal meningitis despite having achieved CD4 counts ≥400 cells/μL. Although initially treated for relapsing cryptococcal immune reconstitution syndrome, a brain biopsy taken 17 months after initial presentation showed budding Cryptococci. Conclusion. This unusually protracted case highlights the difficulties in differentiating relapsing cryptococcal meningitis from immune reconstitution and raises questions concerning the optimum timing of initiation of combined antiretroviral therapy in such patients.
Published: 2014
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3. The spectrum of imaging features in craniocervical dissection

Author: Aparna Madhavan and Amit Herwadkar
Subjects: Radiology, Nuclear Medicine and imaging, General Medicine
Published: 2022
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4. 141 Guillain-Barre as a post-operative syndrome following resection of anaplastic astrocytoma

Author: Christopher Leahy, Tim Lavin, David Gosal, Amit Herwadkar, Pietro D’Urso, and Varduhi Cahill
Subjects: Psychiatry and Mental health, Surgery, Neurology (clinical)
Abstract: We present a case of Guillain Barre Syndrome (GBS) following resection of a brain neoplasm. A 43 y.o. man presented with diplopia and lower back pain 2 weeks after resection of left mesiotemporal and fusiform gyrus grade III IDH 1 mutant anaplastic astrocytoma. Within a week he was unable to ambulate due to marked leg weakness. Examination showed bilateral weakness of lateral rectus muscles and lower motor bilateral facial weakness. Hip flexion was 1/5 bilaterally, otherwise 0/5. Tone was flaccid. Lower limb reflexes were absent and plantar responses were mute. Imaging showed no evidence of tumour recurrence or drop metastasis. CSF analysis demonstrated raised WCC (43/ul WBCs, sensory, demyelinating neuropathy. This case highlights the importance of considering GBS as a potential cause of progressive neurological deficit in the postoperative period where “atypical” CSF findings are confounded by the preceding neurosurgical intervention.christopherleahy@doctors.org.uk
Published: 2022
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5. Confused and tetraplegic: examine your ICU patient

Author: Aram Aslanyan, Amit Herwadkar, Nazar Sharaf, Matthew Jones, Christopher Kobylecki, Tim Lavin, and Varduhi Cahill
Subjects: Psychiatry and Mental health, Surgery, Neurology (clinical)
Abstract: IntroductionGlial Fibrillary Acidic Protein (GFAP) astrocytopathy can manifest as a combination of meningitis, encephalitis or myelitis syndrome, which makes the diagnosis challenging, especially in the Intensive Care setting.Case PresentationWe present a case of 43-year-old male who presented to ED with headache, fever, myalgia and acute confusion complicated by respiratory failure attributed to aspiration pneumonia in need of ventilatory support. CSF findings were remarkable for lymphocytic pleocytosis (WCC 197, 95% lymphocytes) and markedly elevated protein of 3.52g/L resulting in the diagnosis of meningoencephalitis. Following a sedation hold he was found to have flaccid quadriparesis and a truncal sensory level, which was not present on admission. An MRI brain showed linear perivascular radial enhancement while the cervicothoracic spine showed longitudinally extensive transverse myelitis. Extensive investigations rendered positive CSF GFAP antibodies. The patient was treated with intravenous Methylprednisolone and plasma exchange followed by a tapering dose of oral steroids. Upon his discharge to a rehabilitation facility the patient was a manual wheelchair user.DiscussionThis case demonstrates the importance of a thorough assessment of ICU patients for the timely detection of an evolving neurological deficit. A high index of suspicion for GFAP-mediated inflammation is warranted in patients presenting with meningoencephalomyelitis.aram.aslanyan@srft.nhs.uk
Published: 2022
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6. 072 Diffuse Astrocytoma as a radiological mimic of Neuro-Behcet’s Disease

Author: Christopher Leahy, Philip McNulty, Amit Herwadkar, Pietro D’Urso, and Varduhi Cahill
Subjects: Psychiatry and Mental health, Surgery, Neurology (clinical)
Abstract: We present a case of diffuse astrocytoma mimicking the radiological features of Neuro-Behcet’s disease. A 61 year old man presented with a progressive asymmetric brainstem syndrome (left>right). Examination of cranial nerves revealed a left lateral rectus palsy, a left trigeminal sensory loss V1-V3 and left lower motor facial palsy. There were no oral or genital ulcerations, no ophthalmic symptoms or signs and no skin rashes. MR imaging showed an asymmetric mesencephalic- diencephalic hyperintensity on T2 without contrast enhancement. Cerebrospinal fluid was within normal limits including large volume cytological exam. Whole body CT and FDG-PET demonstrated no evidence of malignancy. IV methylprednisolone (1g daily) for three days was given then a 60mg prednisolone taper.He subsequently developed a right hemiparesis and was found to have on repeat MR brain a new right prefrontal cortex lesion involving the middle frontal lobe, without contrast enhancement. Biopsy showed a IDH-1 wild-type diffuse astrocytoma. He was administered chemotherapy and whole brain radiotherapy with no interval changes at 2 month follow up. Our case highlights a rare and important presentation of diffuse astrocytoma masquerading as rhombencephalitis syndrome. Timely brain biopsy allows for prompt intervention and improved performance status.christopherleahy@doctors.org.uk61
Published: 2022
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7. 3D printing as an adjunct to complex airway assessment

Author: David Chambers, Glyn J. Smurthwaite, Govind W. Tol, and Amit Herwadkar
Subjects: medicine.medical_specialty, business.industry, Medicine, 3D printing, Geology, Ocean Engineering, business, Intensive care medicine, Airway, Adjunct, Water Science and Technology
Published: 2016
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8. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data

Author: Bruce C V Campbell, Charles B L M Majoie, Gregory W Albers, Bijoy K Menon, Nawaf Yassi, Gagan Sharma, Wim H van Zwam, Robert J van Oostenbrugge, Andrew M Demchuk, Francis Guillemin, Philip White, Antoni Dávalos, Aad van der Lugt, Kenneth S Butcher, Aboubaker Cherifi, Henk A Marquering, Geoffrey Cloud, Juan M Macho Fernández, Jeremy Madigan, Catherine Oppenheim, Geoffrey A Donnan, Yvo B W E M Roos, Jai Shankar, Hester Lingsma, Alain Bonafé, Hélène Raoult, María Hernández-Pérez, Aditya Bharatha, Reza Jahan, Olav Jansen, Sébastien Richard, Elad I Levy, Olvert A Berkhemer, Marc Soudant, Lucia Aja, Stephen M Davis, Timo Krings, Marie Tisserand, Luis San Román, Alejandro Tomasello, Debbie Beumer, Scott Brown, David S Liebeskind, Serge Bracard, Keith W Muir, Diederik W J Dippel, Mayank Goyal, Jeffrey L Saver, Tudor G Jovin, Michael D Hill, Peter J Mitchell, Puck SS Fransen, Lucie A van den Berg, Hester F Lingsma, Albert J Yoo, Wouter J Schonewille, Jan Albert Vos, Paul J Nederkoorn, Marieke JH Wermer, Marianne AA van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A. van Oostayen, Geert J. Lycklama à Nijeholt, Jelis Boiten, Patrick A. Brouwer, Bart J. Emmer, Sebastiaan F. de Bruijn, Lukas C. van Dijk, Jaap Kappelle, Rob H Lo, Ewoud J. van Dijk, Joost de Vries, Paul L.M. de Kort, Willem Jan J. van Rooij, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Marieke C. Visser, Joseph C.J. Bot, Patrick C. Vroomen, Omid Eshghi, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Alexander V. Tielbeek, Heleen M. den Hertog, Dick G. Gerrits, Renske M. van den Berg-Vos, Giorgos B. Karas, Ewout W. Steyerberg, Zwenneke Flach, Henk A. Marquering, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, Ludo F.M. Beenen, René van den Berg, Peter J. Koudstaal, Wim H. van Zwam, Yvo B.W.E.M. Roos, Robert J. van Oostenbrugge, Charles B.L.M. Majoie, Diederik W.J. Dippel, Martin M. Brown, Thomas Liebig, Theo Stijnen, Tommy Andersson, Heinrich Mattle, Nils Wahlgren, Esther van der Heijden, Naziha Ghannouti, Nadine Fleitour, Imke Hooijenga, Corina Puppels, Wilma Pellikaan, Annet Geerling, Annemieke Lindl-Velema, Gina van Vemde, Ans de Ridder, Paut Greebe, José de Bont-Stikkelbroeck, Joke de Meris, Kirsten Janssen, Willy Struijk, Silvan Licher, Nikki Boodt, Adriaan Ros, Esmee Venema, Ilse Slokkers, Raymie-Jayce Ganpat, Maxim Mulder, Nawid Saiedie, Alis Heshmatollah, Stefanie Schipperen, Stefan Vinken, Tiemen van Boxtel, Jeroen Koets, Merel Boers, Emilie Santos, Jordi Borst, Ivo Jansen, Manon Kappelhof, Marit Lucas, Ralph Geuskens, Renan Sales Barros, Roeland Dobbe, Marloes Csizmadia, MD Hill, M Goyal, AM Demchuk, BK Menon, M Eesa, KJ Ryckborst, MR Wright, NR Kamal, L Andersen, PA Randhawa, T Stewart, S Patil, P Minhas, M Almekhlafi, S Mishra, F Clement, T Sajobi, A Shuaib, WJ Montanera, D Roy, FL Silver, TG Jovin, DF Frei, B Sapkota, JL Rempel, J Thornton, D Williams, D Tampieri, AY Poppe, D Dowlatshahi, JH Wong, AP Mitha, S Subramaniam, G Hull, MW Lowerison, M Salluzzi, M Maxwell, S Lacusta, E Drupals, K Armitage, PA Barber, EE Smith, WF Morrish, SB Coutts, C Derdeyn, B Demaerschalk, D Yavagal, R Martin, R Brant, Y Yu, RA Willinsky, A Weill, C Kenney, H Aram, PK Stys, TW Watson, G Klein, D Pearson, P Couillard, A Trivedi, D Singh, E Klourfeld, O Imoukhuede, D Nikneshan, S Blayney, R Reddy, P Choi, M Horton, T Musuka, V Dubuc, TS Field, J Desai, S Adatia, A Alseraya, V Nambiar, R van Dijk, NJ Newcommon, B Schwindt, KS Butcher, T Jeerakathil, B Buck, K Khan, SS Naik, DJ Emery, RJ Owen, TB Kotylak, RA Ashforth, TA Yeo, D McNally, M Siddiqui, M Saqqur, D Hussain, H Kalashyan, A Manosalva, M Kate, L Gioia, S Hasan, A Mohammad, M Muratoglu, A Cullen, P Brennan, A O'Hare, S Looby, D Hyland, S Duff, M McCusker, B Hallinan, S Lee, J McCormack, A Moore, M O'Connor, C Donegan, L Brewer, A Martin, S Murphy, K O'Rourke, S Smyth, P Kelly, T Lynch, T Daly, P O'Brien, A O'Driscoll, M Martin, R Collins, T Coughlan, D McCabe, D O'Neill, M Mulroy, O Lynch, T Walsh, M O'Donnell, T Galvin, J Harbison, P McElwaine, K Mulpeter, C McLoughlin, M Reardon, E Harkin, E Dolan, M Watts, N Cunningham, C Fallon, S Gallagher, P Cotter, M Crowe, R Doyle, I Noone, M Lapierre, VA Coté, S Lanthier, C Odier, A Durocher, J Raymond, N Daneault, Y Deschaintre, B Jankowitz, L Baxendell, L Massaro, C Jackson-Graves, S Decesare, P Porter, K Armbruster, A Adams, J Billigan, J Oakley, A Ducruet, A Jadhav, D-V Giurgiutiu, A Aghaebrahim, V Reddy, M Hammer, M Starr, V Totoraitis, L Wechsler, S Streib, S Rangaraju, D Campbell, M Rocha, D Gulati, T Krings, L Kalman, A Cayley, J Williams, R Wiegner, LK Casaubon, C Jaigobin, JM del Campo, E Elamin, JD Schaafsma, R Agid, R Farb, K ter Brugge, BL Sapkoda, BW Baxter, K Barton, A Knox, A Porter, A Sirelkhatim, T Devlin, C Dellinger, N Pitiyanuvath, J Patterson, J Nichols, S Quarfordt, J Calvert, H Hawk, C Fanale, A Bitner, A Novak, D Huddle, R Bellon, D Loy, J Wagner, I Chang, E Lampe, B Spencer, R Pratt, R Bartt, S Shine, G Dooley, T Nguyen, M Whaley, K McCarthy, J Teitelbaum, W Poon, N Campbell, M Cortes, C Lum, R Shamloul, S Robert, G Stotts, M Shamy, N Steffenhagen, D Blacquiere, M Hogan, M AlHazzaa, G Basir, H Lesiuk, D Iancu, M Santos, H Choe, DC Weisman, K Jonczak, A Blue-Schaller, Q Shah, L MacKenzie, B Klein, K Kulandaivel, O Kozak, DJ Gzesh, LJ Harris, JS Khoury, J Mandzia, D Pelz, S Crann, L Fleming, K Hesser, B Beauchamp, B Amato-Marzialli, M Boulton, P Lopez- Ojeda, M Sharma, S Lownie, R Chan, R Swartz, P Howard, D Golob, D Gladstone, K Boyle, M Boulos, J Hopyan, V Yang, L Da Costa, CA Holmstedt, AS Turk, R Navarro, E Jauch, S Ozark, R Turner, S Phillips, J Shankar, J Jarrett, G Gubitz, W Maloney, R Vandorpe, M Schmidt, J Heidenreich, G Hunter, M Kelly, R Whelan, L Peeling, PA Burns, A Hunter, I Wiggam, E Kerr, M Watt, A Fulton, P Gordon, I Rennie, P Flynn, G Smyth, S O'Leary, N Gentile, G Linares, P McNelis, K Erkmen, P Katz, A Azizi, M Weaver, C Jungreis, S Faro, P Shah, H Reimer, V Kalugdan, G Saposnik, A Bharatha, Y Li, P Kostyrko, T Marotta, W Montanera, D Sarma, D Selchen, J Spears, JH Heo, K Jeong, DJ Kim, BM Kim, YD Kim, D Song, K-J Lee, J Yoo, OY Bang, S Rho, J Lee, P Jeon, KH Kim, J Cha, SJ Kim, S Ryoo, MJ Lee, S-I Sohn, C-H Kim, H-G Ryu, J-H Hong, H-W Chang, C-Y Lee, J Rha, Bruce CV Campbell, Leonid Churilov, Bernard Yan, Richard Dowling, Thomas J Oxley, Teddy Y Wu, Gabriel Silver, Amy McDonald, Rachael McCoy, Timothy J Kleinig, Rebecca Scroop, Helen M Dewey, Marion Simpson, Mark Brooks, Bronwyn Coulton, Martin Krause, Timothy J Harrington, Brendan Steinfort, Kenneth Faulder, Miriam Priglinger, Susan Day, Thanh Phan, Winston Chong, Michael Holt, Ronil V Chandra, Henry Ma, Dennis Young, Kitty Wong, Tissa Wijeratne, Hans Tu, Elizabeth Mackay, Sherisse Celestino, Christopher F Bladin, Poh Sien Loh, Amanda Gilligan, Zofia Ross, Skye Coote, Tanya Frost, Mark W Parsons, Ferdinand Miteff, Christopher R Levi, Timothy Ang, Neil Spratt, Lara Kaauwai, Monica Badve, Henry Rice, Laetitia de Villiers, P. Alan Barber, Ben McGuinness, Ayton Hope, Maurice Moriarty, Patricia Bennett, Andrew Wong, Alan Coulthard, Andrew Lee, Jim Jannes, Deborah Field, Simon Salinas, Elise Cowley, Barry Snow, John Kolbe, Richard Stark, John King, Richard Macdonnell, John Attia, Cate D'Este, Hans-Christoph Diener, Elad I. Levy, Vitor Mendes Pereira, Gregory W. Albers, Christophe Cognard, David J. Cohen, Werner Hacke, Tudor G. Jovin, Heinrich P. Mattle, Raul G. Nogueira, Adnan H. Siddiqui, Dileep R. Yavagal, Rüdiger von Kummer, Wade Smith, Francis Turjman, Scott Hamilton, Richard Chiacchierini, Arun Amar, Nerses Sanossian, Yince Loh, B Baxter, VK Reddy, A Horev, M Star, A Siddiqui, LN Hopkins, K Snyder, R Sawyer, S Hall, V Costalat, C Riquelme, P Machi, E Omer, C Arquizan, I Mourand, M Charif, X Ayrignac, N Menjot de Champfleur, N Leboucq, G Gascou, M Moynier, R du Mesnil de Rochemont, O Singer, J Berkefeld, C Foerch, M Lorenz, W Pfeilschifer, E Hattingen, M Wagner, SJ You, S Lescher, H Braun, S Dehkharghani, SR Belagaje, A Anderson, A Lima, M Obideen, D Haussen, R Dharia, M Frankel, V Patel, K Owada, A Saad, L Amerson, C Horn, S Doppelheuer, K Schindler, DK Lopes, M Chen, R Moftakhar, C Anton, M Smreczak, JS Carpenter, S Boo, A Rai, T Roberts, A Tarabishy, L Gutmann, C Brooks, J Brick, J Domico, G Reimann, K Hinrichs, M Becker, E Heiss, C Selle, A Witteler, S Al-Boutros, M-J Danch, A Ranft, S Rohde, K Burg, C Weimar, V Zegarac, C Hartmann, M Schlamann, S Göricke, A Ringlestein, I Wanke, C Mönninghoff, M Dietzold, R Budzik, T Davis, G Eubank, WJ Hicks, P Pema, N Vora, J Mejilla, M Taylor, W Clark, A Rontal, J Fields, B Peterson, G Nesbit, H Lutsep, H Bozorgchami, R Priest, O Ologuntoye, S Barnwell, A Dogan, K Herrick, C Takahasi, N Beadell, B Brown, S Jamieson, MS Hussain, A Russman, F Hui, D Wisco, K Uchino, Z Khawaja, I Katzan, G Toth, E Cheng-Ching, M Bain, S Man, A Farrag, P George, S John, L Shankar, A Drofa, R Dahlgren, A Bauer, A Itreat, A Taqui, R Cerejo, A Richmond, P Ringleb, M Bendszus, M Möhlenbruch, T Reiff, H Amiri, J Purrucker, C Herweh, M Pham, O Menn, I Ludwig, I Acosta, C Villar, W Morgan, C Sombutmai, F Hellinger, E Allen, M Bellew, R Gandhi, E Bonwit, J Aly, RD Ecker, D Seder, J Morris, M Skaletsky, J Belden, C Baker, LS Connolly, P Papanagiotou, C Roth, A Kastrup, M Politi, F Brunner, M Alexandrou, H Merdivan, C Ramsey, C Given II, S Renfrow, V Deshmukh, K Sasadeusz, F Vincent, JT Thiesing, J Putnam, A Bhatt, A Kansara, D Caceves, T Lowenkopf, L Yanase, J Zurasky, S Dancer, B Freeman, T Scheibe-Mirek, J Robison, J Roll, D Clark, M Rodriguez, B-FM Fitzsimmons, O Zaidat, JR Lynch, M Lazzaro, T Larson, L Padmore, E Das, A Farrow-Schmidt, A Hassan, W Tekle, C Cate, O Jansen, C Cnyrim, F Wodarg, C Wiese, A Binder, C Riedel, A Rohr, N Lang, H Laufs, S Krieter, L Remonda, M Diepers, J Añon, K Nedeltchev, T Kahles, S Biethahn, M Lindner, V Chang, C Gächter, C Esperon, M Guglielmetti, JF Arenillas Lara, M Martínez Galdámez, AI Calleja Sanz, E Cortijo Garcia, P Garcia Bermejo, S Perez, P Mulero Carrillo, E Crespo Vallejo, M Ruiz Piñero, L Lopez Mesonero, FJ Reyes Muñoz, C Brekenfeld, J-H Buhk, A Krützelmann, G Thomalla, B Cheng, C Beck, J Hoppe, E Goebell, B Holst, U Grzyska, G Wortmann, S Starkman, G Duckwiler, R Jahan, N Rao, S Sheth, K Ng, A Noorian, V Szeder, M Nour, M McManus, J Huang, J Tarpley, S Tateshima, N Gonzalez, L Ali, D Liebeskind, J Hinman, M Calderon-Arnulphi, C Liang, J Guzy, S Koch, K DeSousa, G Gordon-Perue, M Elhammady, E Peterson, V Pandey, S Dharmadhikari, P Khandelwal, A Malik, R Pafford, P Gonzalez, K Ramdas, G Andersen, D Damgaard, P Von Weitzel-Mudersbach, C Simonsen, N Ruiz de Morales Ayudarte, M Poulsen, L Sørensen, S Karabegovich, M Hjørringgaard, N Hjort, T Harbo, K Sørensen, E Deshaies, D Padalino, A Swarnkar, JG Latorre, E Elnour, Z El-Zammar, M Villwock, H Farid, A Balgude, L Cross, K Hansen, M Holtmannspötter, D Kondziella, J Hoejgaard, S Taudorf, H Soendergaard, A Wagner, M Cronquist, T Stavngaard, M Cortsen, LH Krarup, T Hyldal, H-P Haring, S Guggenberger, M Hamberger, J Trenkler, M Sonnberger, K Nussbaumer, C Dominger, E Bach, BD Jagadeesan, R Taylor, J Kim, K Shea, R Tummala, H Zacharatos, D Sandhu, M Ezzeddine, A Grande, D Hildebrandt, K Miller, J Scherber, A Hendrickson, M Jumaa, S Zaidi, T Hendrickson, V Snyder, M Killer-Oberpfalzer, J Mutzenbach, F Weymayr, E Broussalis, K Stadler, A Jedlitschka, A Malek, N Mueller-Kronast, P Beck, C Martin, D Summers, J Day, I Bettinger, W Holloway, K Olds, S Arkin, N Akhtar, C Boutwell, S Crandall, M Schwartzman, C Weinstein, B Brion, S Prothmann, J Kleine, K Kreiser, T Boeckh-Behrens, H Poppert, S Wunderlich, ML Koch, V Biberacher, A Huberle, G Gora-Stahlberg, B Knier, T Meindl, D Utpadel-Fischler, M Zech, M Kowarik, C Seifert, B Schwaiger, A Puri, S Hou, A Wakhloo, M Moonis, N Henninger, R Goddeau, F Massari, A Minaeian, JD Lozano, M Ramzan, C Stout, A Patel, A Tunguturi, S Onteddu, R Carandang, M Howk, M Ribó, E Sanjuan, M Rubiera, J Pagola, A Flores, M Muchada, P Meler, E Huerga, S Gelabert, P Coscojuela, A Tomasello, D Rodriguez, E Santamarina, O Maisterra, S Boned, L Seró, A Rovira, CA Molina, M Millán, L Muñoz, N Pérez de la Ossa, M Gomis, L Dorado, E López-Cancio, E Palomeras, J Munuera, P García Bermejo, S Remollo, C Castaño, R García-Sort, P Cuadras, P Puyalto, M Hernández-Pérez, M Jiménez, A Martínez-Piñeiro, G Lucente, A Dávalos, A Chamorro, X Urra, V Obach, A Cervera, S Amaro, L Llull, J Codas, M Balasa, J Navarro, H Ariño, A Aceituno, S Rudilosso, A Renu, JM Macho, L San Roman, J Blasco, A López, N Macías, P Cardona, H Quesada, F Rubio, L Cano, B Lara, MA de Miquel, L Aja, J Serena, E Cobo, Kennedy R Lees, J Arenillas, R Roberts, F Al-Ajlan, L Zimmel, S Patel, J Martí-Fàbregas, M Salvat-Plana, S Bracard, Xavier Ducrocq, René Anxionnat, Pierre-Alexandre Baillot, Charlotte Barbier, Anne-Laure Derelle, Jean-Christophe Lacour, Yves Samson, Nader Sourour, Flore Baronnet-Chauvet, Frédéric Clarencon, Sophie Crozier, Sandrine Deltour, Federico Di Maria, Raphael Le Bouc, Anne Leger, Gurkan Mutlu, Charlotte Rosso, Zoltan Szatmary, Marion Yger, Chiara Zavanone, Serge Bakchine, Laurent Pierot, Nathalie Caucheteux, Laurent Estrade, Krzysztof Kadziolka, Alexandre Leautaud, Céline Renkes, Isabelle Serre, Hubert Desal, Benoît Guillon, Claire Boutoleau-Bretonniere, Benjamin Daumas-Duport, Solène De Gaalon, Pascal Derkinderen, Sarah Evain, Fanny Herisson, David-Axel Laplaud, Thibaud Lebouvier, Alina Lintia-Gaultier, Hélène Pouclet-Courtemanche, Tiphaine Rouaud, Violaine Rouaud Jaffrenou, Aurélia Schunck, Mathieu Sevin-Allouet, Frederique Toulgoat, Sandrine Wiertlewski, Jean-Yves Gauvrit, Thomas Ronziere, Vincent Cahagne, Jean-Christophe Ferre, Jean-François Pinel, Jean-Louis Mas, Jean-François Meder, Amen-Adam Al Najjar-Carpentier, Julia Birchenall, Eric Bodiguel, David Calvet, Valérie Domigo, Sylvie Godon-Hardy, Vincent Guiraud, Catherine Lamy, Loubna Majhadi, Ludovic Morin, Olivier Naggara, Denis Trystram, Guillaume Turc, Jérôme Berge, Igor Sibon, Patrice Menegon, Xavier Barreau, François Rouanet, Sabrina Debruxelles, Annabelle Kazadi, Pauline Renou, Olivier Fleury, Anne Pasco-Papon, Frédéric Dubas, Jildaz Caroff, Sophie Godard Ducceschi, Marie-Aurélie Hamon, Alderic Lecluse, Guillaume Marc, Maurice Giroud, Frédéric Ricolfi, Yannick Bejot, Adrien Chavent, Arnaud Gentil, Apolline Kazemi, Guy-Victor Osseby, Charlotte Voguet, Marie-Hélène Mahagne, Jacques Sedat, Yves Chau, Laurent Suissa, Sylvain Lachaud, Emmanuel Houdart, Christian Stapf, Frédérique Buffon Porcher, Hugues Chabriat, Pierre Guedin, Dominique Herve, Eric Jouvent, Jérôme Mawet, Jean-Pierre Saint-Maurice, Hans-Martin Schneble, Norbert Nighoghossian, Nadia-Nawel Berhoune, Françoise Bouhour, Tae-Hee Cho, Laurent Derex, Sandra Felix, Hélène Gervais-Bernard, Benjamin Gory, Luis Manera, Laura Mechtouff, Thomas Ritzenthaler, Roberto Riva, Fabrizio Salaris Silvio, Caroline Tilikete, Raphael Blanc, Michaël Obadia, Mario Bruno Bartolini, Antoine Gueguen, Michel Piotin, Silvia Pistocchi, Hocine Redjem, Jacques Drouineau, Jean-Philippe Neau, Gaelle Godeneche, Matthias Lamy, Emilia Marsac, Stephane Velasco, Pierre Clavelou, Emmanuel Chabert, Nathalie Bourgois, Catherine Cornut-Chauvinc, Anna Ferrier, Jean Gabrillargues, Betty Jean, Anna-Raquel Marques, Nicolas Vitello, Olivier Detante, Marianne Barbieux, Kamel Boubagra, Isabelle Favre Wiki, Katia Garambois, Florence Tahon, Vasdev Ashok, Oguzhan Coskun, Georges Rodesch, Bertrand Lapergue, Frédéric Bourdain, Serge Evrard, Philippe Graveleau, Jean Pierre Decroix, Adrien Wang, François Sellal, Guido Ahle, Gabriela Carelli, Marie-Hélène Dugay, Claude Gaultier, Ariel Pablo Lebedinsky, Lavinia Lita, Raul Mariano Musacchio, Catherine Renglewicz-Destuynder, Alain Tournade, Françis Vuillemet, Francisco Macian Montoro, Charbel Mounayer, Frederic Faugeras, Laetitia Gimenez, Catherine Labach, Géraldine Lautrette, Christian Denier, Guillaume Saliou, Olivier Chassin, Claire Dussaule, Elsa Melki, Augustin Ozanne, Francesco Puccinelli, Marina Sachet, Mariana Sarov, Jean-François Bonneville, Thierry Moulin, Alessandra Biondi, Elisabeth De Bustos Medeiros, Fabrice Vuillier, Patrick Courtheoux, Fausto Viader, Marion Apoil-Brissard, Mathieu Bataille, Anne-Laure Bonnet, Julien Cogez, Emmanuel Touze, Xavier Leclerc, Didier Leys, Mohamed Aggour, Pierre Aguettaz, Marie Bodenant, Charlotte Cordonnier, Dominique Deplanque, Marie Girot, Hilde Henon, Erwah Kalsoum, Christian Lucas, Jean-Pierre Pruvo, Paolo Zuniga, Caroline Arquizan, Vincent Costalat, Paolo Machi, Isabelle Mourand, Carlos Riquelme, Pierre Bounolleau, Charles Arteaga, Anthony Faivre, Marc Bintner, Patrice Tournebize, Cyril Charlin, Françoise Darcel, Pascale Gauthier-Lasalarie, Marcia Jeremenko, Servane Mouton, Jean-Baptiste Zerlauth, Chantal Lamy, Deramond Hervé, Hosseini Hassan, André Gaston, Francis-Guy Barral, Pierre Garnier, Rémy Beaujeux, Valérie Wolff, Denis Herbreteau, Séverine Debiais, Alicia Murray, Gary Ford, Andy Clifton, Janet Freeman, Ian Ford, Hugh Markus, Joanna Wardlaw, Andy Molyneux, Thompson Robinson, Steff Lewis, John Norrie, Fergus Robertson, Richard Perry, Anand Dixit, Andrew Clifton, Christine Roffe, Sanjeev Nayak, Kyriakos Lobotesis, Craig Smith, Amit Herwadkar, Naga Kandasamy, Tony Goddard, John Bamford, Ganesh Subramanian, Rob Lenthall, Edward Littleton, Sal Lamin, Kelley Storey, Rita Ghatala, Azra Banaras, John Aeron-Thomas, Bath Hazel, Holly Maguire, Emelda Veraque, Louise Harrison, Rekha Keshvara, James Cunningham, Clinical Neurophysiology, Weimar, Christian (Beitragende*r), Radiology and nuclear medicine, Rheumatology, ACS - Atherosclerosis & ischemic syndromes, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, MUMC+: MA AIOS Neurologie (9), The Royal Melbourne Hospital, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), Stanford University, University of Calgary, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University [Maastricht], Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute of Neuroscience [Newcastle] (ION), Newcastle University [Newcastle], Universitat Autònoma de Barcelona (UAB), Erasmus University Medical Center [Rotterdam] (Erasmus MC), University of Alberta, Centre d'Investigation Clinique - Innovation Technologique [Nancy] (CIC-IT), Monash University [Melbourne], St George’s University Hospitals, Institut de psychiatrie et neurosciences (U894 / UMS 1266), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Dalhousie University [Halifax], Neuroradiologie [Hôpital Gui de Chauliac], Hôpital Gui de Chauliac [Montpellier], Service de Neuroradiologie [Rennes], CHU Pontchaillou [Rennes], St. Michael's Hospital, University of California [Los Angeles] (UCLA), University of California, University Medical Center of Schleswig–Holstein = Universitätsklinikum Schleswig-Holstein (UKSH), Kiel University, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), University at Buffalo [SUNY] (SUNY Buffalo), State University of New York (SUNY), Toronto Western Hospital, Hôpital Foch [Suresnes], Vall d'Hebron University Hospital [Barcelona], Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), University of Glasgow, Queen Elizabeth University Hospital (Glasgow), David Geffen School of Medicine [Los Angeles], University of California-University of California, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Radiology & Nuclear Medicine, Public Health, Neurology, Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Neurovascular Disorders, ACS - Amsterdam Cardiovascular Sciences, Graduate School, ACS - Pulmonary hypertension & thrombosis, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, ARD - Amsterdam Reproduction and Development, Biomedical Engineering and Physics, APH - Personalized Medicine, APH - Quality of Care, and AMS - Restoration & Development
Subjects: SELECTION, COMPUTED TOMOGRAPHIC PERFUSION, Medizin, Perfusion scanning, 030204 cardiovascular system & hematology, Brain Ischemia, 0302 clinical medicine, Modified Rankin Scale, REPERFUSION, Stroke, ComputingMilieux_MISCELLANEOUS, Thrombectomy, Aged, 80 and over, medicine.diagnostic_test, Penumbra, Endovascular Procedures, Brain, Middle Aged, Magnetic Resonance Imaging, 3. Good health, Treatment Outcome, Cerebral blood flow, Tissue Plasminogen Activator, INFARCT, Cardiology, Female, TRIAL, CT, medicine.medical_specialty, Perfusion Imaging, Neuroimaging, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 03 medical and health sciences, Fibrinolytic Agents, ALTEPLASE, Internal medicine, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Aged, business.industry, MECHANICAL THROMBECTOMY, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Magnetic resonance imaging, Odds ratio, medicine.disease, Neurology (clinical), business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery, Fibrinolytic agent, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and potentially salvageable penumbra volumes were associated with functional outcome and whether they interacted with the treatment effect of endovascular thrombectomy on functional outcome.Methods In this systematic review and meta-analysis, the HERMES collaboration pooled patient-level data from all randomised controlled trials that compared endovascular thrombectomy (predominantly using stent retrievers) with standard medical therapy in patients with anterior circulation ischaemic stroke, published in PubMed from Jan 1,2010, to May 31, 2017. The primary endpoint was functional outcome, assessed by the modified Rankin Scale (mRS) at 90 days after stroke. Ischaemic core was estimated, before treatment with either endovascular thrombectomy or standard medical therapy, by CTP as relative cerebral blood flow less than 30% of normal brain blood flow or by MRI as an apparent diffusion coefficient less than 620 mu m(2)/s. Critically hypoperfused tissue was estimated as the volume of tissue with a CTP time to maximum longer than 6 s. Mismatch volume (ie, the estimated penumbral volume) was calculated as critically hypoperfused tissue volume minus ischaemic core volume. The association of ischaemic core and penumbral volumes with 90-day mRS score was analysed with multivariable logistic regression (functional independence, defined as mRS score 0-2) and ordinal logistic regression (functional improvement by at least one mRS category) in all patients and in a subset of those with more than 50% endovascular reperfusion, adjusted for baseline prognostic variables. The meta-analysis was prospectively designed by the HERMES executive committee, but not registered.Findings We identified seven studies with 1764 patients, all of which were included in the meta-analysis. CTP was available and assessable for 591 (34%) patients and diffusion MRI for 309 (18%) patients. Functional independence was worse in patients who had CTP versus those who had diffusion MRI, after adjustment for ischaemic core volume (odds ratio [OR] 0.47 [95% CI 0.30-0.72], p=0.0007), so the imaging modalities were not pooled. Increasing ischaemic core volume was associated with reduced likelihood of functional independence (CTP OR 0.77 [0.69-0.86] per 10 mL, p(interaction)=0.29; diffusion MRI OR 0.87 [0.81-0.94] per 10 mL, p(interaction)=0.94). Mismatch volume, examined only in the CTP group because of the small numbers of patients who had perfusion MRI, was not associated with either functional independence or functional improvement. In patients with CTP with more than 50% endovascular reperfusion (n=186), age, ischaemic core volume, and imaging-to-reperfusion time were independently associated with functional improvement. Risk of bias between studies was generally low.Interpretation Estimated ischaemic core volume was independently associated with functional independence and functional improvement but did not modify the treatment benefit of endovascular thrombectomy over standard medical therapy for improved functional outcome. Combining ischaemic core volume with age and expected imagingto-reperfusion time will improve assessment of prognosis and might inform endovascular thrombectomy treatment decisions. Copyright (C) 2018 Elsevier Ltd. All rights reserved.
Published: 2019
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9. Varicella zoster virus cerebral aneurysmal vasculopathy presenting in a newly-diagnosed HIV-positive patient

Author: Rekha Siripurapu, Amit Herwadkar, Andrew Tomkins, Chitra Babu, and David McKee
Subjects: 0301 basic medicine, Adult, medicine.medical_specialty, Herpesvirus 3, Human, Computed Tomography Angiography, viruses, Prednisolone, 030106 microbiology, Human immunodeficiency virus (HIV), Dermatology, Newly diagnosed, Intrathecal, medicine.disease_cause, Antiviral Agents, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, HIV Seropositivity, medicine, Humans, Pharmacology (medical), Encephalitis, Varicella Zoster, integumentary system, biology, business.industry, Public Health, Environmental and Occupational Health, Varicella zoster virus, virus diseases, Brain, Intracranial Aneurysm, Positive patient, Magnetic Resonance Imaging, Infectious Diseases, Treatment Outcome, Anti-Retroviral Agents, Varicella Zoster Virus Infection, biology.protein, Female, Cerebral Arterial Diseases, Antibody, business, Intracranial Hemorrhages, 030217 neurology & neurosurgery, medicine.drug
Abstract: We report the case of a newly-diagnosed HIV-positive patient with varicella zoster virus aneurysmal vasculopathy confirmed on intrathecal antibody testing, despite a negative Cerebrospinal fluid (CSF) Varicella Zoster Virus (VZV) Polymerase Chain Reaction (PCR). This highlights the importance of prompt treatment with antiviral and steroid therapy in the presence of clinical or radiological suspicion whilst awaiting further confirmatory testing.
Published: 2018

10. Atypical late presentation of BPAN in a male: A case report

Author: Christopher Kobylecki, Nicholas Beauchamp, Amit Herwadkar, Monty Silverdale, Mihaela Boca, Kate Garrard, and Catherine Breen
Subjects: Late presentation, Pediatrics, medicine.medical_specialty, Text mining, Neurology, business.industry, MEDLINE, Medicine, Neurology (clinical), Geriatrics and Gerontology, business
Published: 2019
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11. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Author: Bruce C V Campbell, Wim H van Zwam, Mayank Goyal, Bijoy K Menon, Diederik W J Dippel, Andrew M Demchuk, Serge Bracard, Philip White, Antoni Dávalos, Charles B L M Majoie, Aad van der Lugt, Gary A Ford, Natalia Pérez de la Ossa, Michael Kelly, Romain Bourcier, Geoffrey A Donnan, Yvo B W E M Roos, Oh Young Bang, Raul G Nogueira, Thomas G Devlin, Lucie A van den Berg, Frédéric Clarençon, Paul Burns, Jeffrey Carpenter, Olvert A Berkhemer, Dileep R Yavagal, Vitor Mendes Pereira, Xavier Ducrocq, Anand Dixit, Helena Quesada, Jonathan Epstein, Stephen M Davis, Olav Jansen, Marta Rubiera, Xabier Urra, Emilien Micard, Hester F Lingsma, Olivier Naggara, Scott Brown, Francis Guillemin, Keith W Muir, Robert J van Oostenbrugge, Jeffrey L Saver, Tudor G Jovin, Michael D Hill, Peter J Mitchell, Puck SS Fransen, Debbie Beumer, Albert J Yoo, Wouter J Schonewille, Jan Albert Vos, Paul J Nederkoorn, Marieke JH Wermer, Marianne AA van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A. van Oostayen, Geert J. Lycklama à Nijeholt, Jelis Boiten, Patrick A. Brouwer, Bart J. Emmer, Sebastiaan F. de Bruijn, Lukas C. van Dijk, Jaap Kappelle, Rob H Lo, Ewoud J. van Dijk, Joost de Vries, Paul L.M. de Kort, Willem Jan J. van Rooij, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Marieke C. Visser, Joseph C.J. Bot, Patrick C. Vroomen, Omid Eshghi, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Alexander V. Tielbeek, Heleen M. den Hertog, Dick G. Gerrits, Renske M. van den Berg-Vos, Giorgos B. Karas, Ewout W. Steyerberg, Zwenneke Flach, Henk A. Marquering, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, Ludo F.M. Beenen, René van den Berg, Peter J. Koudstaal, Wim H. van Zwam, Yvo B.W.E.M. Roos, Robert J. van Oostenbrugge, Charles B.L.M. Majoie, Diederik W.J. Dippel, Martin M. Brown, Thomas Liebig, Theo Stijnen, Tommy Andersson, Heinrich Mattle, Nils Wahlgren, Esther van der Heijden, Naziha Ghannouti, Nadine Fleitour, Imke Hooijenga, Corina Puppels, Wilma Pellikaan, Annet Geerling, Annemieke Lindl-Velema, Gina van Vemde, Ans de Ridder, Paut Greebe, José de Bont-Stikkelbroeck, Joke de Meris, Kirsten Janssen, Willy Struijk, Silvan Licher, Nikki Boodt, Adriaan Ros, Esmee Venema, Ilse Slokkers, Raymie-Jayce Ganpat, Maxim Mulder, Nawid Saiedie, Alis Heshmatollah, Stefanie Schipperen, Stefan Vinken, Tiemen van Boxtel, Jeroen Koets, Merel Boers, Emilie Santos, Jordi Borst, Ivo Jansen, Manon Kappelhof, Marit Lucas, Ralph Geuskens, Renan Sales Barros, Roeland Dobbe, Marloes Csizmadia, MD Hill, M Goyal, AM Demchuk, BK Menon, M Eesa, KJ Ryckborst, MR Wright, NR Kamal, L Andersen, PA Randhawa, T Stewart, S Patil, P Minhas, M Almekhlafi, S Mishra, F Clement, T Sajobi, A Shuaib, WJ Montanera, D Roy, FL Silver, TG Jovin, DF Frei, B Sapkota, JL Rempel, J Thornton, D Williams, D Tampieri, AY Poppe, D Dowlatshahi, JH Wong, AP Mitha, S Subramaniam, G Hull, MW Lowerison, M Salluzzi, M Maxwell, S Lacusta, E Drupals, K Armitage, PA Barber, EE Smith, WF Morrish, SB Coutts, C Derdeyn, B Demaerschalk, D Yavagal, R Martin, R Brant, Y Yu, RA Willinsky, A Weill, C Kenney, H Aram, PK Stys, TW Watson, G Klein, D Pearson, P Couillard, A Trivedi, D Singh, E Klourfeld, O Imoukhuede, D Nikneshan, S Blayney, R Reddy, P Choi, M Horton, T Musuka, V Dubuc, TS Field, J Desai, S Adatia, A Alseraya, V Nambiar, R van Dijk, NJ Newcommon, B Schwindt, KS Butcher, T Jeerakathil, B Buck, K Khan, SS Naik, DJ Emery, RJ Owen, TB Kotylak, RA Ashforth, TA Yeo, D McNally, M Siddiqui, M Saqqur, D Hussain, H Kalashyan, A Manosalva, M Kate, L Gioia, S Hasan, A Mohammad, M Muratoglu, A Cullen, P Brennan, A O'Hare, S Looby, D Hyland, S Duff, M McCusker, B Hallinan, S Lee, J McCormack, A Moore, M O'Connor, C Donegan, L Brewer, A Martin, S Murphy, K O'Rourke, S Smyth, P Kelly, T Lynch, T Daly, P O'Brien, A O'Driscoll, M Martin, R Collins, T Coughlan, D McCabe, D O'Neill, M Mulroy, O Lynch, T Walsh, M O'Donnell, T Galvin, J Harbison, P McElwaine, K Mulpeter, C McLoughlin, M Reardon, E Harkin, E Dolan, M Watts, N Cunningham, C Fallon, S Gallagher, P Cotter, M Crowe, R Doyle, I Noone, M Lapierre, VA Coté, S Lanthier, C Odier, A Durocher, J Raymond, N Daneault, Y Deschaintre, B Jankowitz, L Baxendell, L Massaro, C Jackson-Graves, S Decesare, P Porter, K Armbruster, A Adams, J Billigan, J Oakley, A Ducruet, A Jadhav, D-V Giurgiutiu, A Aghaebrahim, V Reddy, M Hammer, M Starr, V Totoraitis, L Wechsler, S Streib, S Rangaraju, D Campbell, M Rocha, D Gulati, T Krings, L Kalman, A Cayley, J Williams, R Wiegner, LK Casaubon, C Jaigobin, JM del Campo, E Elamin, JD Schaafsma, R Agid, R Farb, K ter Brugge, BL Sapkoda, BW Baxter, K Barton, A Knox, A Porter, A Sirelkhatim, T Devlin, C Dellinger, N Pitiyanuvath, J Patterson, J Nichols, S Quarfordt, J Calvert, H Hawk, C Fanale, A Bitner, A Novak, D Huddle, R Bellon, D Loy, J Wagner, I Chang, E Lampe, B Spencer, R Pratt, R Bartt, S Shine, G Dooley, T Nguyen, M Whaley, K McCarthy, J Teitelbaum, W Poon, N Campbell, M Cortes, C Lum, R Shamloul, S Robert, G Stotts, M Shamy, N Steffenhagen, D Blacquiere, M Hogan, M AlHazzaa, G Basir, H Lesiuk, D Iancu, M Santos, H Choe, DC Weisman, K Jonczak, A Blue-Schaller, Q Shah, L MacKenzie, B Klein, K Kulandaivel, O Kozak, DJ Gzesh, LJ Harris, JS Khoury, J Mandzia, D Pelz, S Crann, L Fleming, K Hesser, B Beauchamp, B Amato-Marzialli, M Boulton, P Lopez- Ojeda, M Sharma, S Lownie, R Chan, R Swartz, P Howard, D Golob, D Gladstone, K Boyle, M Boulos, J Hopyan, V Yang, L Da Costa, CA Holmstedt, AS Turk, R Navarro, E Jauch, S Ozark, R Turner, S Phillips, J Shankar, J Jarrett, G Gubitz, W Maloney, R Vandorpe, M Schmidt, J Heidenreich, G Hunter, M Kelly, R Whelan, L Peeling, PA Burns, A Hunter, I Wiggam, E Kerr, M Watt, A Fulton, P Gordon, I Rennie, P Flynn, G Smyth, S O'Leary, N Gentile, G Linares, P McNelis, K Erkmen, P Katz, A Azizi, M Weaver, C Jungreis, S Faro, P Shah, H Reimer, V Kalugdan, G Saposnik, A Bharatha, Y Li, P Kostyrko, T Marotta, W Montanera, D Sarma, D Selchen, J Spears, JH Heo, K Jeong, DJ Kim, BM Kim, YD Kim, D Song, K-J Lee, J Yoo, OY Bang, S Rho, J Lee, P Jeon, KH Kim, J Cha, SJ Kim, S Ryoo, MJ Lee, S-I Sohn, C-H Kim, H-G Ryu, J-H Hong, H-W Chang, C-Y Lee, J Rha, Bruce CV Campbell, Leonid Churilov, Bernard Yan, Richard Dowling, Nawaf Yassi, Thomas J Oxley, Teddy Y Wu, Gabriel Silver, Amy McDonald, Rachael McCoy, Timothy J Kleinig, Rebecca Scroop, Helen M Dewey, Marion Simpson, Mark Brooks, Bronwyn Coulton, Martin Krause, Timothy J Harrington, Brendan Steinfort, Kenneth Faulder, Miriam Priglinger, Susan Day, Thanh Phan, Winston Chong, Michael Holt, Ronil V Chandra, Henry Ma, Dennis Young, Kitty Wong, Tissa Wijeratne, Hans Tu, Elizabeth Mackay, Sherisse Celestino, Christopher F Bladin, Poh Sien Loh, Amanda Gilligan, Zofia Ross, Skye Coote, Tanya Frost, Mark W Parsons, Ferdinand Miteff, Christopher R Levi, Timothy Ang, Neil Spratt, Lara Kaauwai, Monica Badve, Henry Rice, Laetitia de Villiers, P. Alan Barber, Ben McGuinness, Ayton Hope, Maurice Moriarty, Patricia Bennett, Andrew Wong, Alan Coulthard, Andrew Lee, Jim Jannes, Deborah Field, Gagan Sharma, Simon Salinas, Elise Cowley, Barry Snow, John Kolbe, Richard Stark, John King, Richard Macdonnell, John Attia, Cate D'Este, Hans-Christoph Diener, Elad I. Levy, Alain Bonafé, Reza Jahan, Gregory W. Albers, Christophe Cognard, David J. Cohen, Werner Hacke, Tudor G. Jovin, Heinrich P. Mattle, Raul G. Nogueira, Adnan H. Siddiqui, Dileep R. Yavagal, Rüdiger von Kummer, Wade Smith, Francis Turjman, Scott Hamilton, Richard Chiacchierini, Arun Amar, Nerses Sanossian, Yince Loh, B Baxter, VK Reddy, A Horev, M Star, A Siddiqui, LN Hopkins, K Snyder, R Sawyer, S Hall, V Costalat, C Riquelme, P Machi, E Omer, C Arquizan, I Mourand, M Charif, X Ayrignac, N Menjot de Champfleur, N Leboucq, G Gascou, M Moynier, R du Mesnil de Rochemont, O Singer, J Berkefeld, C Foerch, M Lorenz, W Pfeilschifer, E Hattingen, M Wagner, SJ You, S Lescher, H Braun, S Dehkharghani, SR Belagaje, A Anderson, A Lima, M Obideen, D Haussen, R Dharia, M Frankel, V Patel, K Owada, A Saad, L Amerson, C Horn, S Doppelheuer, K Schindler, DK Lopes, M Chen, R Moftakhar, C Anton, M Smreczak, JS Carpenter, S Boo, A Rai, T Roberts, A Tarabishy, L Gutmann, C Brooks, J Brick, J Domico, G Reimann, K Hinrichs, M Becker, E Heiss, C Selle, A Witteler, S Al-Boutros, M-J Danch, A Ranft, S Rohde, K Burg, C Weimar, V Zegarac, C Hartmann, M Schlamann, S Göricke, A Ringlestein, I Wanke, C Mönninghoff, M Dietzold, R Budzik, T Davis, G Eubank, WJ Hicks, P Pema, N Vora, J Mejilla, M Taylor, W Clark, A Rontal, J Fields, B Peterson, G Nesbit, H Lutsep, H Bozorgchami, R Priest, O Ologuntoye, S Barnwell, A Dogan, K Herrick, C Takahasi, N Beadell, B Brown, S Jamieson, MS Hussain, A Russman, F Hui, D Wisco, K Uchino, Z Khawaja, I Katzan, G Toth, E Cheng-Ching, M Bain, S Man, A Farrag, P George, S John, L Shankar, A Drofa, R Dahlgren, A Bauer, A Itreat, A Taqui, R Cerejo, A Richmond, P Ringleb, M Bendszus, M Möhlenbruch, T Reiff, H Amiri, J Purrucker, C Herweh, M Pham, O Menn, I Ludwig, I Acosta, C Villar, W Morgan, C Sombutmai, F Hellinger, E Allen, M Bellew, R Gandhi, E Bonwit, J Aly, RD Ecker, D Seder, J Morris, M Skaletsky, J Belden, C Baker, LS Connolly, P Papanagiotou, C Roth, A Kastrup, M Politi, F Brunner, M Alexandrou, H Merdivan, C Ramsey, C Given II, S Renfrow, V Deshmukh, K Sasadeusz, F Vincent, JT Thiesing, J Putnam, A Bhatt, A Kansara, D Caceves, T Lowenkopf, L Yanase, J Zurasky, S Dancer, B Freeman, T Scheibe-Mirek, J Robison, J Roll, D Clark, M Rodriguez, B-FM Fitzsimmons, O Zaidat, JR Lynch, M Lazzaro, T Larson, L Padmore, E Das, A Farrow-Schmidt, A Hassan, W Tekle, C Cate, O Jansen, C Cnyrim, F Wodarg, C Wiese, A Binder, C Riedel, A Rohr, N Lang, H Laufs, S Krieter, L Remonda, M Diepers, J Añon, K Nedeltchev, T Kahles, S Biethahn, M Lindner, V Chang, C Gächter, C Esperon, M Guglielmetti, JF Arenillas Lara, M Martínez Galdámez, AI Calleja Sanz, E Cortijo Garcia, P Garcia Bermejo, S Perez, P Mulero Carrillo, E Crespo Vallejo, M Ruiz Piñero, L Lopez Mesonero, FJ Reyes Muñoz, C Brekenfeld, J-H Buhk, A Krützelmann, G Thomalla, B Cheng, C Beck, J Hoppe, E Goebell, B Holst, U Grzyska, G Wortmann, S Starkman, G Duckwiler, R Jahan, N Rao, S Sheth, K Ng, A Noorian, V Szeder, M Nour, M McManus, J Huang, J Tarpley, S Tateshima, N Gonzalez, L Ali, D Liebeskind, J Hinman, M Calderon-Arnulphi, C Liang, J Guzy, S Koch, K DeSousa, G Gordon-Perue, M Elhammady, E Peterson, V Pandey, S Dharmadhikari, P Khandelwal, A Malik, R Pafford, P Gonzalez, K Ramdas, G Andersen, D Damgaard, P Von Weitzel-Mudersbach, C Simonsen, N Ruiz de Morales Ayudarte, M Poulsen, L Sørensen, S Karabegovich, M Hjørringgaard, N Hjort, T Harbo, K Sørensen, E Deshaies, D Padalino, A Swarnkar, JG Latorre, E Elnour, Z El-Zammar, M Villwock, H Farid, A Balgude, L Cross, K Hansen, M Holtmannspötter, D Kondziella, J Hoejgaard, S Taudorf, H Soendergaard, A Wagner, M Cronquist, T Stavngaard, M Cortsen, LH Krarup, T Hyldal, H-P Haring, S Guggenberger, M Hamberger, J Trenkler, M Sonnberger, K Nussbaumer, C Dominger, E Bach, BD Jagadeesan, R Taylor, J Kim, K Shea, R Tummala, H Zacharatos, D Sandhu, M Ezzeddine, A Grande, D Hildebrandt, K Miller, J Scherber, A Hendrickson, M Jumaa, S Zaidi, T Hendrickson, V Snyder, M Killer-Oberpfalzer, J Mutzenbach, F Weymayr, E Broussalis, K Stadler, A Jedlitschka, A Malek, N Mueller-Kronast, P Beck, C Martin, D Summers, J Day, I Bettinger, W Holloway, K Olds, S Arkin, N Akhtar, C Boutwell, S Crandall, M Schwartzman, C Weinstein, B Brion, S Prothmann, J Kleine, K Kreiser, T Boeckh-Behrens, H Poppert, S Wunderlich, ML Koch, V Biberacher, A Huberle, G Gora-Stahlberg, B Knier, T Meindl, D Utpadel-Fischler, M Zech, M Kowarik, C Seifert, B Schwaiger, A Puri, S Hou, A Wakhloo, M Moonis, N Henninger, R Goddeau, F Massari, A Minaeian, JD Lozano, M Ramzan, C Stout, A Patel, A Tunguturi, S Onteddu, R Carandang, M Howk, M Ribó, E Sanjuan, M Rubiera, J Pagola, A Flores, M Muchada, P Meler, E Huerga, S Gelabert, P Coscojuela, A Tomasello, D Rodriguez, E Santamarina, O Maisterra, S Boned, L Seró, A Rovira, CA Molina, M Millán, L Muñoz, N Pérez de la Ossa, M Gomis, L Dorado, E López-Cancio, E Palomeras, J Munuera, P García Bermejo, S Remollo, C Castaño, R García-Sort, P Cuadras, P Puyalto, M Hernández-Pérez, M Jiménez, A Martínez-Piñeiro, G Lucente, A Dávalos, A Chamorro, X Urra, V Obach, A Cervera, S Amaro, L Llull, J Codas, M Balasa, J Navarro, H Ariño, A Aceituno, S Rudilosso, A Renu, JM Macho, L San Roman, J Blasco, A López, N Macías, P Cardona, H Quesada, F Rubio, L Cano, B Lara, MA de Miquel, L Aja, J Serena, E Cobo, Gregory W Albers, Kennedy R Lees, J Arenillas, R Roberts, F Al-Ajlan, L Zimmel, S Patel, J Martí-Fàbregas, M Salvat-Plana, S Bracard, René Anxionnat, Pierre-Alexandre Baillot, Charlotte Barbier, Anne-Laure Derelle, Jean-Christophe Lacour, Sébastien Richard, Yves Samson, Nader Sourour, Flore Baronnet-Chauvet, Frédéric Clarencon, Sophie Crozier, Sandrine Deltour, Federico Di Maria, Raphael Le Bouc, Anne Leger, Gurkan Mutlu, Charlotte Rosso, Zoltan Szatmary, Marion Yger, Chiara Zavanone, Serge Bakchine, Laurent Pierot, Nathalie Caucheteux, Laurent Estrade, Krzysztof Kadziolka, Alexandre Leautaud, Céline Renkes, Isabelle Serre, Hubert Desal, Benoît Guillon, Claire Boutoleau-Bretonniere, Benjamin Daumas-Duport, Solène De Gaalon, Pascal Derkinderen, Sarah Evain, Fanny Herisson, David-Axel Laplaud, Thibaud Lebouvier, Alina Lintia-Gaultier, Hélène Pouclet-Courtemanche, Tiphaine Rouaud, Violaine Rouaud Jaffrenou, Aurélia Schunck, Mathieu Sevin-Allouet, Frederique Toulgoat, Sandrine Wiertlewski, Jean-Yves Gauvrit, Thomas Ronziere, Vincent Cahagne, Jean-Christophe Ferre, Jean-François Pinel, Hélène Raoult, Jean-Louis Mas, Jean-François Meder, Amen-Adam Al Najjar-Carpentier, Julia Birchenall, Eric Bodiguel, David Calvet, Valérie Domigo, Sylvie Godon-Hardy, Vincent Guiraud, Catherine Lamy, Loubna Majhadi, Ludovic Morin, Denis Trystram, Guillaume Turc, Jérôme Berge, Igor Sibon, Patrice Menegon, Xavier Barreau, François Rouanet, Sabrina Debruxelles, Annabelle Kazadi, Pauline Renou, Olivier Fleury, Anne Pasco-Papon, Frédéric Dubas, Jildaz Caroff, Sophie Godard Ducceschi, Marie-Aurélie Hamon, Alderic Lecluse, Guillaume Marc, Maurice Giroud, Frédéric Ricolfi, Yannick Bejot, Adrien Chavent, Arnaud Gentil, Apolline Kazemi, Guy-Victor Osseby, Charlotte Voguet, Marie-Hélène Mahagne, Jacques Sedat, Yves Chau, Laurent Suissa, Sylvain Lachaud, Emmanuel Houdart, Christian Stapf, Frédérique Buffon Porcher, Hugues Chabriat, Pierre Guedin, Dominique Herve, Eric Jouvent, Jérôme Mawet, Jean-Pierre Saint-Maurice, Hans-Martin Schneble, Norbert Nighoghossian, Nadia-Nawel Berhoune, Françoise Bouhour, Tae-Hee Cho, Laurent Derex, Sandra Felix, Hélène Gervais-Bernard, Benjamin Gory, Luis Manera, Laura Mechtouff, Thomas Ritzenthaler, Roberto Riva, Fabrizio Salaris Silvio, Caroline Tilikete, Raphael Blanc, Michaël Obadia, Mario Bruno Bartolini, Antoine Gueguen, Michel Piotin, Silvia Pistocchi, Hocine Redjem, Jacques Drouineau, Jean-Philippe Neau, Gaelle Godeneche, Matthias Lamy, Emilia Marsac, Stephane Velasco, Pierre Clavelou, Emmanuel Chabert, Nathalie Bourgois, Catherine Cornut-Chauvinc, Anna Ferrier, Jean Gabrillargues, Betty Jean, Anna-Raquel Marques, Nicolas Vitello, Olivier Detante, Marianne Barbieux, Kamel Boubagra, Isabelle Favre Wiki, Katia Garambois, Florence Tahon, Vasdev Ashok, Oguzhan Coskun, Georges Rodesch, Bertrand Lapergue, Frédéric Bourdain, Serge Evrard, Philippe Graveleau, Jean Pierre Decroix, Adrien Wang, François Sellal, Guido Ahle, Gabriela Carelli, Marie-Hélène Dugay, Claude Gaultier, Ariel Pablo Lebedinsky, Lavinia Lita, Raul Mariano Musacchio, Catherine Renglewicz-Destuynder, Alain Tournade, Françis Vuillemet, Francisco Macian Montoro, Charbel Mounayer, Frederic Faugeras, Laetitia Gimenez, Catherine Labach, Géraldine Lautrette, Christian Denier, Guillaume Saliou, Olivier Chassin, Claire Dussaule, Elsa Melki, Augustin Ozanne, Francesco Puccinelli, Marina Sachet, Mariana Sarov, Jean-François Bonneville, Thierry Moulin, Alessandra Biondi, Elisabeth De Bustos Medeiros, Fabrice Vuillier, Patrick Courtheoux, Fausto Viader, Marion Apoil-Brissard, Mathieu Bataille, Anne-Laure Bonnet, Julien Cogez, Emmanuel Touze, Xavier Leclerc, Didier Leys, Mohamed Aggour, Pierre Aguettaz, Marie Bodenant, Charlotte Cordonnier, Dominique Deplanque, Marie Girot, Hilde Henon, Erwah Kalsoum, Christian Lucas, Jean-Pierre Pruvo, Paolo Zuniga, Caroline Arquizan, Vincent Costalat, Paolo Machi, Isabelle Mourand, Carlos Riquelme, Pierre Bounolleau, Charles Arteaga, Anthony Faivre, Marc Bintner, Patrice Tournebize, Cyril Charlin, Françoise Darcel, Pascale Gauthier-Lasalarie, Marcia Jeremenko, Servane Mouton, Jean-Baptiste Zerlauth, Chantal Lamy, Deramond Hervé, Hosseini Hassan, André Gaston, Francis-Guy Barral, Pierre Garnier, Rémy Beaujeux, Valérie Wolff, Denis Herbreteau, Séverine Debiais, Alicia Murray, Gary Ford, Martin M Brown, Andy Clifton, Janet Freeman, Ian Ford, Hugh Markus, Joanna Wardlaw, Andy Molyneux, Thompson Robinson, Steff Lewis, John Norrie, Fergus Robertson, Richard Perry, Geoffrey Cloud, Andrew Clifton, Jeremy Madigan, Christine Roffe, Sanjeev Nayak, Kyriakos Lobotesis, Craig Smith, Amit Herwadkar, Naga Kandasamy, Tony Goddard, John Bamford, Ganesh Subramanian, Rob Lenthall, Edward Littleton, Sal Lamin, Kelley Storey, Rita Ghatala, Azra Banaras, John Aeron-Thomas, Bath Hazel, Holly Maguire, Emelda Veraque, Louise Harrison, Rekha Keshvara, James Cunningham, University of Melbourne, University of Calgary, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), University of Amsterdam [Amsterdam] (UvA), Universitat Autònoma de Barcelona (UAB), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, Neurology, Graduate School, Other Research, APH - Personalized Medicine, APH - Quality of Care, Biomedical Engineering and Physics, ARD - Amsterdam Reproduction and Development, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, ACS - Pulmonary hypertension & thrombosis, Radiology & Nuclear Medicine, Public Health, Weimar, Christian (Beitragende*r), Molecular cell biology and Immunology, Pathology, Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, Rheumatology, Beeldvorming, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: CARIM - R3.11 - Imaging, MUMC+: DA BV Medisch Specialisten Radiologie (9), Klinische Neurowetenschappen, and MUMC+: MA Neurologie (3)
Subjects: Male, medicine.medical_specialty, Sedation, Medizin, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, Anesthesia, General, CONTROLLED-TRIAL, THERAPY, law.invention, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, All institutes and research themes of the Radboud University Medical Center, Randomized controlled trial, law, Modified Rankin Scale, Journal Article, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Medicine, Humans, General anaesthesia, Stroke, Aged, Randomized Controlled Trials as Topic, Thrombectomy, Aged, 80 and over, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Odds ratio, MR, Middle Aged, Outcome and Process Assessment (Health Care), medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], 3. Good health, Surgery, Outcome and Process Assessment, Health Care, Meta-analysis, Observational study, Female, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Meta-Analysis
Abstract: BACKGROUND: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care.METHODS: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered.FINDINGS: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09-2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75-3·10, pINTERPRETATION: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons.FUNDING: Medtronic.
Published: 2018
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12. Hypoglossal Nerve Palsy Due to Internal Carotid Artery Dissection

Author: Amit Herwadkar, Martin Punter, Vinodh Devakumar, and William Allingham
Subjects: Hypoglossal Nerve Palsy, Internal carotid artery dissection, medicine.medical_specialty, business.industry, Images in Clinical Neurology, 030204 cardiovascular system & hematology, medicine.disease, Surgery, 03 medical and health sciences, 0302 clinical medicine, medicine, Neurology (clinical), business, Stroke, 030217 neurology & neurosurgery
Published: 2017

13. A Confirmed Case in the United Kingdom of Hirayama Disease in a Young White Male Presenting with Hand Weakness

Author: John Leach, Daniel Lewis, Amit Herwadkar, and Ankur Saxena
Subjects: Male, Pediatrics, medicine.medical_specialty, Adolescent, Treatment outcome, White male, Disease, Spinal Muscular Atrophies of Childhood, Hand weakness, White People, 030218 nuclear medicine & medical imaging, Diagnosis, Differential, 03 medical and health sciences, Myelopathy, 0302 clinical medicine, medicine, Humans, Muscle Weakness, medicine.diagnostic_test, business.industry, Disease progression, Magnetic resonance imaging, medicine.disease, Hand, United Kingdom, Physical therapy, Surgery, Cervical collar, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: Background We present the first reported case of Hirayama disease in the United Kingdom. A literature review of Hirayama disease in the Western literature shows that this case is unique in being the first in the United Kingdom, constituting one of only a few cases in Europe with supporting magnetic resonance imaging and reported treatment outcome. Case Description Our patient was a young Caucasian male who presented with progressive bilateral hand weakness, had confirmatory magnetic resonance imaging findings of Hirayama disease, and experienced improvement of symptoms with cervical collar immobilization. Conclusions This case lends further evidence to the flexion-induced myelopathy theory of Hirayama disease and supports the findings of other studies in which avoidance of neck flexion and cervical immobilization helped to attenuate disease progression in this patient group.
Published: 2017

14. 019 A rare cause of oculomotor nerve palsy

Author: Amit Herwadkar, David McKee, Chris Kobylecki, Andrew Jones, and Toby Williams
Subjects: Diplopia, medicine.medical_specialty, Neck pain, Palsy, Photophobia, business.industry, medicine.disease, Psychiatry and Mental health, Aneurysm, medicine, Surgery, Neurology (clinical), Radiology, medicine.symptom, Oculomotor nerve palsy, Complication, Vasculitis, business
Abstract: IntroductionBehçet’s disease is a multisystem inflammatory disease of unknown aetiology characterised by oral and genital ulceration, vascular lesions, and ocular, cutaneous and neurological manifestations. Many disease features are due to vasculitis and it is particular for its involvement of all sizes of blood vessels on both sides of the circulation.Case reportWe present a report of a 43-year-old female with a background of severe neurological complications of Behçet’s disease (previous rhombencephalitis) presenting with left-sided headache, neck pain, photophobia, diplopia, nausea and vomiting. Complete left third nerve palsy developed during admission. MR brain imaging excluded acute parenchymal disease but was suggestive of a left posterior communicating artery aneurysm, confirmed on CT angiogram. Urgent catheter angiography demonstrated a 5×3 mm left anterior choroidal artery aneurysm, which was occluded by coiling. Two months later, left oculomotor nerve palsy had resolved and follow-up imaging at six months showed stable appearances.DiscussionIntracranial aneurysms are a rare but potentially life-threatening complication of Behçet’s disease. Intracranial aneurysms are potentially treatable and should be considered in Behçet’s patients presenting with intracranial pathology.
Published: 2019
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15. Sonothrombolysis in acute large vessel ischemic stroke

Author: Amit, Herwadkar
Subjects: Stroke, Ultrasonic Waves, Mechanical Thrombolysis, Humans, Arterial Occlusive Diseases, Cerebral Arterial Diseases, Brain Ischemia
Published: 2017

16. Traumatic clival subdural hematoma in an adult

Author: Paul Leach, Bedansh Roy Chaudhary, Konstantina Karabatsou, Amit Herwadkar, and David Casey
Subjects: medicine.medical_specialty, Nausea, business.industry, Head injury, Rare entity, Context (language use), Adult case, medicine.disease, Surgery, body regions, Hematoma, medicine, Headaches, medicine.symptom, business, Pediatric population
Abstract: Retroclival hematomas are a rare entity. They are usually associated with significant trauma, and patients frequently have focal neurological deficits, especially cranial nerve palsies. Previous case reports of epidural clival hematomas have been described almost exclusively in the pediatric population. The authors report a unique case of traumatic clival subdural hematoma, which has never been described in an adult except in the context of hemophilia. An 18-year-old man presented with continuing nausea and headaches following a seemingly trivial head injury. He was found to have a posterior fossa retroclival hematoma extending into the spinal subdural space but without any neurological deficits. He was treated conservatively, with a good outcome. The authors discuss the possible mechanisms of injury, management, and complications related to this rare condition, and they review the pertinent literature.
Published: 2009
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17. Dumbbell ganglioneuroma mimicking lumbar neurofibroma: a case report and review of the literature

Author: Nikolaos Tzerakis, I. Ibrahim, D. G. Du Plessis, O. Sobowale, and Amit Herwadkar
Subjects: medicine.medical_specialty, Treatment outcome, Diagnosis, Differential, Lumbar, medicine, Humans, Neurofibroma, In patient, Spinal Cord Neoplasms, Ganglioneuroma, Lumbar Vertebrae, business.industry, General Medicine, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Surgery, Treatment Outcome, Female, Lumbar spine, Neurology (clinical), Radiology, Dumbbell, Differential diagnosis, business
Abstract: Spinal ganglioneuromas may grow in a dumbbell fashion. We report the first case of an intradural, extramedullary ganglioneuroma in the lumbar spine and review the pertinent literature. Although rare, we propose that ganglioneuroma be considered a differential diagnosis in patients presenting with a large mass occupying both intraspinal and extraspinal compartments.
Published: 2013
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18. Use of intraoperative Doppler ultrasound with neuronavigation to guide arteriovenous malformation resection: a pediatric case series

Author: Zsolt Zador, James S Walkden, Amit Herwadkar, and Ian Kamaly-Asl
Subjects: Intracranial Arteriovenous Malformations, Male, medicine.medical_specialty, Neuronavigation, Adolescent, medicine.medical_treatment, Neurosurgical Procedures, Resection, Monitoring, Intraoperative, medicine, Humans, Ultrasonography, Doppler, Color, Child, Craniotomy, Microscopy, medicine.diagnostic_test, business.industry, Infant, Arteriovenous malformation, General Medicine, medicine.disease, Embolization, Therapeutic, Surgery, Cerebral Angiography, Child, Preschool, Angiography, Female, Doppler ultrasound, Radiology, Ultrasonography, business, Vascular Surgical Procedures, Pediatric population
Abstract: OBJECT Over the last 20 years, several intraoperative adjuncts, including ultrasonography, neuronavigation, and angiography, have been said to aid the intraoperative localization and resection of cerebral arteriovenous malformations (AVMs). The authors assessed the value of intraoperative Doppler ultrasonography in conjunction with neuronavigation during surgery for cerebral AVMs in the pediatric population. METHODS The authors reviewed all cranial AVM resections performed by a single surgeon at their institution in the period from 2007 to 2013 and here describe their experience and results in a series of 20 consecutive AVM resections in 19 pediatric patients. Intraoperative Doppler ultrasonography had been used in conjunction with preoperative CT or neuronavigational MRI. Preoperative and postoperative clinical findings, patient age, and Spetzler-Martin AVM grade were identified in all patients. RESULTS All patients, whose ages ranged from 2 to 16 years, underwent craniotomy and excision of an AVM, which was supratentorial in 18 cases and infratentorial in 2. Patients in 11 cases underwent preoperative embolization, and all other patients underwent cerebral angiography prior to surgery, except for 2 patients who were urgently surgically treated because of low Glasgow Coma Scale scores and associated hematoma. Spetzler-Martin Grades I (3 cases), II (6), III (7), and IV (4) AVMs were represented in this series. Intraoperative Doppler ultrasound provided high-quality images in all cases and demonstrated the location, size, and flow characteristics of the AVM and any associated hematoma. Delayed postoperative cerebral angiography demonstrated successful AVM resection in all cases. An assessment of clinical outcomes revealed no new long-term neurological deficits at 3 months postoperatively. CONCLUSIONS Intraoperative Doppler ultrasonography is a reliable and useful tool for intraoperative localization and guidance for AVM resection in the pediatric population. When used in conjunction with neuronavigation equipment and modern microscopes, this technique has shown a very high complete resection rate with extremely low associated morbidity.
Published: 2014

19. Visual field deficit due to downward displacement of optic chiasm

Author: Paul Leach, Kanna K. Gnanalingham, Amit Herwadkar, and Daniel Holsgrove
Subjects: Adult, Ventriculostomy, genetic structures, medicine.medical_treatment, Vision, Low, Optic chiasm, medicine, Humans, Foramen Magnum, Encephalocele, Third Ventricle, Chiari malformation, Third ventricle, business.industry, Endoscopic third ventriculostomy, Anatomy, Decompression, Surgical, medicine.disease, Magnetic Resonance Imaging, eye diseases, Arnold-Chiari Malformation, Hydrocephalus, Visual field, Treatment Outcome, medicine.anatomical_structure, Optic Chiasm, Visual Disturbance, Female, Surgery, sense organs, Neurology (clinical), Visual Fields, business, Craniotomy
Abstract: Visual disturbance in hydrocephalus is typically due to raised intracranial pressure. We describe a patient who presented with marked loss of peripheral visual fields, but without features suggestive of raised intracranial pressure. MR scan showed an enlarged third ventricle and a downward displacement of the optic chiasm, Chiari II malformation. These radiological changes and the visual field deficits reversed after endoscopic third ventriculostomy and foramen magnum decompression. These observations support the view that the treatment of the hydrocephalus in such patients can help to reverse the change in the position of the optic chiasm and the visual field deficits.
Published: 2009
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20. Double origin of the posterior inferior cerebellar artery with findings on conventional and CT angiography

Author: Amit Herwadkar, Andrew A. Plumb, and Roger Laitt
Subjects: Cerebellum, medicine.medical_specialty, Pathology and Forensic Medicine, Aneurysm, medicine.artery, Female patient, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Pica (disorder), medicine.diagnostic_test, business.industry, Intracranial Aneurysm, Middle Aged, medicine.disease, Cerebral Angiography, Posterior inferior cerebellar artery, medicine.anatomical_structure, Angiography, Female, Surgery, Radiology, Anatomy, medicine.symptom, Tomography, X-Ray Computed, business, Cerebellar artery, Cerebral angiography
Abstract: A case of double origin of the posterior inferior cerebellar artery (PICA) is presented, with appearances on both cross-sectional imaging and conventional angiography. An associated aneurysm was found, strengthening the belief that this variation is associated with intracranial aneurysms. Furthermore, this is the first report of a right-sided double-origin PICA in a female patient, which calls into question the previously proposed male and left-sided preponderance of this variation.
Published: 2008
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21. A case of a spontaneous intraorbital arteriovenous fistula: clinico-radiological findings and treatment by transvenous embolisation via the superior ophthalmic vein

Author: Brian Leatherbarrow, Amit Herwadkar, Roger Laitt, and Jawad Naqvi
Subjects: Male, Central retinal artery, medicine.medical_specialty, Catheterization, Central Venous, genetic structures, Exophthalmos, Arteriovenous fistula, Eye, Radiography, Interventional, Veins, Ophthalmic Artery, medicine.artery, Occlusion, medicine, Orbital Diseases, Humans, Aged, medicine.diagnostic_test, business.industry, Vascular malformation, medicine.disease, Embolization, Therapeutic, Surgery, Cerebral Angiography, Ophthalmology, Ophthalmic artery, Arteriovenous Fistula, Radiology, medicine.symptom, business, Superior ophthalmic vein, Cerebral angiography
Abstract: A 72-year-old male presented with progressive right axial proptosis and red eye. Catheter angiography demonstrated an intraorbital arteriovenous fistula (IAVF) distal to the central retinal artery (CRA). Transvenous embolisation following direct surgical exposure of the superior ophthalmic vein (SOV) resulted in rapid resolution of his symptoms and signs. Transvenous embolisation via the SOV is a safe, effective alternative to transarterial embolisation for treating spontaneous IAVF where transarterial embolisation poses a risk of CRA occlusion.
Published: 2013

22. Outcome of Aneurysmal Subarachnoid Haemorrhage in the Elderly: Retrospective Study of a Contemporary Cohort Treated in a Regional Neuroscience Centre

Author: Jeremy Holl, Hiren C. Patel, K.H. Carlos Chung, Amit Herwadkar, and Louise Dulhanty
Subjects: education.field_of_study, Pediatrics, medicine.medical_specialty, business.industry, health care facilities, manpower, and services, Incidence (epidemiology), Population, Retrospective cohort study, social sciences, medicine.disease, humanities, nervous system diseases, Surgery, Aneurysm, Cohort, Medicine, Subarachnoid haemorrhage, cardiovascular diseases, business, education, Developed country, Healthcare system
Abstract: Outcome of Aneurysmal Subarachnoid Haemorrhage in the Elderly: Retrospective Study of a Contemporary Cohort Treated in a Regional Neuroscience Centre The incidence of subarachnoid haemorrhage (SAH) increases with age, and together with the elderly constituting a significant and growing proportion of the population in developed countries, this poses unique challenges to the healthcare system. Treatment of SAH in the elderly is traditionally underrepresented due to pessimism toward its outcome. With recent advances in management techniques, it has been suggested that elderly patients with SAH may benefit from treatment.
Published: 2013
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23. SPINAL CORD INFARCTION DUE TO NEUROFIBROMATOSIS TYPE 1 ASSOCIATED VASCULOPATHY

Author: John Ealing, Amit Herwadkar, Christopher Murphy, and Tim Lavin
Subjects: medicine.medical_specialty, Henoch-Schonlein purpura, medicine.diagnostic_test, business.industry, medicine.disease, Asymptomatic, Nephropathy, Psychiatry and Mental health, Dysplasia, Angiography, medicine, Back pain, Surgery, Neurology (clinical), Radiology, medicine.symptom, Neurofibromatosis, business, Paraplegia
Abstract: We report a 28 yr old woman presented with acute onset lower limb weakness, urinary retention and back pain. She has a history of neurofibromatosis type 1, epilepsy, Henoch Schonlein purpura, IgA nephropathy and hypertension. Examination revealed lower limb paraplegia, lower limb areflexia, patchy loss of pain and temperature to knees and preserved proprioception. MR imaging confirmed a T10 spinal cord infarction. CT angiography confirmed stenotic and aneurysmal changes affecting aorta, renal and infrarenal vessels. Similar changes were seen on CT angiography in 2010, when she was investigated for IgA Nephropathy. The changes are consistent with the changes seen in vascular dysplasia associated with NF1. Cerebrovascular dysplasia is reported in NF1. Incidence is between 2–5%.1 Dysplastic vascular abnormalities affecting other vessels, including aorta, renal, infrarenal and mesenteric is recognised.2 Most are asymptomatic, and more common in the paediatric population. To our knowledge spinal cord infarction due to NF1 vascular dysplasia has not been reported.
Published: 2016
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24. Rate and clinical impact of intra-procedural complications during coil embolisation of ruptured small (3 mm or less) cerebral aneurysms

Author: Roger Laitt, Hiren C. Patel, K.H. Carlos Chung, and Amit Herwadkar
Subjects: Adult, Male, Risk, medicine.medical_specialty, Databases, Factual, Glasgow Outcome Scale, Aneurysm, Ruptured, Retrospective analysis, Medicine, Humans, Vasospasm, Intracranial, Prospective Studies, Prospective cohort study, Coil embolization, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Retrospective cohort study, Magnetic resonance imaging, Intracranial Aneurysm, General Medicine, Middle Aged, Embolization, Therapeutic, Magnetic Resonance Imaging, Surgery, Cerebral Angiography, Treatment Outcome, Subarachnoid haemorrhage, Female, Neurology (clinical), Radiology, Nervous System Diseases, business, Tomography, X-Ray Computed, Cerebral angiography
Abstract: Objective Coiling of small (≤3 mm) cerebral aneurysms can be technically challenging and is associated with increased procedural-related morbidity and mortality. The authors report the clinical and radiological results following coiling of ruptured small cerebral aneurysms in a single-institution, and define the rates of intra-procedural rupture and thromboembolism. Methods A retrospective analysis was conducted on consecutive patients from 01/01/2008 to 31/12/2010 with subarachnoid haemorrhage (SAH) from ruptured cerebral aneurysms (≤3 mm) managed in a tertiary neurosurgical institution in the United Kingdom. Results Of the 108 patients identified, 72 patients (66.7%) underwent coil embolisation. A favourable outcome, defined as a Glasgow outcome score of 4–5, was achieved in 63 (87.5%) of these patients. Intra-procedural complications were observed in 11.1% (±7.3% 95% CI) of cases, wherein the rate of intra-procedural rupture was determined to be 8.3% (±6.4% 95% CI) and intra-procedural thromboembolism to be 2.8% (±3.8% 95% CI). Conclusion Although coil embolisation of small ruptured cerebral aneurysms is technically feasible and an efficacious means of treatment, it is associated with an increased rate of intra-procedural complications. This should be taken into account when embarking upon treatment of patients with ruptured small cerebral aneurysms.
Published: 2012

25. Factors Influencing Decision-making and Outcome in the Surgical Management of Trigeminal Neuralgia

Author: Amit Herwadkar, Scott A. Rutherford, Rekha Siripurapu, Andrew T. King, and Mohannad B. Ammori
Subjects: medicine.medical_specialty, Percutaneous, Multivariate analysis, genetic structures, business.industry, medicine.medical_treatment, Multiple sclerosis, Microvascular decompression, medicine.disease, Neurovascular bundle, Article, Surgery, nervous system diseases, body regions, Trigeminal neuralgia, cardiovascular system, Etiology, Medicine, Effective treatment, Neurology (clinical), business
Abstract: Objectives The aim was to optimize the algorithm of operative intervention for trigeminal neuralgia (TN). Design A multivariate analysis was undertaken to determine factors that had influenced both the initial choice of surgical intervention and the subsequent outcomes. Setting The study was undertaken with patients who underwent microvascular decompression (MVD) or percutaneous glycerol injection (PGI) for TN between 2007 and 2009. Participants Seventy-one consecutive patients (43 female) were selected. Main Outcome Measures Data were prospectively recorded and included demographics, etiology, and presentation of TN, duration of symptoms, neurovascular contact, and the outcomes of surgery. Results The response rates for MVD and PGI were 96.2% and 87.5%, respectively. The recurrence rates were 9.8% following MVD and 33.3% following PGI. Multivariate analyses confirmed multiple sclerosis and the identification of neurovascular contact as the only factors predictive of the choice of surgical intervention and the risk of recurrence following MVD. Conclusions Our approach to choosing an operative intervention has been validated. The presence of neurovascular contact and the diagnosis of multiple sclerosis influenced the choice of surgery and were predictive of subsequent outcome. Both MVD and PGI offer effective treatment options for TN. Surgery should be offered early when medical management fails.
Published: 2012

26. Minimally invasive decompression and stabilisation for extensive haemangiomas of lumbar spine

Author: M. B. Afridi, Kanna K. Gnanalingham, A. Abou-Zeid, and Amit Herwadkar
Subjects: Adult, Male, medicine.medical_specialty, Decompression, Bone Screws, Asymptomatic, Lumbar, Blood loss, medicine, Humans, Minimally Invasive Surgical Procedures, Pedicle screw fixation, Vertebroplasty, Surgical approach, Lumbar Vertebrae, Spinal Neoplasms, business.industry, General Medicine, Middle Aged, Decompression, Surgical, Surgery, Spinal Fusion, Treatment Outcome, Radiological weapon, Lumbar spine, Neurology (clinical), Radiology, medicine.symptom, business, Hemangioma
Abstract: INTRODUCTION: Vertebral haemangiomas are a common incidental finding and are largely asymptomatic. Extensive haemangiomas of the spine causing neurological deficits are exceedingly rare. Traditional open surgical approaches in these cases can be complicated by life-threatening blood loss. PATIENT CASE HISTORY: We describe 2 patients (ages 27 and 53 years) who presented with severe back pain and lower limb weakness. Radiological investigations revealed very extensive lesions of the L1 and L4 vertebral bodies, respectively, with severe narrowing of the lumbar canal. After selective embolisation of the spinal arterial feeders, both patients underwent a posterior decompression, vertebroplasty, and bilateral pedicle screw fixation in a minimally invasive fashion. Blood loss was minimal and a rapid clinical recovery was seen. CONCLUSIONS: Combinations of embolisation, vertebroplasty and minimally invasive posterolateral instrumentation are treatment strategies that can be used to treat extensive vertebral haemangiomas presenting with neurological deficits.
Published: 2011

27. Tumefactive demyelination-an unusual neurological presentation of HIV

Author: Penny Lewthwaite, Amit Herwadkar, Jeremy Holland, Ed Wilkins, Daniel du Plessis, Rachael Stow, Francois Gray, Alison Uriel, Anoop Varma, and Leann Johnson
Subjects: Microbiology (medical), Adult, Male, Pathology, medicine.medical_specialty, Human immunodeficiency virus (HIV), Brain Edema, HIV Infections, medicine.disease_cause, Pharmacotherapy, Tumefactive demyelination, medicine, Humans, Brain Diseases, medicine.diagnostic_test, business.industry, Brain biopsy, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Toxoplasmosis, Infectious Diseases, Anti-Retroviral Agents, Female, Steroids, Presentation (obstetrics), business, Brain syndromes, Demyelinating Diseases
Abstract: We describe 3 individuals infected with human immunodeficiency virus with unusual focal brain syndromes; magnetic resonance imaging revealed "open-ring" pattern space occupying lesions. After deterioration while the patients were receiving anti-Toxoplasma therapy, brain biopsy was performed, which revealed aggressive demyelination consistent with tumefactive demyelination. Treatment with high-dose steroids resulted in complete recovery in all cases.
Published: 2010

28. Pituitary adenoma and incidental superior hypophyseal aneurysm

Author: Kenny Yu, Tara Kearney, Kanna K. Gnanalingham, and Amit Herwadkar
Subjects: Carotid Artery Diseases, medicine.medical_specialty, Pituitary macroadenoma, medicine.medical_treatment, Carotid arteries, Treatment outcome, Neurosurgical Procedures, Aneurysm, Pituitary adenoma, Rare case, medicine, Humans, In patient, Pituitary Neoplasms, cardiovascular diseases, Transsphenoidal surgery, Incidental Findings, business.industry, Intracranial Aneurysm, General Medicine, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Surgery, Cerebral Angiography, Treatment Outcome, cardiovascular system, Female, Neurology (clinical), business, Carotid Artery, Internal
Abstract: In patients with pituitary adenomas, intra-cranial aneurysms can be an incidental finding, and are usually located outside the pituitary region. The authors describe the multi-modal management of a rare case of an aneurysm of the supraclinoid carotid that encroached into a pituitary macroadenoma.
Published: 2010

29. Thorotrast-induced primary cerebral angiosarcoma: case report

Author: Gopalakrishnan Balamurali, Amit Herwadkar, Nicholas D. Bryan, Daniel du Plessis, Peter L Richardson, and Moses Wengoy
Subjects: Male, Pathology, medicine.medical_specialty, Hemangiosarcoma, chemistry.chemical_compound, medicine, Humans, Angiosarcoma, Abscess, Thorotrast, Brain abscess, Aged, Cerebral Cortex, medicine.diagnostic_test, business.industry, Brain Neoplasms, Primary Angiosarcoma, medicine.disease, Cerebral Angiography, Contrast medium, chemistry, Carcinogens, Surgery, Thorium Dioxide, Neurology (clinical), business, Tomography, X-Ray Computed, Cerebral angiography
Abstract: Objective Thorotrast was used as a contrast medium in clinical practice until the 1960s for outlining cerebral abscess cavities and ventricular cavities, and for angiography. Gliosarcomas, meningiomas, and schwannomas have been reported previously, as has Thorotrast-associated angiosarcoma, typically in the liver. A unique case of a primary intracerebral well-differentiated angiosarcoma in a 68-year-old man with a history of colocalized exposure to Thorotrast is described. This may be the first case of a primary angiosarcoma in the brain. Clinical presentation The patient presented with a progressive left-sided weakness 62 years after initial surgery for a right parietal cerebral abscess, which included the instillation of Thorotrast into the abscess cavity. Computed tomography showed a right parietal tumor. Intervention An explorative craniotomy showed an intrinsic, infiltrating, very vascular tumor with surrounding calcification. The tumor appeared to arise from a benign cavernous vasoformative lesion intimately associated with a Thorotrast-type granuloma. The patient declined further surgery or radiotherapy. Conclusion The histology, confirmation of radioactivity of the material obtained from within the tumor, and latency period of presentation provide compelling support for tumor induction by the Thorotrast. Primary lesions of the central nervous system associated with Thorotrast are very rarely reported, despite its extensive use in cerebral angiography and management of brain abscess between 1930 and 1960.
Published: 2009

30. The expanding role of interventional radiology in head and neck surgery

Author: Amit Herwadkar, Andrew Birzgalis, Stephen J. Broomfield, and Iain A. Bruce
Subjects: medicine.medical_specialty, medicine.medical_treatment, Hemorrhage, Review, Radiology, Interventional, medicine, Humans, Embolization, Vascular Diseases, medicine.diagnostic_test, Vascular disease, business.industry, Head and neck cancer, Angiography, Interventional radiology, General Medicine, medicine.disease, Gastrostomy, Embolization, Therapeutic, Epistaxis, Surgical instrument, Neurosurgery, Radiology, business, Carotid Artery Injuries, Head, Neck
Abstract: Interventional radiology is defined by the Society of Interventional Radiology as ‘the delivery of minimally invasive, targeted treatments, performed using imaging for guidance’. Although the principles of angiography for diagnosis have existed since the 1920s, and today remain a well-established modality for the diagnosis of many common conditions, it was not until the 1960s that the American Charles Dotter, and other pioneers, extended these techniques from diagnosis to treatment.1 Their foresight, together with ever-increasing technological capability, allowed the use of transluminal angioplasty for the treatment of peripheral vascular disease and led Dotter to say, in 1964, that ‘it should be evident that the vascular catheter can be more than a tool for passive means for diagnostic observations: used with imagination it can become an important surgical instrument’.2,3 Thus, interventional radiology as a specialty was born. Work on the cerebral vasculature began in the 1970s, largely for neurosurgical conditions. It is perhaps not surprising that the initial, and still best known, uses of interventional radiology were for the highly accessible vascular system, and for the type of non-vascular conditions that offered poor surgical access, such as in neurosurgery. More recently, interventional radiology techniques have been applied to head and neck cancer patients, initially with the use of detachable balloon occlusion in patients with laryngeal cancer and impending carotid artery rupture. From this, the range of applications of interventional radiology in the extra-cranial head and neck has continued to evolve and expand. These applications include line placement, foreign body removal, placement of feeding tubes (primary gastrostomy, gastrojejunostomy or jejunostomy tubes), and oesophageal or bronchial dilatation and stenting. The main focus of this review is on the vascular applications of interventional radiology in the head and neck, which can be divided into three main categories: management of acute haemorrhage (e.g. epistaxis, carotid blowout); management of vascular lesions (e.g. tumours, arterio-venous malformations); and venous sampling.
Published: 2009

31. Incidental finding of fenestration of the supraclinoid internal carotid artery with appearances on magnetic resonance angiography

Author: Andrew A. Plumb, Gwynedd E. Pickett, and Amit Herwadkar
Subjects: medicine.medical_specialty, Carotid arteries, Magnetic resonance angiography, Pathology and Forensic Medicine, Aneurysm, medicine.artery, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Incidental Findings, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Angiography, cardiovascular system, Rare Lesion, Surgery, Female, Radiology, Anatomy, Internal carotid artery, business, Fenestration, Carotid Artery, Internal, Magnetic Resonance Angiography
Abstract: A case of incidentally diagnosed fenestration of the supraclinoid internal carotid artery (ICA) with an associated aneurysm is presented. We present appearances on magnetic resonance angiography, which have not been previously described. Careful interrogation of the data in volume-rendered and multiplanar reformats was required to make the diagnosis. The relationship between fenestrations and aneurysms in the anterior circulation is discussed both in general terms and with specific regard to the supraclinoid ICA. We also review the embryology of the distal ICA, which may help explain the adult anatomy of this rare lesion as a failure of caudal separation of the rostral and caudal divisions of the primitive distal ICA.
Published: 2009

32. Traumatic clival subdural hematoma in an adult

Author: David, Casey, Bedansh Roy, Chaudhary, Paul A, Leach, Amit, Herwadkar, and Konstantina, Karabatsou
Subjects: Male, Adolescent, Cranial Fossa, Posterior, Hematoma, Subdural, Intracranial, Humans
Abstract: Retroclival hematomas are a rare entity. They are usually associated with significant trauma, and patients frequently have focal neurological deficits, especially cranial nerve palsies. Previous case reports of epidural clival hematomas have been described almost exclusively in the pediatric population. The authors report a unique case of traumatic clival subdural hematoma, which has never been described in an adult except in the context of hemophilia. An 18-year-old man presented with continuing nausea and headaches following a seemingly trivial head injury. He was found to have a posterior fossa retroclival hematoma extending into the spinal subdural space but without any neurological deficits. He was treated conservatively, with a good outcome. The authors discuss the possible mechanisms of injury, management, and complications related to this rare condition, and they review the pertinent literature.
Published: 2008

33. Pneumococcal meningitis secondary to intra-sphenoidal encephalocoele

Author: Anoop Varma, Kevin Green, Kanna K. Gnanalingham, Gillian M. Sare, and Amit Herwadkar
Subjects: Reoperation, medicine.medical_specialty, Hernia, Sphenoid Sinus, Cerebrospinal Fluid Rhinorrhea, Neurosurgical Procedures, Transsphenoidal approach, Rare case, Sphenoid Bone, medicine, Humans, Treatment Failure, Neuroradiology, Encephalocele, medicine.diagnostic_test, business.industry, Meningitis, Pneumococcal, Interventional radiology, Endoscopy, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Temporal Lobe, Surgery, Skull, medicine.anatomical_structure, Female, Neurology (clinical), Neurosurgery, Nasal Cavity, business, Tomography, X-Ray Computed, Meningitis
Abstract: Basal encephalocoeles are rare congenital abnormalities of the skull base. The authors describe a rare case of spontaneous CSF leak and meningitis secondary to an intra-sphenoidal encephalocoele. Initial endoscopic transsphenoidal repair was unsuccessful, necessitating a combined subtemporal and transsphenoidal approach to close the defect.
Published: 2008

34. Dumbbell-shaped intrathoracic-extradural haemangioma of the thoracic spine

Author: D. G. Du Plessis, Amit Herwadkar, Paul M. Doyle, Kanna K. Gnanalingham, and A. Abou-Zeid
Subjects: medicine.medical_specialty, Spinal Neoplasms, Thoracic spine, business.industry, Localized pain, General Medicine, Middle Aged, Asymptomatic, Thoracic Vertebrae, Surgery, body regions, Dumbbell shaped, Diagnosis, Differential, Treatment Outcome, Rare case, medicine, Humans, Female, Neurology (clinical), Radiology, medicine.symptom, business, Hemangioma
Abstract: Spinal haemangiomas are benign vasoproliferative lesions that are typically intra-osseous and generally asymptomatic, although localized pain can be a symptom. Capillary and cavernous variants have been described. We describe a rare case of a dumbbell-shaped haemangioma of the thoracic spine with both an intraspinal-extradural and intrathoracic component.
Published: 2008

35. Thoracic intradural extramedullary capillary haemangioma

Author: Amit Herwadkar, L. M. Alakandy, J. P. Holland, Gopalakrishnan Balamurali, H. Reid, and S. Hercules
Subjects: Male, Angiolipoma, Dura mater, Thoracic Vertebrae, Angioma, Meningioma, Paraganglioma, medicine, Meningeal Neoplasms, Humans, Hemangioma, Capillary, Hemangiopericytoma, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, General Medicine, Anatomy, Middle Aged, medicine.disease, Magnetic Resonance Imaging, medicine.anatomical_structure, Surgery, Neurology (clinical), Presentation (obstetrics), business, Spinal Cord Compression
Abstract: The authors report a rare case of thoracic intradural extramedullary capillary haemangioma, the clinical presentation of which was similar to any other intraspinal mass. Magnetic resonance imaging does not always distinguish this entity from others, but the presence of enlarged vasculature is often a useful clue. Complete resection is the treatment of choice of this hamartomatous lesion.
Published: 2006

36. Isolated Extradural Rosai-Dorfman Disease of the Thoracic Spine

Author: A. Abou-Zeid, Kanna K. Gnanalingham, Amit Herwadkar, and Daniel du Plessis
Subjects: Male, medicine.medical_specialty, Cord, medicine.medical_treatment, Bone Screws, Thoracic Vertebrae, Lesion, Young Adult, Spinal cord compression, Biopsy, medicine, Humans, Rosai–Dorfman disease, medicine.diagnostic_test, business.industry, Laminectomy, Magnetic resonance imaging, Decompression, Surgical, medicine.disease, Immunohistochemistry, Magnetic Resonance Imaging, Internal Fixators, Spine, Surgery, Histiocytosis, Connective Tissue, Paraparesis, Spastic, Neurology (clinical), Histiocytosis, Sinus, medicine.symptom, business, Spinal Cord Compression
Abstract: OBJECTIVE: Rosai-Dorfman disease is a rare benign histiocytic disease of unknown origin that arises predominantly in lymph nodes with generalized fever and malaise but can affect a variety of organs. We describe a case of isolated Rosai-Dorfman disease causing thoracic cord compression. CLINICAL PRESENTATION: A 24-year-old man presented with progressive spastic paraparesis. A magnetic resonance scan revealed an anteriorly placed extradural lesion of the T4-T7 thoracic spine causing cord compression. He was systemically well with no other disease. INTERVENTION: The patient made a complete recovery after a limited T4-T7 laminectomy and biopsy of the lesion. Repeat magnetic resonance scan at 6 months revealed a further posteriorly placed lesion at the T8/9 level. More extensive posterior surgery was carried out with subtotal resection of the lesion with pedicle screw fixation. Histologically, all specimens revealed fibrous connective tissue infiltrated by histiocytic cells with CD68 and S100 positivity, confirming a diagnosis of Rosai-Dorfman disease. CONCLUSIONS: This is a rare case of isolated Rosai-Dorfman disease causing thoracic cord compression. It should be considered among the differential diagnoses of extradural cord compression. Radiological features and treatment options are discussed.
Published: 2010
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37. VISUAL PATHWAY COMPROMISE AFTER HYDROCOIL TREATMENT OF LARGE OPHTHALMIC ANEURYSMS

Author: Amit Herwadkar, Roger Laitt, Gwynedd E. Pickett, and David Hughes
Subjects: Male, medicine.medical_specialty, genetic structures, Optic tract, medicine.medical_treatment, Vision Disorders, Optic chiasm, Aneurysm, Occlusion, medicine, Humans, Visual Pathways, Thrombus, Endovascular coiling, medicine.diagnostic_test, business.industry, Intracranial Aneurysm, Magnetic resonance imaging, Middle Aged, medicine.disease, Embolization, Therapeutic, Hydrocephalus, medicine.anatomical_structure, Female, Surgery, Neurology (clinical), Radiology, business
Abstract: OBJECTIVE Hydrogel-coated coils (MicroVention, Inc., Aliso Viejo, CA) for endovascular aneurysm treatment offer the theoretical advantages of increased volumetric occlusion, thrombus stabilization, and improved neointimal healing. Reports of local inflammation and hydrocephalus after coiling of unruptured aneurysms have raised questions about the safety profile or appropriate usage of these new devices. CLINICAL PRESENTATION Two patients with large ophthalmic aneurysms underwent elective endovascular coiling with HydroCoils. Three to 4 weeks later, they developed profound, progressive bilateral visual loss. Magnetic resonance imaging scans demonstrated extensive enhancement of the coil ball, surrounding brain parenchyma, and optic chiasm, with perianeurysmal edema. INTERVENTION Dexamethasone produced impressive but temporary improvement in vision in one patient; the other experienced only minor improvement. One patient also developed hydrocephalus; ventriculoperitoneal shunting reduced ventricular size but had no effect on vision. Follow-up imaging demonstrated persistent enhancement of the coil ball, as well as recurrence and extension of the abnormal signal in the parenchyma and along the optic tract. CONCLUSION Both patients have been left with no functional vision in the eye ipsilateral to the aneurysm and have experienced marked visual field loss and reduced acuity in the contralateral eye. Ongoing international studies will provide more information on the rate of inflammatory complications. The biological mechanisms underlying the phenomenon also require investigation. Meanwhile, we caution against using HydroCoils in situations in which worsened mass effect or local inflammation would have highly deleterious consequences, such as in large aneurysms adjacent to the visual pathways or the brainstem.
Published: 2007
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