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Objectives: To investigate the association between venous outflow (VO) profiles and outcomes among acute ischemic stroke caused by anterior circulation large vessel occlusion (AIS-LVO) patients who had undergone endovascular treatment (EVT) in the late window of 6–24 h from stroke onset. Methods: This was a post-hoc analysis of our preceding RESCUE-BT trial, with findings validated in an external cohort. Baseline computed tomographic angiography (CTA) was performed to assess VO using the Cortical Vein Opacification Score (COVES). The primary clinical outcome was functional independence at 90 days (modified Rankin Scale score of 0–2). The adjusted odd ratio (aOR) and confidence interval (CI) were obtained from multivariable logistic regressions. Results: A total of 440 patients were included in the present study. After identifying the cutoff of COVES by marginal effects approach, enrolled patients were divided into the favorable VO group (COVES 4–6) and the poor VO (COVES 0–3) group. Multivariable logistic regression analysis showed that favorable VO (aOR 2.25; 95% CI 1.31–3.86; p = 0.003) was associated with functional independence. Similar results were detected in the external validation cohort. Among those with poor arterial collateralization, favorable VO was still an independent predictor of functional independence (aOR 2.09; 95% CI 1.06–4.10; p = 0.032). Conclusion: The robust VO profile indicated by COVES 4–6 could promote the frequency of functional independence among AIS-LVO patients receiving EVT in the late window, and the prognostic value of VO was independent of the arterial collateral status. Clinical relevance statement: The robust venous outflow profile was a valid predictor for functional independence among AIS-LVO patients receiving EVT in the late window (6–24 h) and the predictive role of venous outflow did not rely on the status of arterial collateral circulation. Key Points: Many patients undergoing EVT within 6–24 h after stroke onset have non-functionally independent outcomes. Favorable VO was associated with an increased frequency of functional independence in AIS-LVO after EVT. The predictive value of VO didn't rely on the status of arterial collateral circulation. [ABSTRACT FROM AUTHOR]

We aim to explore the feasibility of head and neck time‐of‐flight (TOF) magnetic resonance angiography (MRA) at ultra‐low‐field (ULF). TOF MRA was conducted on a highly simplified 0.05 T MRI scanner with no radiofrequency (RF) and magnetic shielding. A flow‐compensated three‐dimensional (3D) gradient echo (GRE) sequence with a tilt‐optimized nonsaturated excitation RF pulse, and a flow‐compensated multislice two‐dimensional (2D) GRE sequence, were implemented for cerebral artery and vein imaging, respectively. For carotid artery and jugular vein imaging, flow‐compensated 2D GRE sequences were utilized with venous and arterial blood presaturation, respectively. MRA was performed on young healthy subjects. Vessel‐to‐background contrast was experimentally observed with strong blood inflow effect and background tissue suppression. The large primary cerebral arteries and veins, carotid arteries, jugular veins, and artery bifurcations could be identified in both raw GRE images and maximum intensity projections. The primary brain and neck arteries were found to be reproducible among multiple examination sessions. These preliminary experimental results demonstrated the possibility of artery TOF MRA on low‐cost 0.05 T scanners for the first time, despite the extremely low MR signal. We expect to improve the quality of ULF TOF MRA in the near future through sequence development and optimization, ongoing advances in ULF hardware and image formation, and the use of vascular T1 contrast agents. [ABSTRACT FROM AUTHOR]

ABSTRACT During the past two decades, an emerging group of genes coding for proteins involved in glycosylphosphatidylinositol (GPI) anchor biosynthesis are being implicated in early‐infantile epileptic encephalopathy. Amongst these, a hypomorphic promoter mutation in the mannosyltransferase‐encoding PIGM gene was described in seven patients to date, exhibiting intractable absence epilepsy, portal and cerebral vein thrombosis and intellectual disability (ID). We describe here three siblings exhibiting intractable epilepsy and ID, found to harbor a homozygous c.224G>A p.(Arg75His) missense variant in PIGM, which segregated with the disease in the family. The variant is evolutionary conserved, extremely rare in general population databases and predicted to be deleterious. Structural modeling of the PIGM protein and the p.(Arg75His) variant indicates that it is located in a short luminal region of the protein, predicted to be hydrophilic. Functional prediction suggests that the entire local region is sensitive to mutations, with the p.(Arg75His) variant in particular. This is the first report of a PIGM coding variant, and the second variant altogether to be described affecting this gene. This phenotype differs from that of patients with the shared PIGM promoter mutation by lack of thrombotic events and no decrease in PIGM cDNA levels or CD59 expression on red blood cells. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Cerebral venous thrombosis (CVT) is a rare type of stroke. Functional outcome (FOC) in CVT can be affected by different factors, and recanalization is an important determinant. This study aimed to identify the FOC predictors including recanalization in patients with CVT. METHODS: This retrospective study reviewed electronic charts of patients with CVT admitted to the King Fahd Hospital of the University, a teaching and referral hospital between January 2012 and March 2023. Demographic and other clinicoradiological characteristics were noted. Factors affecting FOC were investigated using the Chi-square test, odds ratios (ORs), and 95% confidence interval (CI). RESULTS: Out of 64 patients, 78% achieved good FOC. Age was significantly higher in patients having poor FOC as compared to those having good FOC (P ≤ 0.001). Women had more likelihood to be functionally independent as compared to men (OR = 1.35, 95% CI = 1.01-1.80, P = 0.02). Altered consciousness (OR = 2.94, 95% CI = 1.23-6.99, P = 0.01), venous hemorrhagic infarction (OR = 3.26, 95% CI = 1.36-7.82, P = 0.008), and nonrecanalization (OR = 1.44, 95% CI = 0.97-2.14, P = 0.02) were significantly associated with poor FOC. Hereditary thrombophilia (OR = 0.60, 95% CI = 0.31-1.12, P = 0.03) and infections (OR = 0.59, 95% CI = 0.31-1.12, P = 0.01) were associated with less likelihood of good FOC. Age ≥50 years (P = 0.01) and illness of more than 1-month duration (P = 0.01) were associated with nonrecanalization. CONCLUSION: Older age, male sex, presence of venous hemorrhagic infarction, and nonrecanalization can predict poor FOC in CVT. The recanalization process can be affected by late presentation, and the plausible reason could be a delay in therapeutic anticoagulation. Further prospective and multicenter studies are needed to determine the predictors of FOC and to understand the process of recanalization in CVT. [ABSTRACT FROM AUTHOR]

Background Robust venous outflow (VO) profiles, measured by degree of venous opacification on pre-thrombectomy CT angiography (CTA) studies, are strongly correlated with favorable outcomes in patients with large vessel occlusion acute ischemic stroke treated by thrombectomy. However, VO measurements are laborious and require neuroimaging expertise. Objective To develop a semi-automated method to measure VO using CTA and CT perfusion imaging studies. Methods We developed a graphical interface using The Visualization Toolkit, allowing for voxel selection at the confluence and bilateral internal cerebral veins on CTA along with arterial input functions (AlFs) from both internal carotid arteries. We extracted concentration-time curves from the CT perfusion study at the corresponding locations associated with AIF and venous output function (VOF). Outcome analyses were primarily conducted by the Mann-Whitney U and Jonckheere-Terpstra tests. Results Segmentation at the pre-selected AIF and VOF locations was performed on a sample of 97 patients. 65 patients had favorable VO (VO+) and 32 patients had unfavorable VO (VO-). VO+ patients were found to have a significantly shorter VOF time to peak (8.26; 95% CI 7.07 to 10.34) than VO- patients (9.44; 95% CI 8.61 to 10.91), P=0.007. No significant difference was found in VOF curve width and the difference in time between AIF and VOF peaks. Conclusions Time to peak of VOF at the confluence of sinuses was significantly associated with manually scored venous outflow. Further studies should aim to understand better the association between arterial inflow and venous outflow, and capture quantitative metrics of venous outflow at other locations. [ABSTRACT FROM AUTHOR]

Purpose: Venous outflow impediment is increasingly recognized in idiopathic intracranial hypertension (IIH). We aim to search for the value of tortuous occipital emissary vein (OEV) in IIH by integrating measurable transverse sinus (TS) stenosis in contrast-enhanced MR venography (CE-MRV). Methods: Twenty-one IIH patients were evaluated with CE-MRV. Each patient had high LP opening pressure (> 25 cm.H2O), and presented papilledema. Age- and sex-matched 21 control subjects who underwent cranial CE-MRV were selected. The OEV and the following features: intraosseous diameter of more than 3 mm, twisted course, and continuous with prominent sub-occipital extracranial veins were named tortuous OEV. TS stenosis was measured by utilizing the coronal T1-VIBE series to calculate quantitative metrics such as TS max./min.. The tortuous OEV and TS max./min. were registered to create a bivariate logistic regression model to assess the performance of tortuous OEV for IIH when accompanied by TS stenosis. Results: Six (29%) tortuous OEVs were observed in the IIH group, while no tortuous OEV was identified in the control group (p = 0.021). The mean TSmax./min. was 2.48 ± 1.19 in patients with IIH and 1.23 ± 0.33 in the control group (p < 0.001). According to regression analysis, tortuous OEV is not predictive of IIH (p = 0.999), while the higher TSmax./min. (> 1.69) is predictive of IIH (p = 0.022, OR: 8.9; %95 CI; 1.4–59.0) when accompanied together. Conclusion: Tortuous occipital emissary vein is more frequently seen in patients with IIH. However, the tortuous appearance alone does not predict idiopathic intracranial hypertension unless associated with measurable transverse sinus narrowing in CE-MRV. [ABSTRACT FROM AUTHOR]

Breast cancer has important co-morbidities including vascular disease but there has been little research undertaken on a possible link between venous disease and breast cancer. This pilot study aims to explore a possible relationship. Methods: The venous drainage of the breasts is described and the cerebrospinal venous systems (CSVS) of six patients with treated breast cancer were assessed using duplex ultrasound to measure venous blood volume flows in the neck veins. Results: All six patients with breast cancer showed evidence of cerebrospinal venous obstruction (CSVO). Further, all six demonstrated collateral flow in the erect position in the internal jugular vein on the same side as the diagnosed breast cancer. Conclusion: There is an indication for a well-designed case-control study using the duplex ultrasound neck vein examination, comparing patients treated for breast cancer with healthy women. [ABSTRACT FROM AUTHOR]

Despite the unequivocal medical and social advantages of introducing vaccines against the novel coronavirus SARS-CoV-2, there were also some concerns regarding possible post-vaccination adverse events. Most of these are mild. But in rare cases, severe neurological symptoms including ischaemic stroke, intracranial haemorrhage (ICH), cerebral venous and sinus thrombosis (CVT), and thrombosis with thrombocytopenia (TTS) have been observed. Literature data suggests that thrombosis with thrombocytopenia was the major underlying cause of the ICH; dural venous sinuses/cerebral veins were indicated as the primarily affected sites of thrombosis. Our review confirms the previously documented suspicion that CVT and TTS are most likely to occur following vector-type, rather than mRNA, vaccine administration. The postulated mechanism of TTS is similar to heparin-induced thrombocytopenia (HIT) both clinically and serologically. Although ICH and VITT are very rare side effects of the COVID-19 vaccine, for patients with risk factors for thrombosis (e.g. pregnancy), physicians should carefully consider the benefit/risk ratio of vaccination. [ABSTRACT FROM AUTHOR]

Post-traumatic cerebral venous sinus thrombosis (ptCVST) often remains underdiagnosed due to the non-specific nature of clinical signs, commonly mimicking severe traumatic brain injury (TBI) manifestations. Early recognition of this rare and potentially life-threatening complication is crucial for the effective management of severe TBI patients in Intensive Care. The present study reports the case of a 66-year-old male who was transferred to the emergency department due to moderate TBI. Initial emergency brain computed tomography (CT) scans revealed certain traumatic lesions, not necessitating any urgent neurosurgical intervention. During his stay in an Intensive Care Unit (ICU), multiple transient episodes of intracranial pressure (ICP) values were managed conservatively, and through placement of an external ventricular drain. Following a series of CT scans, there was a continuous improvement of the initial traumatic hemorrhagic findings despite his worsening clinical condition. This paradox raised suspicion for ptCVST, and a brain CT venography (CTV) was carried out, which showed venous sinus thrombosis close to a concomitant skull fracture. Therapeutic anticoagulant treatment was administered. The patient was discharged with an excellent neurological status. To date, there are no clearly defined guidelines for medical and/or surgical management of patients presenting with ptCVST. Therapy is mainly based on intracranial hypertension control and the maintenance of normal cerebral perfusion pressure (CCP) in the ICU. The mismatch between clinical and imaging findings in patients with TBI and certain risk factors raises the suspicion of ptCVST. [ABSTRACT FROM AUTHOR]

OBJECTIVES Cerebral venous thrombosis (CVT) is a rare type of stroke. Functional outcome (FOC) in CVT can be affected by different factors, and recanalization is an important determinant. This study aimed to identify the FOC predictors including recanalization in patients with CVT. METHODS This retrospective study reviewed electronic charts of patients with CVT admitted to the King Fahd Hospital of the University, a teaching and referral hospital between January 2012 and March 2023. Demographic and other clinicoradiological characteristics were noted. Factors affecting FOC were investigated using the Chi-square test, odds ratios (ORs), and 95% confidence interval (CI). RESULTS Out of 64 patients, 78% achieved good FOC. Age was significantly higher in patients having poor FOC as compared to those having good FOC (P ≤ 0.001). Women had more likelihood to be functionally independent as compared to men (OR = 1.35, 95% CI = 1.01–1.80, P = 0.02). Altered consciousness (OR = 2.94, 95% CI = 1.23–6.99, P = 0.01), venous hemorrhagic infarction (OR = 3.26, 95% CI = 1.36–7.82, P = 0.008), and nonrecanalization (OR = 1.44, 95% CI = 0.97–2.14, P = 0.02) were significantly associated with poor FOC. Hereditary thrombophilia (OR = 0.60, 95% CI = 0.31–1.12, P = 0.03) and infections (OR = 0.59, 95% CI = 0.31–1.12, P = 0.01) were associated with less likelihood of good FOC. Age ≥50 years (P = 0.01) and illness of more than 1-month duration (P = 0.01) were associated with nonrecanalization. CONCLUSION Older age, male sex, presence of venous hemorrhagic infarction, and nonrecanalization can predict poor FOC in CVT. The recanalization process can be affected by late presentation, and the plausible reason could be a delay in therapeutic anticoagulation. Further prospective and multicenter studies are needed to determine the predictors of FOC and to understand the process of recanalization in CVT.

Cerebral veins are responsible for the outflow drainage of brain interstitial fluid (ISF). The importance of cerebral venous drainage has been emphasized in various neurological diseases. Impaired venous outflow may lead to brain edema, blood–brain barrier (BBB) disruption, inflammatory responses and hemorrhagic complications. With the development of imaging technologies, several imaging-based signs for venous assessment are proposed. Therapies targeting cerebral venous drainage have shown beneficial outcomes in cerebral venous sinus thrombosis (CVST) in clinic, however more insight into the cellular and molecular level should be elucidated. Here we review the pathological changes following cerebral venous drainage impairment, summary the advances in image-based evaluation, address the potential molecular mechanisms, and discuss venous drainage-focused therapies. A better understanding of cerebral venous drainage and its underlying mechanism will promote the pharmacological development and clinical management of CVST.

Background: Alterations in the cerebral venous system have been increasingly recognized as a significant component of the pathophysiology of multiple sclerosis (MS). This study aimed to explore the relationship between venous sinus diameter and MS to understand potential vascular alterations in MS patients compared with controls. We sought to determine whether these alterations were correlated with disease characteristics such as duration, lesion type, and disability score. Methods: This study included 79 MS patients diagnosed according to the 2017 McDonald criteria and 67 healthy individuals. Magnetic resonance imaging (MRI) scans via a 1.5 Tesla system provided measurements of the superior sagittal sinus, right and left transverse sinus, sinus rectus, and venous structures. Statistical analysis was conducted via SPSS, employing independent sample t tests, ANOVA, chi-square tests, and Pearson correlation analysis, with the significance level set at p < 0.05. Results: This study revealed significant differences in venous sinus diameter between MS patients and controls, with MS patients exhibiting larger diameters. Specifically, patients with brainstem and spinal lesions had larger diameters in certain sinus regions. No significant correlations were found between venous sinus diameter and demographic factors, expanded disability status scale scores, or lesion counts. However, a significant increase in perivenular lesions was noted in patients with longer disease durations. Conclusions: The findings indicate notable vascular alterations in MS patients, particularly in venous sinus diameters, suggesting a potential vascular component in MS pathology. The lack of correlation with conventional clinical and MRI metrics highlights the complexity of MS pathology. These insights underscore the need for further research, particularly longitudinal studies, to elucidate the role of venous changes in MS progression and their potential as therapeutic targets. [ABSTRACT FROM AUTHOR]

Introduction: The cerebral venous system consists of dural venous sinuses, superficial cortical veins, deep medullary and subependymal veins [1]. Cerebral veins contain about 70% of the total cerebral blood volume but CVT occurs about thousand times less often than arterial stroke. Arterial and venous stroke cause different neurological deficits and occur in people of different ages. About half of the patients with an arterial stroke are older than 75 years, whereas CVT most often affects young adults and children. Any pathology that alters the Virchow's triads of flow vessel wall and fluid blood physiology can cause thrombosis [2]. Materials & Methods: All patients 50 Patients confirmed by MRI and MRV as cerebral venous sinus thrombosis. Both Males and females are included. All age groups included. Patients with MR incompatible devices or implants. Patients on life support systems. Patients with claustrophobia. Discussion & Results: In our study done in various tertiary Medical College colleges, Karnataka for two years, between Feb 2022 to Jan 2024, 50 patients were included. All these patients were selected with MR evidence of cerebral venous sinus thrombosis. The age range of the affected patients is 18 to 70 with a mean age of 38. There is no statistically significant association of age with poor outcome in our study as against the study of Stolz, Rahimi et al. who showed increasing age to be a poor prognostic indicator. There is no significant association between age of the patients and the prognosis. Conclusion: In our study of cerebral venous thrombosis it can be concluded that MRI is useful in prognostic evaluation. Diffusion weighted images are good prognostic tools. Restriction of diffusion is a poor prognostic indicator. [ABSTRACT FROM AUTHOR]

In recent years, ultra-high-field magnetic resonance imaging (MRI) applications have been rapidly increasing in both clinical research and practice. Indeed, 7-Tesla (7T) MRI allows improved depiction of smaller structures with high signal-to-noise ratio, and, therefore, may improve lesion visualization, diagnostic capabilities, and thus potentially affect treatment decision-making. Incremental evidence emerging from research over the past two decades has provided a promising prospect of 7T magnetic resonance angiography (MRA) in the evaluation of intracranial vasculature. The ultra-high resolution and excellent image quality of 7T MRA allow us to explore detailed morphological and hemodynamic information, detect subtle pathological changes in early stages, and provide new insights allowing for deeper understanding of pathological mechanisms of various cerebrovascular diseases. However, along with the benefits of ultra-high field strength, some challenges and concerns exist. Despite these, ongoing technical developments and clinical oriented research will facilitate the widespread clinical application of 7T MRA in the near future. In this review article, we summarize technical aspects, clinical applications, and recent advances of 7T MRA in the evaluation of intracranial vascular disease. The aim of this review is to provide a clinical perspective for the potential application of 7T MRA for the assessment of intracranial vascular disease, and to explore possible future research directions implementing this technique. [ABSTRACT FROM AUTHOR]

Distinguishing arteries from veins in the cerebral cortex is critical for studying hemodynamics under pathophysiological conditions, which plays an important role in the diagnosis and treatment of various vessel‐related diseases. However, due to the complexity of the cerebral vascular network, it is challenging to identify arteries and veins in vivo. Here, we demonstrate an artery–vein separation method that employs a combination of multiple scanning modes of two‐photon microscopy and a custom‐designed stereoscopic fixation device for mice. In this process, we propose a novel method for determining the line scanning direction, which allows us to determine the blood flow directions. The vasculature branches have been identified using an optimized z‐stack scanning mode, followed by the separation of blood vessel types according to the directions of blood flow and branching patterns. Using this strategy, the penetrating arterioles and penetrating venules in awake mice could be accurately identified and the type of cerebral thrombus has been also successfully isolated without any empirical knowledge or algorithms. Our research presents a new, more accurate, and efficient method for cortical artery–vein separation in awake mice, providing a useful strategy for the application of two‐photon microscopy in the study of cerebrovascular pathophysiology. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether cerebral collateral and venous outflow (VO) patterns on colour-coded multi-phase computed tomography angiography (mCTA) can estimate ischaemic core growth rate (IGR) and predict 90-day functional independence for patients with late-presenting acute ischaemic stroke (AIS). Methods: The retrospective analysis included 127 AIS patients with a late time window. All patients underwent baseline mCTA with colour-coded reconstruction and computed tomography perfusion. Both collateral score and VO score on colour-coded mCTA maps were analysed and recorded. The IGR was calculated as ischaemic core volume divided by the time from onset to imaging. A 90-day modified Rankin Scale score of 0-2 was defined as functional independence. Kendall's Tau-b analysis was used for nonparametric correlation analysis. Propensity scores, logistic regressions, and receiver operator characteristic (ROC) curves were applied to construct the prediction model. Results: Moderate correlations were found between collateral delay and IGR (Tau-b = -0.554) and between VO and IGR (Tau-b = -0.501). High collateral score (odds ratio = 3.01) and adequate VO (odds ratio = 4.89) remained independent predictors for 90-day functional independence after adjustment. The joint predictive model, which integrated the VO score and clinical features, demonstrated an area under the ROC curve (AUC) of 0.878. The AUCs of collateral score and VO score were 0.836 and 0.883 for outcome prediction after adjustment. Conclusions: Cerebral collateral and VO patterns based on colour-coded mCTA can effectively predict infarct progression and 90-day clinical outcomes, even for AIS patients beyond the routine time window. Advances in knowledge: Colour-coded mCTA is a readily understandable post-processing technique for the rapid assessment of collateral circulation and VO status in stroke imaging. A moderate correlation was observed between the characteristics of collateral delay/VO on colour-coded mCTA and IGR in patients with AIS. Both high-quality collateral circulation and "red superficial middle cerebral vein sign" can predict 90-day functional independence even for patients beyond the routine time window. [ABSTRACT FROM AUTHOR]

This study aimed to establish an intelligent segmentation algorithm to count the number of deep medullary veins (DMVs) and analyze the relationship between DMVs and imaging markers of cerebral small vessel disease (CSVD). DMVs on magnetic resonance imaging (MRI) of patients with CSVD were counted by intelligent segmentation and manual counting. The dice coefficient and intraclass correlation coefficient (ICC) were used to evaluate their consistency and correlation. Structural MR images were used to assess imaging markers and total burden of CSVD. A multivariate linear regression model was used to evaluate the correlation between the number of DMVs counted by intelligent segmentation and imaging markers of CSVD, including white matter hyperintensities of the presumed vascular origin, lacune, perivascular spaces, cerebral microbleeds, and total CSVD burden. A total of 305 patients with CSVD were enrolled. An intelligent segmentation algorithm was established to calculate the number of DMVs, and it was validated and tested. The number of DMVs counted intelligently significantly correlated with the manual counting method (r = 0.761, P < 0.001). The number of smart-counted DMVs negatively correlated with the imaging markers and total burden of CSVD (P < 0.001), and the correlation remained after adjusting for age and hypertension (P < 0.05). The proposed intelligent segmentation algorithm, which was established to count DMVs, can provide objective and quantitative imaging information for the follow-up of patients with CSVD. DMVs are involved in CSVD pathogenesis and a likely new imaging marker for CSVD. • An intelligent segmentation algorithm was established to count DMVs. • DMVs may play an important role in the pathological mechanism of CSVD. • The number of DMVs decreased with age and the progression of hypertension. [ABSTRACT FROM AUTHOR]

The article focuses on how iron deficiency anemia (IDA) can manifest as ischemic stroke, highlighting the importance for pediatric providers to recognize risk factors for IDA and intervene early to prevent severe clinical outcomes. Topics include the presentation of IDA as ischemic stroke in severe cases, risk factors such as excessive cow's milk consumption, and the need for early intervention to prevent critical manifestations.

Background and purpose: Cerebral sinus venous thrombosis (CSVT) is a rare but life-threatening disease and its diagnosis remains challenging. Blood biomarkers, including D-Dimer are currently not recommended in guidelines. Soluble endothelial receptor proteins (sICAM-1, sPECAM-1 and sVCAM-1) have been shown to be promising diagnostic biomarkers in deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore, we examined endothelial receptor proteins as potential biomarkers for detecting CSVT. Methods: In this bi-centre, prospective study, we quantified D-Dimer as well as sICAM-1, sPECAM-1 and sVCAM-1 in plasma of patients with clinically suspected CSVT managed in the neurological emergency department (ED) of a tertiary care hospital. All patients underwent cerebral magnetic resonance imaging (MRI) and were followed up after 3, 6 and 12 months to detect thrombus resolution. Results: Twenty-four out of 75 (32%) patients with clinically suspected CSVT presenting with headache to the ED were diagnosed with acute CSVT. These patients had a mean age of 45 ± 16 years and 78% were female. In patients with CSVT, mean baseline D-dimer (p < 0.001) and sPECAM-1 (p < 0.001) were significantly higher compared to patients without CSVT. The combination of D-Dimer and sPECAM-1 yielded the best ROC-AUC (0.994; < 0.001) with a negative predictive value of 95.7% and a positive predictive value of 95.5%. In addition, higher baseline sPECAM-1 levels (> 198 ng/ml) on admission were associated with delayed venous thrombus resolution at 3 months (AUC = 0.83). Conclusion: sPECAM-1 in combination with D-Dimer should be used to improve the diagnostic accuracy of acute CSVT and sPECAM-1 may predict long-term outcome of CSVT. Confirmatory results are needed in other settings in order to show their value in the management concept of CSVT patients. [ABSTRACT FROM AUTHOR]

Purpose: Intracranial hypertension (IH) frequently complicates cerebral venous thrombosis (CVT). Distinct neuroimaging findings are associated with IH, yet their discriminative power, reversibility and factors favoring normalization in prospective CVT patients are unknown. We determined test performance measures of neuroimaging signs in acute CVT patients, their longitudinal change under anticoagulation, association with IH at baseline and with recanalization at follow-up. Methods: We included 26 consecutive acute CVT patients and 26 healthy controls. Patients were classified as having IH based on CSF pressure > 25 cmH2O and/or papilledema on ophthalmological examination or ocular MRI. We assessed optic nerve sheath diameter (ONSD), optic nerve tortuousity, bulbar flattening, lateral and IVth ventricle size, pituitary configuration at baseline and follow-up, and their association with IH and venous recanalization. Results: 46% of CVT patients had IH. ONSD enlargement > 5.8 mm, optic nerve tortuousity and pituitary grade ≥ III had highest sensitivity, ocular bulb flattening and pituitary grade ≥ III highest specificity for IH. Only ONSD reliably discriminated IH at baseline. Recanalization was significantly associated with regressive ONSD and pituitary grade. Other neuroimaging signs tended to regress with recanalization. After treatment, 184.9 ± 44.7 days after diagnosis, bulbar flattening resolved, whereas compared with controls ONSD enlargement (p < 0.001) and partially empty sella (p = 0.017), among other indicators, persisted. Conclusion: ONSD and pituitary grading have a high diagnostic value in diagnosing and monitoring CVT-associated IH. Given their limited sensitivity during early CVT and potentially persistent alterations following IH, neuroimaging indicators can neither replace CSF pressure measurement in diagnosing IH, nor determine the duration of anticoagulation. [ABSTRACT FROM AUTHOR]

Purpose: Abnormalities in cerebral veins are a common finding in many neurological diseases, yet there is a scarcity of MRI techniques to assess venous hemodynamic function. The present study aims to develop a noncontrast technique to measure a novel blood flow circulatory measure, venous transit time (VTT), which denotes the time it takes for water to travel from capillary to major veins. Methods: The proposed sequence, venous transit time imaging by changes in T1 relaxation (VICTR), is based on the notion that as water molecules transition from the tissue into the veins, they undergo a change in T1 relaxation time. The validity of the measured VTT was tested by studying the VTT along the anatomically known flow trajectory of venous vessels as well as using a physiological vasoconstrictive challenge of caffeine ingestion. Finally, we compared the VTT measured with VICTR MRI to a bolus‐tracking method using gadolinium‐based contrast agent. Results: VTT was measured to be 3116.3 ± 326.0 ms in the posterior superior sagittal sinus (SSS), which was significantly longer than 2865.0 ± 390.8 ms at the anterior superior sagittal sinus (p = 0.004). The test–retest assessment showed an interclass correlation coefficient of 0.964. VTT was significantly increased by 513.8 ± 239.3 ms after caffeine ingestion (p < 0.001). VTT measured with VICTR MRI revealed a strong correlation (R = 0.84, p = 0.002) with that measured with the contrast‐based approach. VTT was found inversely correlated to cerebral blood flow and venous oxygenation across individuals. Conclusion: A noncontrast MRI technique, VICTR MRI, was developed to measure the VTT of the brain. [ABSTRACT FROM AUTHOR]

Background: About 13–25% of cerebral venous thrombosis (CVT) cases lack clear etiology, which may be associated with underlying genetic factors. This study aims to investigate genetic factors in CVT patients using whole exome sequencing (WES). Methods: Thirty-eight CVT patients hospitalized underwent WES. 977 subjects with WES data from a community cohort study --the Shunyi cohort were as the control group. Using bioinformatics analysis, differential genes with rare damaging variants between two groups were filtered (P < 0.05). KEGG enrichment analysis was performed on the screened genes to identify pathways associated with CVT. Results: Through analysis of medical history, routine tests, and imaging examinations, the etiology of 38 patients: 8 cases of antiphospholipid syndrome, 6 cases with hematologic diseases, 3 cases of protein C deficiency, and 2 cases of protein S deficiency. Five cases occurred during pregnancy or puerperium, and 3 cases had a history of oral contraceptive use, and so on. The etiology was unknown in 12 cases (31.6%), and the etiology of 4 patients were further clarified through WES: F9 c.838 + 1_838 + 16del, Hemizygote: F9 EX1-EX7 Dup; CBS c.430G > A, CBS c.949 A > G; F2 c.1787G > A; SERPINC1 c.409-11G > T. Comparing the WES data of two groups, a total of 179 different genes with rare damaging variants were screened (P < 0.05), with 5 genes of interest (JAK2, C3, PROC, PROZ, SERPIND1). Enrichment analysis of the 179 different genes revealed the complement and coagulation pathway and the mitogen activated protein kinases (MAPK) pathway were associated with CVT. Conclusion: For CVT patients with unknown etiology, WES could help identify the cause of CVT early, which is of great significance for treatment decisions and prognosis. In addition to the complement and coagulation pathway, MAPK pathway is associated with CVT, potentially related to platelet regulation and inflammatory response. [ABSTRACT FROM AUTHOR]

The vein of Rolando, also known as the central sulcal vein, is a critical superficial cerebral vein located in the central sulcus, playing a pivotal role in the venous drainage of the motor and sensory cortices. Named after the Italian anatomist Luigi Rolando, this vein serves as a crucial anatomical landmark in neurosurgery, guiding surgeons to approach critical brain structures with minimal damage. This article explores the anatomy and clinical significance of the vein of Rolando, emphasizing its role in neurosurgery and neuroimaging. Advanced imaging techniques such as functional MRI (fMRI), Magnetic Resonance Venography (MRV), and CT Angiography have enhanced the ability to diagnose and preserve this vein, reducing surgical risks. The article also discusses the interconnectedness of the vein of Rolando with other cerebral veins like the vein of Trolard and underscores the importance of understanding venous variations and drainage patterns for successful surgical outcomes. Preventive measures to protect the vein during neurosurgery are essential to prevent complications such as venous congestion and intracranial pressure. This overview highlights the necessity for precise anatomical knowledge and advanced diagnostic tools in optimizing neurosurgical procedures and patient care. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have investigated the influence of posture on the external jugular and diploic venous systems in the head and cranial region. In this study, we aimed to investigate the effects of posture on these systems using upright computed tomography (CT) scanning. Methods: This study retrospectively analysed an upright CT dataset from a previous prospective study. In each patient, the diameters of the vessels in three external jugular tributaries and four diploic veins were measured using CT digital subtraction venography in both supine and sitting positions. Results: Amongst the 20 cases in the original dataset, we eventually investigated 19 cases due to motion artifacts in 1 case. Compared with the supine position, most of the external jugular tributaries collapsed, and the average size significantly decreased in the sitting position (decreased by 22–49% on average). In contrast, most of the diploic veins, except the occipital diploic veins, tended to increase or remain unchanged (increased by 12–101% on average) in size in the sitting position compared with the supine position. However, the changes in the veins associated with this positional shift were not uniform; in approximately 5–30% of the cases, depending on each vein, an opposite trend was observed. Conclusion: Compared to the supine position, the contribution of external jugular tributaries to head venous drainage decreased in the sitting position, whilst most diploic veins maintained their contribution. These results could enhance our understanding of the physiology and pathophysiology of the head region in upright and sitting positions. [ABSTRACT FROM AUTHOR]

Purpose: To validate a semiautomated method for segmenting vein of Galen aneurysmal malformations (VGAM) and to assess the relationship between VGAM volume and other angioarchitectural features, cardiological findings, and outcomes. Methods: In this retrospective study, we selected all subjects with VGAM admitted to the Gaslini Children's Hospital between 2009 and 2022. Clinical data were retrieved from electronic charts. We compared 3D-Slicer segmented VGAM volumes obtained by two independent observers using phase-contrast MR venography to those obtained with manual measurements performed on T2-weighted images. The relationship between VGAM volumes and clinical and neuroimaging features was then explored. Results: Forty-three subjects with VGAM (22 males, mean age 6.56 days) were included in the study. Manual and semiautomated VGAM volumes were well correlated for both readers (r = 0.86 and 0.82, respectively). Regarding reproducibility, the inter-rater interclass correlation coefficients were 0.885 for the manual method and 0.992 for the semiautomated method (p < 0.001). The standard error for repeated measures was lower for the semiautomated method (0.04 versus 0.40 of manual method). Higher VGAM volume was associated with superior sagittal sinus narrowing, jugular bulb stenosis, and aqueductal stenosis (p < 0.05). A weak correlation was found between VGAM volume and straight sinus dilatation (r = 0.331) and superior sagittal sinus index (r = − 0.325). No significant associations were found with cardiac findings, post-embolization complications, and outcome (p > 0.05). Conclusions: Semiautomated VGAM volumetry is feasible and reliable with improved reproducibility compared to the manual method. VGAM volume is not a prognostic factor for clinical outcome, but it is related to other venous findings with potential hemodynamic effects. [ABSTRACT FROM AUTHOR]

The editorial in the European Radiology journal discusses the importance of considering venous outflow (VO) in making decisions for endovascular thrombectomy (EVT) in stroke patients within the late time window (6-24 hours). The study highlights the significance of venous outflow in predicting favorable clinical outcomes, especially in the absence of reliable arterial collateral circulation. The findings suggest that a higher optimal threshold of venous opacification score (COVES) is necessary for achieving functional independence in late window stroke patients, emphasizing the need for personalized prediction systems based on pre-operative CT angiography. Future studies with larger, more homogeneous samples are recommended to validate these findings and establish effective stroke management strategies. [Extracted from the article]

Background: Pericardiectomy due to constrictive pericarditis is usually safe procedure. There was a rare event of thrombosis after pericardiectomy, which was mainly accounted by low-cardiac-output syndrome. Case presentation: Here, we report the case undergoing pericardiectomy after constrictive pericarditis, with fatal cerebral thrombosis after pericardiectomy confirmed by endovascular mechanical thrombectomy. Even though recanalization was completed and suggestive decompressive craniectomy was in preparation, the patient still died for cerebral hernia due to severe edema. The causes of cerebral thrombosis after pericardiectomy in this case was accounted by the persistence of nonpliable pericardium encasing the left ventricular wall limited local myocardium motor, pro-coagulable state due to thermal transmission during decortication like radiofrequency ablation under the condition of postoperative atrial fibrillation and rapid ventricular rates precipitated the information of mural thrombus in cardiac cavity and migration into the main branch of the aortic arch. Conclusion: The protocol of prompt aggressive anticoagulation prophylaxis would be vigilantly recommended for the patients undergoing pericardiectomy. [ABSTRACT FROM AUTHOR]

This article discusses the use of Doppler ultrasound technology to assess the cerebral vessels in the fetal central nervous system (CNS) during prenatal imaging. The development of Doppler technologies that are highly sensitive for low-velocity flow has allowed for the visualization of the intracerebral venous system, including the medullary veins. The article presents a case study where Doppler tools were used to identify a CNS anomaly in a pregnant woman, leading to a diagnosis of subarachnoid hemorrhage. The authors suggest that Doppler technology has the potential to aid in the differential diagnosis of cerebral anomalies and further research is needed to explore its role in assessing fetal CNS health. [Extracted from the article]

BACKGROUND AND PURPOSE: Vessel recanalization after cerebral venous thrombosis (CVT) is associated with favorable outcomes and lower mortality. Several studies examined the timing and predictors of recanalization after CVT with mixed results. We aimed to investigate predictors and timing of recanalization after CVT. METHODS: We used data from the multicenter, international AntiCoagulaTION in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT) study of consecutive patients with CVT from January 2015 to December 2020. Our analysis included patients that had undergone repeat venous neuroimaging more than 30 days after initiation of anticoagulation treatment. Prespecified variables were included in univariate and multivariable analyses to identify independent predictors of failure to recanalize. RESULTS: Among the 551 patients (mean age, 44.4±16.2 years, 66.2% women) that met inclusion criteria, 486 (88.2%) had complete or partial, and 65 (11.8%) had no recanalization. The median time to first follow-up imaging study was 110 days (interquartile range, 60-187). In multivariable analysis, older age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.07), male sex (OR, 0.44; 95% CI, 0.24-0.80), and lack of parenchymal changes on baseline imaging (OR, 0.53; 95% CI, 0.29-0.96) were associated with no recanalization. The majority of improvement in recanalization (71.1%) occurred before 3 months from initial diagnosis. A high percentage of complete recanalization (59.0%) took place within the first 3 months after CVT diagnosis. CONCLUSION: Older age, male sex, and lack of parenchymal changes were associated with no recanalization after CVT. The majority recanalization occurred early in the disease course suggesting limited further recanalization with anticoagulation beyond 3 months. Large prospective studies are needed to confirm our findings.

DOI: 10.3969/j.issn.1672‑6731.2024.03.014

Alzheimer's disease (AD) is the prevailing type of dementia in the elderly, yet a comprehensive comprehension of its precise underlying mechanisms remains elusive. The investigation of the involvement of cerebral small veins in the advancement of AD has yet to be sufficiently explored in previous studies, primarily due to constraints associated with pathological staining techniques. However, recent research has provided valuable insights into multiple pathophysiological occurrences concerning cerebral small veins in AD, which may manifest sequentially, concurrently, or in a self-perpetuating manner. These events are presumed to be among the initial processes in the disease's progression. The impact of cerebral small vein loss on amyloid beta (Aβ) clearance through the glial lymphatic system is noteworthy. There exists a potential interdependence between collagen deposition and Aβ deposition in cerebral small veins. The compromised functionality of cerebral small veins can result in decreased cerebral perfusion pressure, potentially leading to cerebral tissue ischemia and edema. Additionally, the reduction of cerebral small veins may facilitate the infiltration of inflammatory factors into the brain parenchyma, thereby eliciting neuroinflammatory responses. Susceptibility-weighted imaging (SWI) is a valuable modality for the efficient assessment of cerebral small veins, precisely the deep medullary vein (DMV), and holds promise for the identification of precise and reliable imaging biomarkers for AD. This review presents a comprehensive overview of the current advancements and obstacles to the impairment of cerebral small veins in AD. Additionally, we emphasize future research avenues and the importance of conducting further investigations in this domain. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous thrombosis (CVT), thrombosis of the dural sinus, cerebral veins, or both, is a rare cerebrovascular disease. Although mortality rates after CVT have declined over time, this condition can result in devastating neurologic outcomes. CVT is estimated to account for <1% of all strokes. Unlike arterial strokes, CVT tends to affect young patients with a female predominance, is often nonapoplectic in onset, and has a wide spectrum of clinical presentations. These and other features make CVT a challenging disease to diagnose without an understanding of its evolving epidemiology, clinical features, associated conditions, and the neuroimaging findings typically needed to confirm the diagnosis. Methods: This descriptive study retrospectively collected 39 CVT cases in Dr. Wahidin Sudirohusodo General Hospital Makassar. Data were taken from patients' medical records, radiological records, and catheter lab data records. The clinical manifestation and angiographic findings variables of consecutive CVT cases that had digital subtraction angiography (DSA) between January 2017 and December 2023 were analyzed. Results: This study was conducted on a total of 39 CVT patients with a mean age of 42.26 ± 12.98 years, mostly female 53.84%. The most clinical manifestation was vascular headache (87.2%). Presentation of hemiparesis was 30.8%, diplopia was 20.5%, and seizure 10.3%. Based on angiographic findings, most thrombosis is located in the cavernous sinus, as many as 41%, followed by superior sinus sagitalis (SSS), as many as 30.8%, and tranversus sinus (25.6%). The patient with the manifestation of vascular headache was female and located in the cavernous sinus. All patients presented with diplopia were located in the cavernous sinus. Conclusion: Most of CVT's patients were female and of productive age, with the most clinical presentation was vascular headache followed by focal neurological deficits like hemiparesis and diplopia. Based on angiographic findings, mostly thrombosis is located in the cavernous sinus, followed with the superior sagitalis sinus (SSS). The characteristics of patient CVT with vascular headaches mostly were female with thrombosis located in the cavernous sinus. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between asymmetric deep cerebral venous (ADCV) filling and poor outcomes after endovascular treatment (EVT) in patients with acute basilar artery occlusion (ABAO). Methods: ABAO patients were selected from a prospectively collected data at our center. The DCV filling was evaluated using computed tomography perfusion (CTP)‐derived reconstructed 4D‐DSA or mean venous map. ADCV filling was defined as the internal cerebral vein (ICV), thalamostriate vein (TSV), or basal vein of Rosenthal (BVR) presence of ipsilateral filling defects or delayed opacification compared to the contralateral side. Poor prognosis was defined as a modified Rankin scale score >3 at the 90‐day follow‐up. Results: A total of 90 patients were enrolled in the study, with a median Glasgow Coma Scale of 6, 46 (51.1%) showed ADCV filling, 59 (65.6%) had a poor prognosis, and 27 (30.7%) had malignant cerebellar edema (MCE). Multivariate adjusted analysis revealed significant associations between asymmetric TSV and poor prognosis (odds ratio, 9.091, p = 0.006); asymmetric BVR (OR, 9.232, p = 0.001) and asymmetric ICV (OR, 4.028, p = 0.041) were significantly associated with MCE. Conclusion: Preoperative ADCV filling is an independent influencing factor for the poor outcome after EVT in ABAO patients. [ABSTRACT FROM AUTHOR]

Vein of Galen aneurysmal malformation is a relatively rare disease in which failure of the median prosencephalic vein of Markowski to involute early in gestation leads to a grossly dilated deep cerebral vein with multiple arterial feeders, causing a large arteriovenous shunt which leads to high-output cardiac failure. We describe a case of a term neonate who presented to a tertiary neonatal centre on day one of life with history, symptoms, and signs consistent with perinatal asphyxia; however, in the context of worsening multi-organ dysfunction and cardiomegaly, the infant was found to have a severe vein of Galen aneurysmal dilatation leading to high-output cardiac failure. The patient was transferred to a tertiary paediatric hospital and underwent a total of four coiling procedures to embolise the multiple feeder arteries supplying the aneurysmal malformation. This case highlights the difficulties in diagnosing this relatively uncommon condition, particularly in the context of a possible perinatal insult. [ABSTRACT FROM AUTHOR]

Sequestration of infected red blood cells (iRBCs) in the microcirculation is a hallmark of cerebral malaria (CM) in post-mortem human brains. It remains controversial how this might be linked to the different disease manifestations, in particular brain swelling leading to brain herniation and death. The main hypotheses focus on iRBC-triggered inflammation and mechanical obstruction of blood flow. Here, we test these hypotheses using murine models of experimental CM (ECM), SPECT-imaging of radiolabeled iRBCs and cerebral perfusion, MR-angiography, q-PCR, and immunohistochemistry. We show that iRBC accumulation and reduced flow precede inflammation. Unexpectedly, we find that iRBCs accumulate not only in the microcirculation but also in large draining veins and sinuses, particularly at the rostral confluence. We identify two parallel venous streams from the superior sagittal sinus that open into the rostral rhinal veins and are partially connected to infected skull bone marrow. The flow in these vessels is reduced early, and the spatial patterns of pathology correspond to venous drainage territories. Our data suggest that venous efflux reductions downstream of the microcirculation are causally linked to ECM pathology, and that the different spatiotemporal patterns of edema development in mice and humans could be related to anatomical differences in venous anatomy. Cerebral malaria can lead to fatal brain swelling. Oelschlegel et al. find infected red blood cells and reduced flow in large draining cerebral veins in mouse model of cerebral malaria, suggesting that impaired venous efflux could cause the swelling. [ABSTRACT FROM AUTHOR]

The risk of thromboembolic pathologies increases in COVID-19 cases who have risk factors for poor prognosis and are prone to have a severe clinical course. Few cases of cerebral sinus vein thrombosis (CSVT) accompanying COVID-19 have been reported. We present a patient who developed CSVT during COVID-19 without a known risk factor for thrombosis but was found to have a genetic mutation of the prothrombin 20210 G/A gene, which is a congenital thrombophilia risk factor. We aim to emphasize the importance of investigating additional pathologies in thromboembolic events during COVID-19 in cases without known comorbidities. [ABSTRACT FROM AUTHOR]

We report a case with rare complication of cerebral venous thrombosis, as well as an incomplete response, after sigmoid sinus resurfacing surgery for pulsatile tinnitus (PT). A 24-year-old female patient with PT originating from the sigmoid sinus underwent sigmoid sinus resurfacing surgery. The tinnitus was immediately resolved, but it recurred with headache 5 days after surgery. A cerebral venous thrombosis was identified and treated, but PT persisted, although its frequency and loudness decreased. Sigmoid sinus resurfacing surgery is a safe and effective method to treat PT, but in some patients, it can cause serious complications and/or persistent tinnitus. In our patient, factors such as changes in blood viscosity due to warfarin intake or increased blood flow due to weight loss may have influenced the persistence of the tinnitus. It is important to identify the various associated factors and the weight of each of these factors to provide more tailored treatment of PT for individual patients in the future and to reduce complications and increase the effectiveness of sigmoid sinus resurfacing surgery. [ABSTRACT FROM AUTHOR]

Pure ventricular craniopharyngiomas in the pediatric population represent a challenge and it is always helpful to consider all the options based on the specific tumor and anatomic features. In this video, we present an interhemispheric transcallosal interforniceal approach achieving a great view of the tumor by opening the third ventricle from the anterior commissure all the way back to the junction of both internal cerebral veins with the vein of Galen.By Guillermo AldaveReported by Author [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the potential of the cerebral venous system in neurosurgery treatment. The study focuses on determining the internal cerebral vein (ICV) caliber at various points along its course, as the ICV is a practical vessel for supratentorial ventricular access and transvenous neuromodulation. The researchers used magnetic resonance venograms to measure ICV diameter in 102 patients. The results showed that the median ICV diameter was greatest at the inferior apex of the splenium, and the vessel diameter was >1.5 mm at the takeoff of the thalamostriate and just posterior to the massa intermedia vein. These findings will inform the feasibility of ventricular to deep cerebral vein shunting and the development of endovascular devices for neuromodulation procedures. [Extracted from the article]

This article, titled "Falcotentorial Meningiomas: Surgical Outcomes and the Importance of Deep Venous Preservation," discusses the surgical treatment and outcomes of falcotentorial meningiomas, which are rare tumors in the pineal region. The study analyzed the records of nine patients who underwent microsurgical resection of these tumors. The most common symptoms were memory loss, headache, personality changes, blurred vision, and impaired cognition. The study found that maximal safe resection could be achieved using specific surgical approaches, and preservation of the deep venous complex was crucial to avoid complications. The article also mentions the use of endoscopic-assistance during surgery. [Extracted from the article]

The Neonatal Intensive Care Unit (NICU) has a language and culture that is its own. For professionals, it is a place of intense and constant attention to microdetails and cautious optimism. For parents, it is a foreign place with a new and unique language and culture. It is also the setting in which they are introduced to their child and parenthood for this child. This combination has been referred to as an emotional cauldron. The neonatal ethics literature mainly examines complex ethical dilemmas about withholding/drawing life sustaining interventions for fragile children. Rarely are everyday ethics or mundane ethics discussed. Microethics describe the mundane, discrete moments that occur between patients/families and clinicians. A key piece of these microethics is the language used to discuss patient care. Perception of prognoses, particularly around long-term neurodevelopmental outcome, is shaped with the language used. Despite this, clinicians in the NICU often have no specific training in the long-term neurodevelopment outcomes that they discuss. This paper focuses on the microethics of language used to discuss long-term neurodevelopmental outcomes, the developmental neuroscience behind language processing, and offers recommendations for more accurate and improved communication around long-term outcomes with families with critically ill neonates. [ABSTRACT FROM AUTHOR]

Background and Objectives: The adult superficial middle cerebral vein (SMCV) commonly drains into the middle cranial fossa. However, different embryonic types persist, in which the SMCV drains into the lateral sinus. The basal type of SMCV coursing on the middle fossa floor is a scarce variant. Materials and Methods: During a retrospective study of archived computed tomography angiography (CTA) and magnetic resonance angiography (MRA) files, three rare adult cases of the basal or sphenopetrosal type of SMCV were found and further documented. Results: In the first case, which was evaluated via CTA, the basal type of SMCV formed a sagittal loop. It continued on the middle fossa floor, over a dehiscent tegmen tympani, to drain into the lateral sinus. In the second case, documented via MRA, the basal type of SMCV's anterior loop was in the coronal plane and closely related to the internal carotid artery and the cavernous sinus. It continued with the basal segment over a dehiscent glenoid fossa of the temporomandibular joint (TMJ). In the third case, documented via CTA, the initial cerebral part of the SMCV had a large fenestration. The middle fossa floor coursed within a well-configured sulcus of the SMCV and received a tributary through the tympanic roof. Its terminal had a tentorial course. Conclusions: Beyond the fact that such rare variants of the SMCV can unexpectedly interfere with specific approaches via the middle fossa, dehiscences of the middle fossa floor beneath such variants can determine otic or TMJ symptoms. Possible loops and fenestrations of the SMCV should be considered and documented preoperatively. [ABSTRACT FROM AUTHOR]

Quantifying the effects of free breathing on cerebral venous flow is crucial for understanding cerebral circulation mechanisms and clinical applications. Unlike conventional cine phase-contrast MRI sequences (CINE-PC), real-time phase-contrast MRI sequences (RT-PC) can provide a continuous beat-to-beat flow signal that makes it possible to quantify the effect of breathing on cerebral venous flow. In this study, we examined 28 healthy human participants, comprising of 14 males and 14 females. Blood flows in the right/left internal jugular veins in the extracranial plane and the superior sagittal sinus (SSS) and straight sinus in the intercranial plane were quantified using CINE-PC and RT-PC. The first objective of this study was to determine the accuracy of RT-PC in quantifying cerebral venous flow, relative to CINE-PC. The second, and main objective, was to quantify the effect of free breathing on cerebral venous flow, using a time-domain multiparameter analysis method. Our results showed that RT-PC can accurately quantify cerebral venous flow with a 2 x 2 mm² spatial resolution and 75 ms/image time resolution. The mean flow rate, amplitude, stroke volume, and cardiac period of cerebral veins were significantly higher from the mid-end phase of expiration to the mid-end phase of inspiration. Breathing affected the mean flow rates in the jugular veins more than those in the SSS and straight sinus. Furthermore, the effects of free breathing on the flow rate of the left and right jugular veins were not synchronous. These new findings provide a useful reference for better understanding the mechanisms of cerebral circulation. [ABSTRACT FROM AUTHOR]

Simple Summary: Traumatic brain injuries, a primary global health concern, can lead to severe disabilities. Acute subdural haematoma is one type of traumatic brain injury resulting from the rupture of bridging veins in the brain. Existing numerical models often oversimplify these structures. This study's main goals were to understand how the cerebral vein's cross-sectional shape affects its response, more akin to real-life testing, and to introduce a hyperelastic model for these veins that captures their non-linear behaviour. The results reveal that the vein's shape significantly influences its response to stretching, highlighting the need for more realistic geometries in modelling. Additionally, hyperelastic models, like the Marlow and polynomial models, were successfully implemented. This research provides valuable insights into the mechanical properties of bridging veins and their response to tensile loading, potentially improving our understanding of traumatic brain injuries. Traumatic brain injury (TBI) is a serious global health issue, leading to serious disabilities. One type of TBI is acute subdural haematoma (ASDH), which occurs when a bridging vein ruptures. Many numerical models of these structures, mainly based on the finite element method, have been developed. However, most rely on linear elasticity (without validation) and others on simplifications at the geometrical level. An example of the latter is the assumption of a regular cylinder with a constant radius, or the geometry of the vein acquired from medical images. Unfortunately, these do not replicate the real conditions of a mechanical tensile test. In this work, the main goal is to evaluate the influence of the vein's geometry in its mechanical behaviour under tensile loading, simulating the real conditions of experimental tests. The second goal is to implement a hyperelastic model of the bridging veins where it would be possible to observe its non-linear elastic behaviour. The results of the developed finite element models were compared to experimental data available in the literature and other models. It was possible to conclude that the geometry of the vein structure influences the tensile stress–strain curve, which means that flattened specimens should be modelled when validating constitutive models for bridging veins. Additionally, the implementation of hyperelastic material models has been verified, highlighting the potential application of the Marlow and reduced polynomial (of fourth and sixth orders) constitutive models. [ABSTRACT FROM AUTHOR]

We describe our findings in a child with a vein of Galen malformation, in whom the right superior caval and the azygos veins drained into the roof of the morphologically left atrium. A persistent left superior caval vein drained into the morphologically right atrium through the coronary sinus. The additional presence of dual brachiocephalic veins permitted the deployment of a multifunctional ventricular septal defect occluder device to occlude the right superior caval vein, correcting the right-to-left shunt. This also prevented azygos venous drainage into the left atrium. [ABSTRACT FROM AUTHOR]

Cerebral venous oxygenation (Y v) is a key parameter for the brain's oxygen utilization and has been suggested to be a valuable biomarker in various brain diseases including hypoxic ischemic encephalopathy in neonates and Alzheimer's disease in older adults. T 2 -Relaxation-Under-Spin-Tagging (TRUST) MRI is a widely used technique to measure global Y v level and has been validated against gold-standard PET. However, subject motion during TRUST MRI scan can introduce considerable errors in Y v quantification, especially for noncompliant subjects. The aim of this study was to develop an Automatic Rejection based on Tissue Signal (ARTS) algorithm for automatic detection and exclusion of motion-contaminated images to improve the precision of Y v quantification. TRUST MRI data were collected from a neonatal cohort (N = 37, 16 females, gestational age = 39.12 ± 1.11 weeks, postnatal age = 1.89 ± 0.74 days) and an older adult cohort (N = 223, 134 females, age = 68.02 ± 9.01 years). Manual identification of motion-corrupted images was conducted for both cohorts to serve as a gold-standard. 9.3% of the images in the neonatal datasets and 0.4% of the images in the older adult datasets were manually identified as motion-contaminated. The ARTS algorithm was trained using the neonatal datasets. TRUST Y v values, as well as the estimation uncertainty (ΔR 2) and test-retest coefficient-of-variation (CoV) of Y v , were calculated with and without ARTS motion exclusion. The ARTS algorithm was tested on datasets of older adults: first on the original adult datasets with little motion, and then on simulated adult datasets where the percentage of motion-corrupted images matched that of the neonatal datasets. In the neonatal datasets, the ARTS algorithm exhibited a sensitivity of 0.95 and a specificity of 0.97 in detecting motion-contaminated images. Compared to no motion exclusion, ARTS significantly reduced the ΔR 2 (median = 3.68 Hz vs. 4.89 Hz, P = 0.0002) and CoV (median = 2.57% vs. 6.87%, P = 0.0005) of Y v measurements. In the original older adult datasets, the sensitivity and specificity of ARTS were 0.70 and 1.00, respectively. In the simulated adult datasets, ARTS demonstrated a sensitivity of 0.91 and a specificity of 1.00. Additionally, ARTS significantly reduced the ΔR 2 compared to no motion exclusion (median = 2.15 Hz vs. 3.54 Hz, P < 0.0001). ARTS can improve the reliability of Y v estimation in noncompliant subjects, which may enhance the utility of Y v as a biomarker for brain diseases. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral venous thrombosis (CVT) is a thromboembolic disease of the intracranial venous systems. The disease can be difficult to diagnose as it often requires a high index of suspicion. Risk factors for the disease include pregnancy, oral contraceptive pills, congenital thrombophilia, infection, cancer, polycythemia, head trauma, and recent surgery. However, there have been no studies in the United States that have examined whether pregnancy and the postpartum stage are truly a risk factor for CVT. The aim of this study is to determine whether pregnant and postpartum women presenting to the emergency department with headaches have a higher incidence of CVT to better risk stratify which patients need to have advanced imaging pursued. Methods: A retrospective, observational case--control study was performing by querying the electronic medical record at a large county hospital for patients presenting with a headache to the emergency department. Patients were stratified into groups based on whether they were diagnosed with CVT, pregnancy status, and comorbid conditions to determine the risk associated between pregnancy, the puerperium stage, and CVT. Results: A total of 20,955 males and females presented to the emergency department between January 1, 2016 and April 13, 2023, with a chief complaint of headache. There were 19,474 female patients and 9581 male patients. In the case group, there were 793 pregnant women and 53 postpartum women. In the control group, there were 18,628 women who were not pregnant. Of the 22 patients diagnosed with CVT, 1 was in the puerperium stage and no patients were pregnant. Pregnant and postpartum patients were 1.05 (0.14-7.80) times more likely to develop CVT. Pregnant and postpartum patients were 1.73 (0.23-13.52) times more likely to develop CVT when controlled for comorbidities. Patients in the puerperium stage were 26.48 (3.33-210.87) times more likely to develop CVT when controlled for comorbidities. Conclusion: Pregnant patients presenting to the emergency department with headaches do not have a significantly higher risk of CVT; however, puerperium patients have a significantly higher risk of CVT compared to the general population. [ABSTRACT FROM AUTHOR]