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BACKGROUND The COWs is a vascular anastomosis situated near the base of the brain. The association between structural changes in the COW & cerebral infarction is contentious. Aim of our study was “to evaluate the association between anatomical variations in the COWs & occurrence of different patterns of brain infarct”. MATERIAL & METHODS The present cross-sectional study was conducted at Department of Radiology of a tertiary care center among 500 patients of suspected cerebrovascular accidents during the study period of one year. Complete history of patients was taken. The following variations in the COW on MRA were recorded: pfPCA, cfPCA & aplasia or hypoplasia of PCoA. The statistical analysis was conducted using SPSS version 25.0. RESULTS 240 (48%) had infarction while 260 (52%) patients did not have infarction. fPCA was present in 50 (20.8%) patients while aplasia or hypoplasia of communicating artery was present in 182 (75.8%) of patients. Subgroup analysis of the infarcted territory indicated no significant difference between those with & without fPCA & hypoplasia of PCoA. No significant association was found between fPCA & hypoplasia of PCoA & clinical danger factors of CVD in patients with infarction. CONCLUSION This study demonstrated no significant relationship between particular changes in the COW but gives a sign of vulnerability to silent cerebral vascular infarction. [ABSTRACT FROM AUTHOR]

Abstract Background The relationship between anatomical variations in circle of Willis and brain infarction is controversial. The purpose of this study was to evaluate the relationship between anatomical variations in posterior portion of the circle of Willis assessed by MR angiography (MRA) and ischemic infarction in different brain territories. Methods This cross-sectional study was conducted on consecutive patients who underwent brain MRI and MRA for suspected cerebrovascular accident. The frequency of anatomical variations including persistent fetal origin of posterior cerebral artery (fPCA) and hypoplastic/aplastic posterior communicating artery (PCoA) and their association with infarction in different intracranial vascular territories was assessed. Results In total, 298 patients (155 male/143 female with mean age ± SD of 57 ± 15) were enrolled in the study and categorized into two groups with infarction (n = 142) and without infarction (n = 156). Sixty-three patients (21/1%) had fPCA and 231 (77.5%) had PCoA hypoplasia/aplasia. No significant correlation was identified between fPCA or PCoA hypoplasia/aplasia and presence of infarction. However, regarding the territories involved by infarction, the frequency of thalamus infarction was higher in subgroup with PCoA hypoplasia/aplasia, 17/101 (16.8%) compared to 1/41(2.4%) in the subgroup without ipsilateral PCoA hypoplasia/aplasia (p = 0.024). In two subgroups with and without ipsilateral fPCA variation, frequency of infarction in brain territories was not different significantly. Conclusions In patients with brain infarction, aplastic/hypoplastic ipsilateral PCoA is associated with higher incidence of thalamic territory infarction.

Carpal tunnel syndrome is a common peripheral nerve entrapment neuropathy caused due to compression of the median nerve at the level of the wrist joint. Bifid median nerve associated with a persistent median artery is a rare entity and in itself asymptomatic anatomical variant. However, distension of the persistent median artery due to a thrombus can be symptomatic due to compression on the median nerve and can compromise the blood flow to the palm. We report a case of persistent median artery thrombosis in a young female patient who presented with symptoms of carpal tunnel syndrome diagnosed on the ultrasonography and confirmed on the MRI with subsequent improvement post anticoagulation therapy.

Background: The relationship between anatomical variations in circle of Willis and brain infarction is controversial. The purpose of this study was to evaluate the relationship between anatomical variations in posterior portion of the circle of Willis assessed by MR angiography (MRA) and ischemic infarction in different brain territories. Methods: This cross-sectional study was conducted on consecutive patients who underwent brain MRI and MRA for suspected cerebrovascular accident. The frequency of anatomical variations including persistent fetal origin of posterior cerebral artery (fPCA) and hypoplastic/aplastic posterior communicating artery (PCoA) and their association with infarction in different intracranial vascular territories was assessed. Results: In total, 298 patients (155 male/143 female with mean age ± SD of 57 ± 15) were enrolled in the study and categorized into two groups with infarction (n = 142) and without infarction (n = 156). Sixty-three patients (21/1%) had fPCA and 231 (77.5%) had PCoA hypoplasia/aplasia. No significant correlation was identified between fPCA or PCoA hypoplasia/aplasia and presence of infarction. However, regarding the territories involved by infarction, the frequency of thalamus infarction was higher in subgroup with PCoA hypoplasia/aplasia, 17/101 (16.8%) compared to 1/41(2.4%) in the subgroup without ipsilateral PCoA hypoplasia/aplasia (p = 0.024). In two subgroups with and without ipsilateral fPCA variation, frequency of infarction in brain territories was not different significantly. Conclusions: In patients with brain infarction, aplastic/hypoplastic ipsilateral PCoA is associated with higher incidence of thalamic territory infarction. [ABSTRACT FROM AUTHOR]

Vagal paragangliomas are rare tumors. Advances in the imaging have aided the diagnosis and assessment of this disease. Surgery is the mainstay of the treatment however radiotherapy has been tried in the selected cases. Surgery is associated with some mortality but with a lot of morbidity in view of cranial nerve deficit. The necessity to prevent additional cranial nerve deficits needs thorough preoperative evaluation and influences the therapeutic approach. This study involves the retrograde evaluation of five patients of vagal paraganglioma histopathologically confirmed, all the patients were operated via trancervical approach. Preoperatively three of five had 9, 11 and 12th cranial nerve involvement, one had horner's syndrome. Postoperative vocal rehabilitation was done in all the patient by medialisation thyroplasty Issiki type 1. Though vagal paragangliomas are associated with mortality and morbidity. Surgical treatment should aim at reducing mortality. Vagal nerve morbidity can be taken care as a planned and staged procedure mainly involving restoring voice as rest of concerns are taken care by compensation from opposite nerves. [ABSTRACT FROM AUTHOR]

Purpose: To develop a quantitative intracranial artery measurement technique to extract comprehensive artery features from time‐of‐flight MR angiography (MRA). Methods: By semiautomatically tracing arteries based on an open‐curve active contour model in a graphical user interface, 12 basic morphometric features and 16 basic intensity features for each artery were identified. Arteries were then classified as one of 24 types using prediction from a probability model. Based on the anatomical structures, features were integrated within 34 vascular groups for regional features of vascular trees. Eight 3D MRA acquisitions with intracranial atherosclerosis were assessed to validate this technique. Results: Arterial tracings were validated by an experienced neuroradiologist who checked agreement at bifurcation and stenosis locations. This technique achieved 94% sensitivity and 85% positive predictive values (PPV) for bifurcations, and 85% sensitivity and PPV for stenosis. Up to 1,456 features, such as length, volume, and averaged signal intensity for each artery, as well as vascular group in each of the MRA images, could be extracted to comprehensively reflect characteristics, distribution, and connectivity of arteries. Length for the M1 segment of the middle cerebral artery extracted by this technique was compared with reviewer‐measured results, and the intraclass correlation coefficient was 0.97. Conclusion: A semiautomated quantitative method to trace, label, and measure intracranial arteries from 3D‐MRA was developed and validated. This technique can be used to facilitate quantitative intracranial vascular research, such as studying cerebrovascular adaptation to aging and disease conditions. Magn Reson Med 79:3229–3238, 2018. © 2017 International Society for Magnetic Resonance in Medicine. [ABSTRACT FROM AUTHOR]

Background: Microvascular decompression is an accepted treatment for primary trigeminal neuralgia. In recent years, efforts have been made to investigate the role of preoperative MRI/MRA in selecting patients with neurovascular compression. Methods: Ninety-two consecutive patients underwent a standard retrosigmoid craniotomy for microvascular decompression between 2005 and 2009, of whom 67 had a preoperative MRI and MRA according to the protocol of our department. Operative findings were accurately recorded and compared to MRI/MRA results. Follow-up was in the form of telephone interview. Results: Preoperative MRI sensitivity was 96%, while specificity was 75% (1 false positive among 4 patients with negative intra-operative findings). The predictive value of a positive MRI/MRA was 98%, while the predictive value of a negative MRI/MRA was 50%. Fifty-four patients were available for outcome assessment at a mean follow-up of 3.8 years (range 1-5). Seventy-two percent of patients were pain-free, 9.5% had mild residual pain, while 18.5% had a poor outcome (moderate to severe residual pain). The correlation between preoperative MRI/MRA and outcome was not statistically significant ( P = 0.570). Conclusions: Preoperative MRI has both good sensitivity and positive predictive value. Specificity and negative predicitve value were limited in this series. No correlation was found between preoperative imaging and outcome. Both radiological and clinical criteria are important for patient selection. [ABSTRACT FROM AUTHOR]

Abstract: Posterior communicating artery (PCoA) hypoplasia is a fetal variant of the Circle of Willis. According to angiograms and autopsy reports, this congenital variation is found in 6–21% of the general population. PCoA hypoplasia only becomes a risk factor for ischemic stroke in the presence of ipsilateral internal carotid artery (ICA) occlusion. The aim of our study was to determine the role of PCoA hypoplasia in acute ischemic stroke in the absence of ICA occlusion. We examined 310 acute ischemic stroke patients (mean age±standard deviation; 68.9±15.6 years). Cerebral magnetic resonance angiography was performed within 72 hours of ischemic stroke onset. For comparison, a risk factor-matched control group was recruited. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) to estimate the independent effect of potential risk factors. The overall incidence of PCoA hypoplasia in our experimental group was 19.35% (n =60), which was significantly higher than in the control group (8.20%, n =22, p =0.036, OR, 3.21; 95% CI, 1.43–9.62). The most common ischemic event was ipsilateral thalamic lacunar infarctions with or without occipital lobe involvement. Based on our results, PCoA hypoplasia appears to be a contributor to the risk of ischemic stroke, even in the absence of ICA occlusion. This risk is especially pronounced for strokes involving arteries that penetrate the thalamus. [Copyright &y& Elsevier]

Anterior cerebral artery A1 segment hypoplasia is an uncommon fetal variant of the circle of Willis. The frequency of this congenital variation is 1–13% as derived from angiograms and autopsy reports. Impaired collateral blood flow through the circle of Willis is a recognized risk factor for ischemic stroke. The A1 segment of the anterior cerebral artery is a principal supplier of anterior collateral blood flow. The aim of our study was to determine whether A1 segment hypoplasia may be responsible for acute ischemic stroke. We consecutively examined 280 acute ischemic stroke patients (aged 66.9 ± 14.2 years). Cerebral magnetic resonance angiography was performed within 72 h of ischemic stroke onset. The overall incidence of A1 variation in our experimental group was 15.0% (n = 42, agenesis/hypoplasia = 18/24), which was statistically higher than in the control group (n = 12). The majority (n = 30, 71.42%) had ipsilateral striatal lacunar infarctions. Based on our results, A1 agenesis/hypoplasia appears to be a risk factor contributing to ischemic stroke, especially to strokes in arteries penetrating the striatal area. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

A 16-year-old male patient with hereditary multiple exostoses (HME) was found to have a pseudoaneurysm of the left popliteal artery caused by osteochondroma in the lower femur. The diagnosis was confirmed by ultrasound, magnetic resonance imaging and magnetic resonance angiography without the need to perform an angiogram. The osteochondroma was excised and the popliteal artery was repaired with a saphenous graft. Vascular complications are extremely rare in HME, pseudoaneurysm being the most common and mostly located in the popliteal artery. This complication should be considered in young HME patients with a mass at the knee region. The radiological spectrum of investigations allows the diagnosis of this complication with proper and less invasive management procedures for the patient. [ABSTRACT FROM AUTHOR]

Hypothenar hammer syndrome is a rare but serious cause of digital ischemia and morbidity. Presented here is a case of a manual laborer who had symptoms of digital ischemia after acute hyperextension injury to the ring finger. Magnetic resonance imaging revealed thrombosed ulnar artery aneurysm. Etiology, presentation, and current treatments are reviewed.