Hemangioblastomas (HBMs) are rare vascular tumors commonly located in the posterior fossa of adults. A mid-50s patient presented with sudden unconsciousness. Computed tomography scans revealed acute hemorrhages around the posterior fossa, predominantly in the subarachnoid space. Digital subtraction angiography (DSA) revealed an 8-mm round lesion filled with contrast agent, fed by the C1 segmental artery of the left vertebral artery (VA), showing early venous drainage to the spinal cord and brainstem. Emergent embolization was attempted under suspicion of a ruptured dural arteriovenous fistula, resulting in parent artery occlusion due to feeder selection failure. Follow-up DSA after a month depicted a persistent aneurysm via collaterals from both VAs. Consequently, the decision was made to proceed with surgical intervention, leading to the resection of the lesion, confirming its diagnosis as a HBM through histological examination. This case underscores the potential for misdiagnosis when HBMs with an intratumoral shunt mimic vascular shunt lesions.
Hemorrhagic transformation (HT) represents a critical complication of reperfusion therapy, often resulting in unfavorable functional outcomes. Our objective was to explore the correlation between endothelial function, assessed through flow-mediated dilation (FMD), and the occurrence of HT in patients undergoing acute reperfusion therapy.
Background: The hyperintense acute reperfusion marker (HARM) sign is a hyperintense signal observed on postcontrast fluid-attenuated recovery inversion images and is strongly associated with cerebral ischemic insults. The clinical significance of the HARM sign in transient ischemic attack (TIA) has rarely been studied, unlike that in stroke. This study investigated the relationship between the HARM sign and various clinical factors in diffusion-weighted imaging (DWI)-negative TIA. Furthermore, we investigated the relationship between the HARM sign with recurrence of TIA and ischemic stroke. Methods: We included 329 consecutive patients with DWI-negative TIA and divided them into two groups according to the HARM sign: 299 patients in the HARM(-) group and 30 patients in the HARM(+) group. Clinical information, brain imaging, and follow-up data were gathered from medical records and phone calls and compared using the HARM sign. Results: The patients with HARM sign were older (70.7 vs. 64.4 years, p = 0.007), had more previous TIA or stroke history within 12 months (26.7% vs. 4.0%, p < 0.001), and had higher systolic blood pressure (154.3 vs. 144.1, p = 0.022). The HARM(+) group also had a shorter symptom duration of <1 hour (63.3% vs. 38.8%, p = 0.009) and more symptomatic stenosis (50–99%) or occlusion (60.0% vs. 14.0%, p < 0.001). Among the transient neurological symptoms, only cortical symptoms were more prevalent in the HARM(+) group (30.0% vs. 8.7%, p = 0.002). The total follow-up duration of both groups was similar, and the Kaplan-Meier analysis showed a higher cumulative incidence of recurrent stroke in the HARM(+) group (log-rank test, p = 0.007). However, multivariate Cox analysis indicated that symptomatic stenosis or occlusion, rather than the HARM sign, was independently associated with stroke recurrence. Conclusion: The HARM sign in DWI-negative TIA patients is linked to older age, recent cerebrovascular events, shorter symptom duration, and large artery stenosis or occlusion. While the HARM sign correlates with higher recurrence of ischemic stroke, large artery stenosis or occlusion is the primary independent predictor.
Vascular complications are extraintestinal manifestations of ulcerative colitis. Although there has been some controversy regarding the association between ulcerative colitis and stroke, hypercoagulability and systemic inflammation are thought to be possible factors contributing to stroke pathogenesis. Herein, we report a case of recurrent ischemic stroke with significant arterial stenosis. Cerebral vasculitis was suggested in high-resolution magnetic resonance vessel wall imaging (VWI) and marked improvement was confirmed by follow-up VWI after steroid treatment. This case suggests that VWI can be a useful tool to diagnose cerebral vasculitis and evaluate therapeutic effect.
The monkeypox is an unusual viral disease which, until recently, has rarely been detected outside of Africa. Approximately over 70,000 laboratory-verified or suspected cases of human monkeypox have been discovered in at least 107 countries in a matter of months. A total of 71,237 laboratory confirmed cases, 1,097 probable cases, and 26 related deaths regarding the monkeypox were confirmed worldwide up to October 6th, 2022. Among the six World Health Organization regions, the Americas demonstrated the highest total laboratory-confirmed monkeypox cases (45,342 cases), followed by the European Region (24,889 cases), the African Region (727 cases), the Western Pacific Region (189 cases), the Eastern Mediterranean Region (67 cases), and the South-East Asia Region (23 cases). The nation with the highest cumulative monkeypox cases was the United States of America (26,723 cases), followed by Brazil (8,147 cases), Spain (7,209 cases), France (4,043 cases), The United Kingdom (3,654 cases), and Germany (3,640 cases). This international and comprehensive review, through analysis of the types and differences among the virus, the reason of its epidemic, and current available vaccines, aims to provide crucial information needed for monkeypox research and enhance global health policies in an individual- and country-level strategies towards the treatment of monkeypox.
Background Digital health care apps have been widely used for managing chronic conditions such as diabetes mellitus and hypertension, providing promising prospects for enhanced health care delivery, increased patient engagement, and improved self-management. However, the impact of integrating these apps within hospital systems for managing such conditions still lacks conclusive evidence. Objective We aimed to investigate the real-world effectiveness of using hospital-linked digital health care apps in lowering blood pressure (BP) and blood glucose levels in patients with hypertension and diabetes mellitus. Methods Nationwide multicenter data on demographic characteristics and the use of a digital health care app from 233 hospitals were collected for participants aged 20 to 80 years in South Korea between August 2021 and June 2022. We divided the participants into 2 groups: 1 group consisted of individuals who exclusively used the digital health app (control) and the other group used the hospital-linked digital health app. All the patients participated in a 12-week digital health care intervention. We conducted a comparative analysis to assess the real-world effectiveness of the hospital-linked digital health app. The primary outcome was the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) level, and postprandial glucose (PPG) level between baseline and 12 weeks. Results A total of 1029 participants were analyzed for the FBG level, 527 participants were analyzed for the PPG level, and 2029 participants for the SBP and DBP were enrolled. After 12 weeks, a hospital-linked digital health app was found to reduce SBP (−5.4 mm Hg, 95% CI −7.0 to −3.9) and DBP (−2.4 mm Hg, 95% CI −3.4 to −1.4) in participants without hypertension and FBG level in all participants (those without diabetes, −4.4 mg/dL, 95% CI −7.9 to −1.0 and those with diabetes, −3.2 mg/dL, 95% CI −5.4 to −1.0); however, there was no statistically significant difference compared to the control group (using only digital health app). Specifically, participants with diabetes using a hospital-linked digital health app demonstrated a significant decrease in PPG after 12 weeks (−10.9 mg/dL, 95% CI −31.1 to −5.3) compared to those using only a digital health app (P=.006). Conclusions Hospital-linked digital interventions have greatly improved glucose control for diabetes compared with using digital health technology only. These hospital-linked digital health apps have the potential to offer consumers and health care professionals cost-effective support in decreasing glucose levels when used in conjunction with self-monitoring.
After carotid artery angioplasty with stenting (CAS), it is unclear which risk factors are related to long-term outcomes, including in-stent restenosis (ISR). This study aimed to assess the factors associated with restenosis after CAS with a median follow-up of 35.7 months.
Abstract Background The hyperintense acute reperfusion marker (HARM) sign is a hyperintense signal observed on postcontrast fluid-attenuated recovery inversion images and is strongly associated with cerebral ischemic insults. The clinical significance of the HARM sign in transient ischemic attack (TIA) has rarely been studied, unlike that in stroke. This study investigated the association between the HARM sign and clinical factors of diffusion-weighted imaging (DWI)-negative TIA, and the relationship between the HARM sign and recurrence of TIA and ischemic stroke. Methods We included 329 consecutive patients with DWI-negative TIA and divided them into two groups according to the HARM sign: 299 patients in the HARM(-) group and 30 patients in the HARM(+) group. Clinical information, brain imaging and follow-up data were collected from medical records and phone calls, and compared using HARM sign. Results The HARM(+) patients were older and had higher systolic blood pressure, shorter symptom duration, and more frequent history of recent TIA or stroke and symptomatic artery stenosis or occlusion. Multivariate logistic regression revealed that recent TIA or stroke within 12 months (OR 6.623), symptom duration under 1 hour (OR 2.735), and relevant artery stenosis or occlusion (OR 2.761) were independently associated with the HARM sign. Cortical symptoms including aphasia were more prevalent in the HARM(+) group. During follow-up, HARM(+) patients showed higher recurrence rates of ischemic stroke (13.3% vs. 3.0%, p = 0.023). However, multivariate Cox analysis indicated that symptomatic stenosis or occlusion, rather than the HARM sign, was independently associated with stroke recurrence. Conclusion The HARM sign in DWI-negative TIA patients is linked to older age, recent cerebrovascular events, shorter symptom duration, and large artery stenosis or occlusion. While the HARM sign correlates with higher recurrence of ischemic stroke, large artery stenosis or occlusion is the primary independent predictor.
Abstract Background Stroke is rarely accompanied with peripheral facial paralysis and supranuclear palsy of the hypoglossal nerve. Both sides of the motor cortex innervate the hypoglossal nucleus; therefore, unilateral lesions of the upper motor neurons rarely result in contralateral lingual paresis. We report a rare case of crossed syndrome with associated hyperacute peripheral hemifacial paralysis and contralateral lingual paresis after a lower pontine tegmentum ischemic stroke. Case presentation : A 73-year-old man presented with symptoms of hyperacute peripheral hemifacial paralysis. Upon protrusion, the patient’s tongue deviated to the contralateral side, without fasciculation or atrophy. Brain imaging showed focal ischemic stroke in the pontine tegmentum. However, lingual hemiparesis and multimodal neuroimaging findings differed. Conclusions We suggest that cortico-hypoglossal fibers pass through the dorsal pontine. This case of crossed syndrome is a rare report of a lower pontine tegmentum ischemic stroke resembling an upper motor neuron lesion of the contralateral hypoglossal nerve.
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