Stroke and intracranial interventions

Can interventions for Intracranial vascular disease prevent stroke better than medical therapies?

Carotid artery disease is recognized as a predisposing factor for the stroke in the diabetic or elderly hypertensive patients. The stroke in such patients is prevented by medical therapies and interventions. Segmental extra cranial carotid artery disease is amenable for endarterectomy or angioplasty stenting. But the intracranial vascular disease is not easily amenable for the operations or interventions. After succeeding with angioplasty and stenting of the extra cranial vessels the attention is now focused on the intracranial vascular repairs with angioplasty and stenting. The intracranial vessels are small and delicate. They can need much more careful handling and softer devices to pass through them and at the same time hard enough to dilate stenotic lesions.The 30-day rate of stroke or death associated with stenting in the SAMMPRIS trial (14.7%) is nearly 2.5 times as high as the 6% rate associated with stenting of symptomatic extracranial carotid-artery stenoses in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST, NCT00004732).

Large vessels with wall inflammation may have symptoms such as fever and body pains. These symptoms may be present even before the development of vascular dilatation or occlusions. MRI and CT scan may show the vascular wall thickness but PET CT ( FDG scan) can show the metabolically active endothelium.

Large Carotid body Tumors - Neurovascular importance

Subclavian artery thrombosis extending in to the Thoracic Aorta

Pulsatile swelling in the forearm

A middle aged man presented with pulsatile swelling in the upper part of the right forearm. There was no history of trauma. There were no dilated pulsatile veins. Radial and ulnar arteries were palpable at the wrist. Duplex scan reported it as a vascular tumor. The Spiral CT angiogram showed lesion arising from the proximal 1/3 of the radial artery. Abnormal dilatations connected with normal radial artery. The picture was not typical of aneurysm. During surgery mass looking like thrombosed aneurysm was completely excised and sent for histopathological examination. The report came as Masson's hemangioma (benign condition) and complete excision is the curative treatment.

AP BlackBerry Client: WHO: Blood tests for tuberculosis are unreliable

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WHO: Blood tests for tuberculosis are unreliable
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Tuberous sclerosis is a group of two genetic disorders that affect the skin, brain/nervous system, kidneys, and heart, and cause tumors to grow. The diseases are named after a tuber- or root-shaped growth in the brain. Recently we have seen a young boy with acute ischemia of the left upper limb due to obstruction starting at the level of left axillary artery. Distally the vessel is diffusely narrowed. Incidentally we have noted abnormalities in the bones and face suggestive of tuberous sclerosis .  We evaluating the brain, kidneys, heart for any associated tumors.

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