Branches Of Left Middle Cerebral Artery Research Articles

Computer Modeling of Clot Retrieval-Circle of Willis.

Endovascular clot retrieval, often referred to as mechanical thrombectomy, has transformed the treatment of patients with ischemic stroke based on an underlying large cerebral vessel occlusion, ranging from the extracranial internal carotid artery (ICA) to the M1 (proximal) segment of the middle cerebral artery (MCA). The aim of this study was to evaluate the effect of a progressive occlusion of the extracranial portion of the ICA on the cerebral blood flow either with a conventional guiding catheter or a balloon-guiding catheter, which enables the operator to completely occlude the parent artery by inflating the balloon around the tip of this type of guiding catheter. We evaluated the impact of flow reduction in the ICA in the setting of ipsilateral MCA occlusion given the different configurations of the circle of Willis (CoW). The computer model of cerebral arteries was based on anatomical works by Rhoton (1) and van der Eecken (2). The interactive experimental results are available on the web at https://gntem3.shinyapps.io/ecrsim. In the setting of left MCA occlusion, compensation from the anterior and posterior communicating artery preserved the flow in the left anterior cerebral artery (ACA) but not the left MCA branches. Under selected CoW configurations, such as classic, missing Acom, or missing A1 segment of the ACA and concurrent right ICA occlusion, there was a progressive decrease of flow in the left ACA to a minimum of 78% when the simulated catheter fully occluded the left ICA. Flow collapsed (<10%) in the left ACA and MCA branches under CoW configurations, such as bilateral fetal PCA. In summary, compensatory flow collapsed under certain clot retrieval scenarios and unusual configurations of CoW.

妊娠１８週で遺伝子組み換え組織プラスミノゲンアクチベーター（ｒｅｃｏｍｂｉｎａｎｔ ｔｉｓｓｕｅ ｐｌａｓｍｉｎｏｇｅｎ ａｃｔｉｖａｔｏｒ：ｒｔ−ＰＡ）静注療法を施行された脳塞栓症の１例

We are reporting a 36 year-old woman, gravid 3, para 1, aborta 2, who was 18 weeks pregnant and developed a sudden onset of motor aphasia and hemiparesis on the right side. On the initial visit to our hospital, the NIH stroke scale was 6, and the brain MRI revealed high intensity areas in the left insular cortex and the periventricular white matter with occlusion of the left middle cerebral artery (MCA) branches. We diagnosed her as having cerebral embolism, and treated with intravenous recombinant tissue plasminogen activator (rt-PA) with subsequent recanalization of the occuluded left MCA branches. Her motor aphasia and hemiparesis disappeared within a few hours of initiating the therapy. She received aspirin for four months and then heparin until delivery to prevent recurrence. She delivered a healthy term infant without any apparent complications. An 18-week pregnancy itself is not considered a risk factor of stroke, and we ruled out the possibilities of dysfibrinogenemia, homocysteinemia, hereditary or acquired deficiencies of protein C, protein S, and antithrombin III deficiencies, and antiphospholipid antibody syndrome. However, her plasma factor VIII level was significantly elevated to more than 200% (reference for 18-week pregnant woman: 151 +/- 44%), which may have led to her acquired activated protein C resistance or hypercoagulability. As safety of thrombolytic therapy with rt-PA during pregnancy has not been established, this therapy could be carefully used upon due consideration of risks and benefits for both mother and fetus.

Pathological crying and laughing: Treatment with sertraline

Objective: To evaluate the efficacy of sertraline for treating pathological laughing and crying after stroke. Design: Case series. Setting: Inpatient rehabilitation units of a community and a tertiary-care hospital. Patients: One patient was a 62-year-old right-handed man who had two strokes approximately 2 years apart and had computed tomography consistent with a cerebral infarct involving the left middle cerebral artery branches in the left parietal lobe. A second patient was a 72-year-old right-handed man who had a right middle cerebral artery infarct. He had a questionable history of depression prior to the stroke. Intervention: Both patients had poststroke labile affect that was interfering with their rehabilitation. Sertraline was prescribed. Main Outcome Measures: Pretreatment and posttreatment scores on the Pathological Crying and Laughing Scale and Functional Independent Measure. Results: Both patients showed significant improvement after taking sertraline—improvement that was reflected in their pretreatment and posttreatment scores on the Pathological Crying and Laughing Scale and Functional Independent Measure. The staff noted improvements in sleeping, eating, social interaction, and therapy participation. Both patients tolerated the sertraline well and had no significant side effects.

Contralateral reperfusion injury after carotid endarterectomy

Reperfusion brain edema occurs infrequently after carotid endarterectomy and has been reported only ipsilateral to the side of surgery. We report a 51-year-old woman who presented with transient right arm weakness followed by left hemiparesis. Angiography showed occlusion of the left internal carotid artery, 90% stenosis of the right internal carotid artery, filling of the left anterior cerebral artery from the right carotid circulation only, and filling of the left middle cerebral artery branches by pial collaterals from the left anterior cerebral and posterior cerebral arteries. The patient had a right carotid endarterectomy and 1 day postoperatively developed a severe headache but had no new focal neurologic findings. Computed tomography showed effacement of sulci and scattered areas of high attenuation in the left parietal lobe, consistent with cerebral edema and petechial hemorrhage or vascular engorgement. Magnetic resonance imaging 2 days later did not show a lesion in the left hemisphere, suggesting resolution of the edema. This report suggests that reperfusion brain edema can occur contralateral to carotid endarterectomy.

Right vs. left hemispheric blood-brain barrier permeability in schizophrenia: A dynamic computed tomographic study

Dynamic computerized tomographic brain scanning was used to make determinations of mean cerebral tissue nonenhanced density and contrast-enhanced density in 10 bilateral brain regions in 10 psychotic subjects. Asymmetry of both nonenhanced and contrast-enhanced density was observed; left regional nonenhanced values were higher than right, whereas contrast-enhanced density values were higher on the right than on the left. No significant differences were observed in arterial mean transit time (AMTT) between right and left middle cerebral artery branches or in capillary or tissue mean transit time (CMTT) in the middle temporal cortex. However, corrected CMTT (CCMTT), i.e., CMTT minus AMTT, amy have been prolonged in five subjects either on the left or right, or in both homologous regions. Only 2 of 10 subjects exhibited anterior-posterior (AP) gradients that resembled to some extent the hyperfrontal pattern reported in normal subjects by other investigators with different techniques.