Neurovascular Disease Research Articles

Physical Activity and Neurodegenerative Diseases: Potential Role in Prevention and Therapy

Physical activity and exercise are low-cost interventions in primary and secondary prevention of several noncommunicable disease (e.g. cardiovascular diseases, chronic kidney disease, neurodegenerative and neurovascular disease). In the context of demographic change, the relative and absolute numbers of patients with neurological, especially neurodegenerative disease, will increase. Based on missing causal therapies and high costs, non-pharmacological (e.g. physical activity) approaches for healthy aging are gaining attention. Epidemiological, observational, and randomized controlled studies have shown that physical activity can enhance brain plasticity and improve cognitive vitality over lifespan. However, the underlying neurobiological mechanisms are still largely unknown. Physical activity can influence different risk factors for neurovascular and neurodegenerative diseases (e.g. arterial hypertension, obesity). Moreover, physical activity can induce cellular and molecular changes (level 1) followed by structural and functionals brain changes (level 2) and/or behavioural adaptations (level 3). In this clinical review we summarize the role of physical activity in the prevention and therapy of neurological disease.

RETROSPECTIVE ANALYSIS OF GLIOBLASTOMA OUTCOMES

Background Glioblastoma (GBM) is one of the most aggressive brain cancers, with a median overall survival (OS) of about 15 months. This retrospective study focuses on 144 GBM cases treated over 12 years in our clinic in Romania, analyzing factors affecting progression-free survival (PFS) and OS, including genetic markers and treatment modalities. Methods This study involved patients treated between 2012 and 2024 at the National Institute of Neurology and Neurovascular Diseases in Bucharest. The cohort included 144 patients, with variables such as age, gender, tumor location, IDH mutation status, Karnofsky Performance Status (KPS), and genetic markers (MGMT methylation and EGFR amplification) analyzed. Survival outcomes were evaluated using Kaplan-Meier curves and log-rank tests. Results - Patient Demographics: The cohort included 64 males (44.4%) and 80 females (55.6%) with a mean age of 60.7 years. - Tumor Characteristics: The most common tumor location was the frontal lobe (31.9%), followed by multilobular GBM (26.3%). Right-side tumors were more prevalent (51.3%). - Genetic Markers: MGMT promoter was methylated in 46 patients (31.9%), and EGFR was amplified in 76 patients (52.7%). - Treatment Modalities: 105 patients (72.9%) received chemotherapy with temozolomide (TMZ), and 116 patients (80.5%) underwent radiotherapy. - Survival Outcomes: Median PFS was 5 months, and median OS was 8.5 months. Kaplan-Meier survival curves indicated significantly increased OS in patients with MGMT methylation undergoing chemotherapy (p<0.005) and radiotherapy (p<0.005). Similarly, OS was significantly higher in patients without EGFR amplification receiving chemotherapy (p<0.005) and radiotherapy (p<0.005). Conclusion The study emphasizes the importance of MGMT methylation and EGFR amplification in predicting survival outcomes in GBM patients. Immediate postoperative adjuvant therapy significantly improves PFS and OS. The findings underscore the need for coordinated care and timely access to adjuvant therapies to enhance survival rates in GBM patients. Second surgical interventions also showed a survival benefit, highlighting their potential role as salvage therapy in recurrent GBM cases.

Clinical Presentations and Treatment Approaches in a Retrospective Analysis of 128 Intracranial Arteriovenous Malformation Cases.

Intracranial AVMs are a highly heterogeneous group of lesions that, while not very common, can pose significant risks. The therapeutic management of AVMs is complicated by ambiguous guidelines, particularly regarding which Spetzler-Martin grades should dictate specific treatment options. This study analyzed the clinical presentations and treatment approaches of 128 brain AVM cases managed between 2014 and 2022 at the National Institute of Neurology and Neurovascular Diseases in Bucharest, Romania. A retrospective analysis was conducted on patient demographics, clinical symptoms, Spetzler-Martin categorization, nidus localization, therapeutic management, and outcomes. Statistical analysis was performed using Python 3.10. In our cohort of patients, the median age was 45 years, with a slight male predominance (67 males, 61 females). At admission, 51.5% presented with elevated blood pressure. The majority of patients had a Spetzler-Martin score of 2 (37.5%), followed by scores of 3 (31.3%) and 1 (20.3%). Treatment strategies included microsurgical resection in 32% of cases, conservative management in 31.2%, Gamma Knife radiosurgery in 22.6%, and endovascular embolization in 13.3%. Notably, open surgery was predominantly chosen for Grade II AVMs. The functional outcomes were favorable, with 69.5% achieving a good recovery score on the Glasgow Outcome Scale. Only four in-hospital deaths occurred, all in patients who underwent open surgery, and no deaths were recorded during the two-year follow-up. AVMs within the same Spetzler-Martin grade display considerable complexity, necessitating personalized treatment strategies. Our findings highlight the limitations of open surgery for Grade I cases but affirm its effectiveness for Grade II AVMs.

Levels of Asymmetric Dimethylar Ginine and Risk of Neurovascular Diseases: A Systematic Review and Meta-Analysis.

The purpose of this study was to provide clear evidence that reliably quantifies the association of Asymmetric dimethylarginine (ADMA) levels with the risk of neurovascular diseases. The Pubmed, Web of Science, and Embase were systematically searched to identify eligible studies published until August 2024. A total of 31 eligible studies were identified. Pooled results indicated that patients with stroke yielded a higher ADMA level than healthy controls [standardized mean difference (SMD) = 1.02, 95% CI = 0.92-1.12, P = 0.001]. Subgroup analyses showed that geographical location, sample type, number of events and the proportion of male participants were statistically significant sources of heterogeneity. Similarly, a significant association with a pooled risk ratio (RR) of 1.60 (95% CI = 1.60-1.91) was shown between ADMA exposure and the risk of stroke from seven cohort studies. There was a statistically significant difference between ADMA level and small vessel disease (SVD) (SMD = 0.33, 95% CI = 0.07-0.58, p = 0.001). In addition, migraine patients tend to have elevated ADMA levels compared to healthy controls (SMD = 0.39, 95% CI = 0.11-0.67, P = 0.001). Our results indicate that ADMA levels have significant effects in patients with stroke, SVD, and migraine.

Comparative efficacy, safety, and DMSO compatibility of detachable vs. non-detachable tip microcatheters in neurointerventional procedures: A systematic review and meta-analysis

BackgroundThe evolution of embolic agents necessitates the use of microcatheters compatible with dimethyl sulfoxide (DMSO), with detachable tip microcatheters (DTMs) emerging as a significant innovation aimed at reducing the risk of catheter entrapment in embolization procedures. This study aims to compare the efficacy, safety, and DMSO compatibility of DTMs with non-detachable tip microcatheters (Non-DTMs) in the context of embolization treatments for neurovascular diseases. MethodFollowing PRISMA guidelines, a systematic literature search was conducted across PubMed, Scopus, Embase, and Web of Science databases until February 25, 2024. Primary outcomes included technical success and microcatheter-related complications, with a meta-analysis performed using a random-effects model to calculate proportions and odds ratios (OR) with 95 % confidence intervals (Cl). ResultsForty-five studies involving 2185 patients and 3758 catheters (995 DTMs and 2763 Non-DTMs) were analyzed. Our analysis revealed that DTMs were associated with comparable rates of technical success (98.3 % vs. 97.6 %, p = 0.68), favorable outcomes (93.9 % vs. 93.6 %, p = 0.89), and microcatheter-related complications compared to Non-DTMs. Specifically, DTMs showed a 0.0 % rate of microcatheter entrapment and hemorrhagic complications. Intended detachment was achieved in 41.7 % (95 % CI = 27.02–57.98) of cases and premature detachment was rare (0.1 %; 95 % %CI = 0.00–1.23). In the analysis of comparative studies, microcatheter-related complications did not defer between DTM and Non-DTM groups. ConclusionOur study demonstrates the safety and efficacy of DTMs in embolization treatments, emphasizing their compatibility with DMSO-based embolic agents and their potential to enhance patient outcomes in neurointerventional procedures. Future research should focus on well-designed, larger, prospective, comparative multi-center studies to strengthen the evidence base and further optimize the use of DTMs in endovascular interventions.

Guideline-recommended basic parameter adherence in neurocritical care stroke patients: Observational multicenter individual participant data analysis.

Neurocritical care patients with neurovascular disease often face poor long-term outcomes, highlighting the pivotal role of evidence-based interventions. Although International Guidelines emphasize managing basic physiological parameters like temperature, blood glucose, blood pressure, and oxygen levels, physician adherence to these targets remains uncertain. This study aimed to assess adherence to guideline-based treatment targets for basic physiological parameters in neurocritical care. This multicenter observational study was conducted across eight tertiary University Hospitals in Germany analyzed 474 patients requiring mechanical ventilation (between January 1st and December 31st, 2021). Adherence was defined as the rate of measurements within therapeutic ranges for systolic blood pressure (situation-adapted), mean blood pressure (MAP, 60-90 mmHg), glucose levels (80-180 mg/dl), body temperature (<37.5°C), partial arterial pressure of oxygen (PaO2) 80-120 mmHg und partial arterial pressure of carbon dioxide (PaCO2) 35-45 mmHg during the initial 96 h of hospitalization in 4 hour-intervals. Overall, 70.7% of all measurements were within the predetermined therapeutic ranges including SBP (71.3%), temperature (68.3%), MAP (71.4%), PaO2 (65.2%), PaCO2 (75.0%) and blood glucose (80.7%). This multicenter study demonstrates adherence to guideline-based treatment targets, underscoring the high standards maintained by neurological intensive care units. Our study offers valuable insights into adherence to guideline-based treatment targets for neurocritical care patients in Germany. To improve patient care and optimize therapeutic strategies in neurovascular diseases, further research is needed to examine the impact of these adherence parameters on long-term outcomes.

A Quality Improvement Project On The Introduction Of A Nurse-Led, Patient Self-Monitored Blood Pressure Telehealth Platform

Abstract Background Telehealth is a strategy for health and wellbeing promotion. Hypertension is a modifiable risk factor in vascular health. Timely, reliable and accessible identification of this risk is important. Working within an interdisciplinary ambulatory neurovascular hub, a nurse-led model of service provided the opportunity to effectively identify and modify this risk through the secondary prevention measure of hypertension management. Methods An interdisciplinary neurovascular service quality improvement group, the “Stroke Big Room”, evaluated service models and telehealth platforms for patient-self monitoring of hypertension. The telehealth “Florence” platform was introduced. An accompanying Patient Information Leaflet was developed with the Communications Team within the Trust. Patients with a blood pressure of 130/80mmHg and a confirmed diagnosis of minor stroke or transient ischaemic attack were offered the “Flo” platform. Results A 20-patient sample found: 50% required no treatment change, 30% were commenced on antihypertensive treatment and 20% required antihypertensive dose increase. In the 2023/24 financial year, 285 patients participated in the Flo platform. Conclusion Timely identification and modification of hypertension is a reversible risk factor for neurovascular disease. A nurse-led service for the provision of, education on and support in use of a telehealth monitoring platform is an effective approach. This service model allows for effective secondary prevention treatment in a rapid and accessible way. The telehealth platform “Flo” was accessible to patients on the basis of patient reported outcome measures. As a result of the use of the platform, pharmacotherapeutic interventions occurred in 50% of participants in this telehealth programme.

Beta-Amyloid Related Neurodegenerative and Neurovascular Diseases: Potential Implications for Transfusion Medicine

Cerebral amyloid angiopathy (CAA) is a progressive cerebrovascular and neurodegenerative disorder that is caused by the aberrant accumulation of soluble beta-amyloid isoforms in the small vessel walls of the cerebral and cerebellar cortices and the leptomeninges. Vascular beta-amyloid deposition increases vulnerability to intracerebral hemorrhage (ICH). Clinically, CAA can be the underlying cause of up to half of spontaneous lobar ICHs and can also present with convexity subarachnoid hemorrhage, transient focal neurologic episodes and progressive cognitive decline leading to dementia. The majority of CAA is sporadic, with increasing prevalence with age and often coexists with Alzheimer's Disease (AD). Genetic and iatrogenic etiologies are rare. Cases of CAA and AD have been linked to the use of cadaveric pituitary hormone and later life iatrogenic CAA has also been described following early-life neurosurgical procedures with cadaveric dura grafts. Together these data suggest a capacity of beta-amyloid transmissibility. A recent study found that in over 1 million transfusion recipients from donors who later developed (i) >1 ICH or (ii) one ICH event and dementia, had an elevated risk of developing future ICH. Considering prior reports of transfusion associated variant-Creutzfeldt Jakob Disease in humans and in vivo evidence in sheep, coupled with emerging data supporting beta-amyloid's prion-like properties, raises the question of whether CAA could be transmissible by blood transfusion. This would also have implications for screening, especially in an era of emerging plasma biomarkers of cerebral amyloidosis. Given the public health concerns raised by this biologically plausible question, there is a need for future studies with well-characterized definitions – and temporal ascertainment – of CAA exposure and outcomes to examine whether CAA is transfusion-transmissible, and, if so, with what frequency and timing of onset.

Proteome-wide Mendelian randomization identified potential drug targets for migraine

BackgroundMigraine is a highly prevalent and complex neurovascular disease. However, the currently available therapeutic drugs often fall to adequately meet clinical needs due to limited effectiveness and numerous undesirable side effects. This study aims to identify putative novel targets for migraine treatment through proteome-wide Mendelian randomization (MR).MethodsWe utilized MR to estimate the causal effects of plasma proteins on migraine and its two subtypes, migraine with aura (MA) and without aura (MO). This analysis integrated plasma protein quantitative trait loci (pQTL) data with genome-wide association studies (GWAS) findings for these migraine phenotypes. Moreover, we conducted a phenome-wide MR assessment, enrichment analysis, protein–protein interaction networks construction, and mediation MR analysis to further validate the pharmaceutical potential of the identified protein targets.ResultsWe identified 35 protein targets for migraine and its subtypes (p < 8.04 × 10–6), with prioritized targets showing minimal side effects. Phenome-wide MR identified novel protein targets—FCAR, UBE2L6, LATS1, PDCD1LG2, and MMP3—that have no major disease side effects and interacted with current acute migraine medication targets. Additionally, MMP3, PDCD1LG2, and HBQ1 interacted with current preventive migraine medication targets. The causal effects of plasma protein on migraine were partly mediated by plasma metabolites (proportion of mediation from 3.8% to 21.0%).ConclusionsA set of potential protein targets for migraine and its subtypes were identified. These proteins showed rare side effects and were responsible for biological mechanisms involved in migraine pathogenesis, indicating priority for the development of migraine treatments.

Abstract 55: Mouse Offspring Exposed to Preeclampsia/Eclampsia-like Symptoms Exhibit Changes in Regional Cerebral Perfusion at 2 months of age

Children born to mothers with preeclampsia, a hypertensive pregnancy disorder, or eclampsia, new-onset seizures during pregnancy, are more likely to develop learning and memory deficits and are more susceptible to neurovascular diseases compared to those born from normal pregnancies. The contributing mechanisms are unknown. The objective of this study was to determine whether mice exposed to reduced uteroplacental perfusion (RUPP), to mimic preeclampsia with or without pentylenetetrazol (PTZ) injection (to induce seizures and model eclampsia), results in regional cerebral perfusion changes at 2 months of age. On gestational day (GD) 13.5, pregnant C57BL/6 mice underwent sham or RUPP surgery followed by injection or no treatment with PTZ (40 mg/kg) on GD 18.5. At 2 months of age, cerebral perfusion was measured using Laser Speckle Imaging, and averaged to obtain mean data per sex, per litter (n = 3-6 average datapoints per group). Perfusion data were normalized to the area of each region of interest. Data were analyzed using Two-Way ANOVA. Our findings indicate a reduction in cerebral perfusion in offspring exposed indirectly to RUPP specifically of the right parietal cortex (p = 0.013), superior sagittal sinus (p = 0.003), cerebellum (p = 0.003) and whole brain (p = 0.021). We also observed an overall significant reduction in perfusion, after indirect PTZ exposure, in the right parietal cortex (p = 0.002), transverse sinus (p = 0.003), and cerebellum (p &lt; 0.001); and increase in prefrontal cortex perfusion (p = 0.001). Further observation showed an overall difference in hematocrit (p = 0.001), SPO2 (p &lt; 0.001), and cerebellum water content (p = 0.007) after indirect PTZ exposure. There was no difference in perfusion of the left parietal cortex, body weight, organ weight (except brain, where RUPP exposure led to overall increased brain weight; p = 0.030). Together, our results are consistent with the hypothesis that exposure to preeclampsia/eclampsia conditions leads to changes in offspring cerebrovascular function, with a net reduction in perfusion. Reduced cerebral perfusion is generally associated with reduced cognitive function. Whether this occurs along with changes in capillary density, or is exacerbated with age are areas of active investigation.

Anatomical study of variations in the configurations of the circle of Willis in relation to age, sex, and diameters of the components.

The circle of Willis (COW) refers to the anastomotic arterial network found on the brain base, tasked with provision of collateral circulation aimed at prevention of ischemia. The COW is of immense clinical importance especially with regard to the assessment of neurovascular diseases. Individuals portray significant variations in the COW's anatomical configuration. The present study seeks to evaluate the existing anatomical variations of the COW and within the anterior and posterior segments of the COW. Thus, the study seeks to evaluate the different anatomical variations of the COW and its segments and components within the study population. To attain the set objectives, the present study has utilized the angiographic images for studying the COW variants in patients who underwent cerebral angiography during assessment of different types of cerebral anomalies and conditions. Therefore, this study used conventional angiography as an important tool in the evaluation of the different variations in the COW, and is most appropriate for evaluation of smaller anatomical variations owing to its perfect spatial resolution and portrayal of COW anatomy. The study findings indicated the existence between age and sex, and anatomical variations of the COW, particularly with regard to diameters of COW components like basilar artery (BA), P1, and internal carotid arterys (ICAs). Males had bigger BA, P1 and ICA diameters than females, while individuals aged below 40 years had bigger BA, A1, posterior communicating artery, and ICA diameters than those aged above 40 years.

Effect of singular value decomposition on removing injection variability in 2D quantitative angiography: An in silico and in vitro phantoms study.

Intraoperative 2D quantitative angiography (QA) for intracranial aneurysms (IAs) has accuracy challenges due to the variability of hand injections. Despite the success of singular value decomposition (SVD) algorithms in reducing biases in computed tomography perfusion (CTP), their application in 2D QA has not been extensively explored. This study seeks to bridge this gap by investigating the potential of SVD-based deconvolution methods in 2D QA, particularly in addressing the variability of injection durations. Building on the identified limitations in QA, the study aims to adapt SVD-based deconvolution techniques from CTP to QA for IAs. This adaptation seeks to capitalize on the high temporal resolution of QA, despite its two-dimensional nature, to enhance the consistency and accuracy of hemodynamic parameter assessment. The goal is to develop a method that can reliably assess hemodynamic conditions in IAs, independent of injection variables, for improved neurovascular diagnostics. The study included three internal carotid aneurysm (ICA) cases. Virtual angiograms were generated using computational fluid dynamics (CFD) for three physiologically relevant inlet velocities to simulate contrast media injection durations. Time-density curves (TDCs) were produced for both the inlet and aneurysm dome. Various SVD variants, including standard SVD (sSVD) with and without classical Tikhonov regularization, block-circulant SVD (bSVD), and oscillation index SVD (oSVD), were applied to virtual angiograms. The method was applied on virtual angiograms to recover the aneurysmal dome impulse response function (IRF) and extract flow related parameters such as Peak Height PHIRF, Area Under the Curve AUCIRF, and Mean transit time MTT. Next, correlations between QA parameters, injection duration, and inlet velocity were assessed for unconvolved and deconvolved data for all SVD methods. Additionally, we performed an in vitro study, to complement our in silico investigation. We generated a 2D DSA using a flow circuit design for a patient-specific internal carotid artery phantom. The DSA showcases factors like x-ray artifacts, noise, and patient motion. We evaluated QA parameters for the in vitro phantoms using different SVD variants and established correlations between QA parameters, injection duration, and velocity for unconvolved and deconvolved data. The different SVD algorithm variants showed strong correlations between flow and deconvolution-adjusted QA parameters. Furthermore, we found that SVD can effectively reduce QA parameter variability across various injection durations, enhancing the potential of QA analysis parameters in neurovascular disease diagnosis and treatment. Implementing SVD-based deconvolution techniques in QA analysis can enhance the precision and reliability of neurovascular diagnostics by effectively reducing the impact of injection duration on hemodynamic parameters.

Patent foramen ovale and migraine: prevalence, pathogenetic relationship and impact of PFO closure

Background. Migraine is a chronic neurovascular disease with high prevalence (12-15% of the population) and social significance [1]. Pathogenesis of migraine has not been clear. Some studies report an association between migraine and the presence of a patent foramen ovale (PFO) and right-to-left shunt [2, 3, 4]. Introduction. The objectives of this study were to clarify the prevalence and clinical characteristics of migraine, as well as the effect of endovascular PFO closure on the course of migraine in a cohort of patients who suffered ischemic stroke (IS) by paradoxical embolism due to PFO. Material and methods. We examined 97 patients from 18 to 50 y.o. (average age 32.29 ± 2.19 years, women 70.8%) with IS due to PFO in The Research Center of Neurology since January 2018 until October 2023. All patients were assessed for migraine, characteristics of headaches and the impact of migraine on social adaptation. Endovascular surgery was performed in 61 patients. The data from a dynamic examination of 24 patients with migraine were assessed before and after PFO closure. Results. Among a cohort of IS due to PFO patients, the prevalence of migraine was 39.2% (migraine with aura - 55%, migraine without aura - 45%), the ratio of women to men was 1.9:1. The frequency of headaches was 4 [1;7] days per month. Six months after PFO closure, patients with migraine showed a significant decrease in the frequency of headaches from 4 [2; 24] up to 2 [1;5] days per month (p=0.009); reduction in pain intensity from 7 [7; 9] to 3 [3; 7] points according to VAS (p=0.0001); reduction of disability from 20 [6; 89] to 17 [2; 26] points (p=0.019) according to the MIDAS. Conclusion. The present study confirmed the high prevalence of migraine in the PFO cohort. PFO closure led to decrease in frequency and intensity of headaches and decrease of migraine’s impact on social adaptation.

ANATOMICAL VARIATIONS IN A FINITE ELEMENT NERVE MODEL OF THE HUMAN FOOT

The nerves in the foot offer a significant role in controlling the movement and correct loading of the foot by providing continuous feedback to the central nervous system. The health importance in the anatomical variations of nerves, such as the locations, the lengths, the communicating branches, and the distance between the adjacent nerve terminals between individuals have given prominence to anatomists as well as physiologists. A previously developed one-dimensional (1D) model of the nerve was extended to determine different anatomical variations in the nerves of the foot, as a realistic anatomical-based variant nerve model of the human foot is not available. The model was verified against experimental data from the literature for communicating branches and distances of various area of the human foot. For instance, the simulated distances of the communicating branches of the plantar nerves and medial dorsal cutaneous nerve (MDCN) division proximal to the first digital space were found to be 43.3 mm and 112.3 mm, respectively, which was in general agreement with the experimental distances of 8-56 mm and 96-116.74 mm, respectively. The developed nerve variant model provides a platform for future studies of the various geometrical and efficient concerns of neurovascular diseases such as diabetic neuropathies by determining the parameters of nerve conduction studies.

Clinical relevance of critical plasma homocysteine levels in predicting rupture risk for small and medium-sized intracranial aneurysms

Plasma homocysteine (Hcy) has been globally recognized as an independent risk factor for various neurovascular diseases. In this study, the authors investigated the relationship between critical Hcy concentration and the risk of rupture in intracranial aneurysms (IAs). This study collected data from 423 patients with both ruptured and unruptured IAs. We compared demographic data, vascular rupture risk factors, and laboratory test results between the two groups. Multivariable logistic regression analysis was employed to determine the correlation between critical plasma Hcy levels and the risk of rupture in small to medium-sized IAs. A total of 330 cases of ruptured intracranial aneurysms (RIA) and 93 cases of unruptured intracranial aneurysms (UIA) were included. Univariate analysis revealed statistically significant differences between the ruptured and unruptured groups in terms of hypertension, hyperlipidemia, plasma Hcy levels, and IA morphology (all P < 0.05). Multivariable logistic regression analysis indicated that hypertension (odds ratio [OR] 0.504; 95% confidence interval [CI] 0.279–0.911; P = 0.023), hyperlipidemia (OR 1.924; 95% CI 1.079–3.429; P = 0.027), and plasma Hcy levels (OR 1.420; 95% CI 1.277–1.578; P < 0.001) were independently associated with the rupture of small to medium-sized IAs, all with statistical significance (P < 0.05). Our study suggests that critical plasma Hcy levels are an independent risk factor for increased rupture risk in small to medium-sized intracranial aneurysms. Therefore, reducing plasma Hcy levels may be considered a valuable strategy to mitigate the risk of intracranial vascular abnormalities rupture and improve patient prognosis.

The Neurovascular Disease Management Course: A Medical Student Opportunity for Early Exposure and Technical Development in Vascular Neurosurgery

As endovascular neurosurgery techniques continue to evolve, medical students in the United States have widely varying exposures to the field, particularly with respect to opportunities for hands-on experiences. Current medical school curricula could benefit from a novel and adaptive course on vascular neurosurgery to increase student exposure earlier in their training. We launched a yearly hands-on vascular neurosurgery course for medical students and residents. The day-long course is a combination of lectures focused on neurovascular disease and management accompanied by hands-on sessions where students practiced fundamental microsurgery and angiography techniques using real microscopes and angiography simulators. We surveyed the students before and after each of the 2 courses. The survey following the second annual course included quiz questions the students had not previously seen. Over 2 courses, we had 149 attendees, 71.8% of which were first and second-year medical students representing fifteen institutions. The average survey completion rate was 41.4% for the 4 surveys across the 2 courses. Attendees' interest in pursuing a surgical specialty (t=1.815, P= 0.039) along with their comfort with neuroanatomy (t=8.780, P ≤ 0.001) and neurosurgical disease (t=6.133, P ≤ 0.001) was significantly elevated after the completion of the second course. Responses to the post-survey showed a good grasp of the fundamentals with 68% of attendees answering 70% of the quiz questions correctly. An interactive course on vascular neurosurgery may be an effective vehicle to provide medical students with exposure to the field and the opportunity to learn the fundamentals.

Heparin-binding epidermal growth factor-like growth factor improves erectile function in streptozotocin-induced diabetic mice.

Heparin-binding epidermal growth factor-like growth factor (HB-EGF) serves as a pro-angiogenic factor; however, there is to our knowledge currently no reported research on the relationship between HB-EGF and diabetic erectile dysfunction (ED). In this study we aimed to determine whether HB-EGF can improve the erectile function of streptozotocin-induced diabetic mice and to explore the related mechanisms. Eight-week-old male C57BL/6 mice were used for diabetes induction. Diabetes mellitus (DM) was induced by low-dose injections of streptozotocin (50mg/kg) for 5 consecutive days. Eight weeks after streptozotocin injections, DM was determined by measuring blood glucose and body weight. Diabetic mice were treated with two intracavernous administrations of phosphate-buffered saline (20μL) or various doses of HB-EGF (days -3 and 0; 1, 5, and 10μg in 20μL of phosphate-buffered saline). The angiogenesis effect of HB-EGF was confirmed by tube formation and migration assays in mouse cavernous endothelial cells and mouse cavernous pericytes under high-glucose conditions. Erectile function was measured by electrical stimulation of the cavernous nerve, as well as histological examination and Western blot analysis for mechanism assessment. In vitro angiogenesis, cell proliferation, in vivo intracavernous pressure, neurovascular regeneration, cavernous permeability, and survival signaling were the outcomes measured. Expression of HB-EGF was reduced under diabetic conditions. Exogenous HB-EGF induced angiogenesis in mouse cavernous endothelial cells and mouse cavernous pericytes under high-glucose conditions. Erectile function was decreased in the DM group, whereas administration of HB-EGF resulted in a significant improvement of erectile function (91% of the age-matched control group) in association with increased neurovascular content, including cavernous endothelial cells, pericytes, and neuronal cells. Histological and Western blot analyses revealed a significant increase in the permeability of the corpus cavernosum in DM mice, which was attenuated by HB-EGF treatment. The protein expression of phospho-Akt Ser473 and phosphorylated endothelial nitric oxide synthase Ser1177 increased after HB-EGF treatment. The use of HB-EGF may be an effective strategy to treat ED associated with DM or other neurovascular diseases. Similarly to other pro-angiogenic factors, HB-EGF has dual roles in vascular and neuronal development. Our study focused on broadly evaluating the role of HB-EGF in diabetic ED. In view of the properties of HB-EGF as an angiogenic factor, its dose concentration should be strictly controlled to avoid potential side effects. In the diabetic ED mouse model in this study erectile function was improved by HB-EGF, which may provide new treatment strategies for patients with ED who do not respond to phosphodiesterase 5 Inhibitors.

Unilateral Double Superior Cerebellar Artery Variation: A Cadaveric Case Report

The superior cerebellar artery (SCA) is a vessel anterior to the brainstem, usually originating from the basilar artery (BA). In this case, a different course of left SCA in a 74-year-old male cadaver was reported. The origin of the SCA was found to be a unilateral double root at the left side on the anterior surface of the pons. The distances of the starting points of roots to the bifurcation of BA were 31.09 mm on the right side, on the left side the rostral root was 33.84 mm and the caudal root was 30.95 mm. The diameter of the right SCA was 2.37 mm, the left rostral root was 2.05 mm and the caudal root was 1.24 mm. Knowing the course of SCA, and especially morphological variations, will be helpful for the clinical branches in preventing complications during surgical operations, evaluating angiographic examinations, and diagnosing and treating neurovascular diseases.

An integrated system of neurovascular and mental disease registries

A nemzetközi regiszterépítési gyakorlat fejlődését is figyelembe vevő, 18 kiemelt hazai regiszter működését rendező 2018. évi jogi szabályozás eredményeképpen szélesebb körben rendezetté vált a személyhez kötött egészségügyi adatok kezelése, megindulhatott a működtető környezet korszerű alapokra helyezése, és megújulhatott az adatok feldolgozási és elemzési folyamata. A személyes adatok kezelésére vonatkozó felhatalmazás alapján technikailag lehetségessé vált a különböző adatforrásokból érkező adatok összekapcsolása, s ezt kiaknázva a Nemzeti Stroke Regiszter és a Nemzeti Affektív Betegségek Regisztere esetén egy összetett regiszterrendszer jött létre. A regiszterrendszer adatokat tud fogadni az ágazat központi adatrendszereiből, a kórházi informatikai rendszerből és webes űrlapokon keresztül közvetlenül a betegellátóktól. Az adatokat egy többszintű, automatizált feldolgozási folyamatokkal támogatott adatbázisrendszer kezeli, amelynek működését irányítópult és jelentéskészítő funkciók is segítik. A feldolgozás magasabb rétegeiben az elemi adatok OMOP-alapú adatmodellt alkotnak, illetve az események láncokká állnak össze, lehetővé téve a komplex betegutak elemzését. A rendszer jelenleg több mint 50 millió ellátási eseményt, közel 100 millió dokumentumot és több mint 200 millió receptet kezel, amely nemzetközi szinten is kiemelkedő adatvagyont képez. Az adatbiztonságot összetett védelmi intézkedések szolgálják, beleértve az adatok álnevesítését és a kutatói adatpiacok szeparációját is. Összetettségüknek, adatmélységüknek és biztonságuknak köszönhetően ezek a regiszterek számtalan kutatásnak tudnak értékes adatforrást biztosítani. Orv Hetil. 2024; 165(24–25): 955–964.

Clinical and Educational Aspects of Neuroimaging in Microsurgery of the Posterior Fossa: A Comprehensive Review.

The clinical and educational value of modern high-resolution magnetic resonance imaging (MRI) and image processing in neurovascular diseases of the posterior fossa with regard to preoperative planning and intraoperative comparison with the actual anatomical situation was consecutively evaluated. Patients with trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia (GN) and arterial hypertension (HTN) were analyzed. The high-resolution MRI data was segmented and visualized three-dimensionally using computer graphics methods. New anatomical insights were gained, such as the classification of neurovascular compression (NVC) in HFS and GN. It was also possible to visualize the pathognomonic cerebrospinal fluid signal in patients with TN for the first time. Using the new imaging methods, pregnant hypertensive patients were examined and the existence of NVC was confirmed for the first time, and the findings were compared to other studies dealing with NVC syndromes. This review gives an overview on the established methods of neuroimaging and image processing of neurovascular structures in the posterior fossa with the focus on clinical and educational aspects.