- Posterior Fossa Dural Arteriovenous Fistulas with Subarachnoid Venous Drainage: Outcomes of Endovascular Treatment
Twenty-six patients treated endovascularly for posterior fossa dural AVFs, type III, IV, or V, were included in this study. One hundred percent of the dural AVFs were occluded. A transarterial approach was performed in 23 dural AVFs; a combined transarterial and transvenous approach, in 2 dural AVFs; and a transvenous approach alone, in 1 dural AVF. The middle meningeal artery was the most common artery chosen to inject embolic liquid (12/26). Procedure-related morbidity was 15.4% at 24 hours, 7.7% at discharge, and 0% at 6 months. Procedure-related mortality was 0%. The authors conclude that endovascular treatment offers high occlusion rates for posterior fossa dural AVFs with low morbidity and mortality rates.
- Intrathecal Use of Gadobutrol for Glymphatic MR Imaging: Prospective Safety Study of 100 Patients
The authors performed a prospective safety and feasibility study in 100 consecutive patients undergoing glymphatic MR imaging from September 2015 to August 2018. Short- and long-term serious and nonserious adverse events were registered clinically and by interview after intrathecal administration of 0.5 mL of gadobutrol (1.0 mmol/mL) along with 3 mL of iodixanol (270 mg I/mL). One serious adverse event (anaphylaxis) occurred in a patient with known allergy to iodine-containing contrast agents (1%). The main nonserious adverse events during the first 1–3 days after contrast injection included severe headache (28%) and severe nausea (34%), though the frequency depended heavily on the diagnosis. They conclude that intrathecal administration of gadobutrol in conjunction with iodixanol for glymphatic MR imaging is safe and feasible.
- Diagnosis and Prediction of Relapses in Susac Syndrome: A New Use for MR Postcontrast FLAIR Leptomeningeal Enhancement
From January 2011 to December 2017, nine consecutive patients with Susac syndrome and a control group of 73 patients with multiple sclerosis or clinically isolated syndrome were included. Two neuroradiologists blinded to the clinical and ophthalmologic data independently reviewed MRIs and assessed leptomeningeal enhancement and parenchymal abnormalities. Follow-up MRIs of patients with Susac syndrome were reviewed and compared with clinical and retinal fluorescein angiographic data evaluated by an independent ophthalmologist. Patients with Susac syndrome were significantly more likely to present with leptomeningeal enhancement: 5/9 (56%) versus 6/73 (8%) in the control group. They had a significantly higher leptomeningeal enhancement burden with ≥3 lesions in 5/9 patients versus 0/73. Regions of leptomeningeal enhancement were significantly more likely to be located in the posterior fossa. The authors conclude that leptomeningeal enhancement occurs frequently in Susac syndrome and could be helpful for diagnosis and prediction of clinical relapse.
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