AIm: Knowledge of cerebrovascular morphology is integral in planning neuroendovascular interventions, especially for procedures involving placement of stents, flow diverters or stentrievers. There is insufficient data on angiographic normative values of cerebral circulation in the pediatric age group since angiograms are uncommonly performed in children except for arteriovenous malformations in which arterial dimensions are larger than normal. We aimed to measure the diameters of internal carotid circulation (ICC) arteries on digital subtraction angiograms of pediatric patients and determine the growth trends. mATeRIAL and meTHods: This is a retrospective cross-sectional study measurements of ICC arteries of 64 pediatric patients (4 -122 months) with retinoblastoma undergoing intra-arterial chemotherapy.ResuLTs: Petrous, cavernous, supraclinoid and choroidal segments of internal carotid artery (ICA) and anterior cerebral artery (ACA) diameters had significant correlation with age. Most of the growth was noted in the first 36-48 months of life. Middle cerebral artery (MCA) diameter did not show significant correlation with age. 87% of the adult diameter of the MCA was attained in the first 6 months of life. ICC arteries reached 81% to 99% of adult sizes in the first 48 months of life. On the contrary, the main iliac artery was only 59% of the adult diameter at this age group.CoNCLusIoN: Use of current intracranial stents in children appears tolerable due to the growth pattern of ICC arteries. Based on this data, the current armamentarium of intracranial stents or stent-like devices is sufficient to cover the need in the pediatric population.KeywoRds: Cerebral arteries, Internal carotid artery, Diameter, Endovascular treatment, Stent, Flow diverter, Morphometry ÖZ AmAÇ: Nöroendovasküler girişimlerde, özellikle de stent, akım yönlendirici ve benzeri cihazlar kullanıldığında, serebrovasküler morfolojinin bilinmesi önemlidir. Serebral anjiyografi, arteryel boyutların normalden daha büyük olduğu arteriovenöz malformasyonlar dışında çocuklarda sık olarak yapılmadığından, pediatrik yaş gurubunda serebral dolaşımın anjiyografik normotif değerleri hakkında yeterli bilgi bulunmamaktadır. Çocuk hastalarda internal karotid dolaşımı (İKD) arterlerinin çaplarını ölçüp büyüme eğilimlerini belirlemeyi amaçladık. yÖNTem ve GeReÇLeR: Çalışmamız, retinoblastom için intraarteryel kemoterapi yapılan 64 çocuk hastada (yaş: 4 -122 ay) İKD arterlerinin ölçüldüğü retrospektif kesitsel bir çalışmadır.BuLGuLAR: İnternal karotid arterin petröz, kavernöz, supraklinoid ve koroidal segmentleriyle anterior serebral arter (ASA) çapları yaş ile anlamlı korelasyon göstermekteydi. Damarsal büyümenin 36-48 ayda tamamlanmaya yaklaştığı saptandı. Orta serebral arter (OSA) çapı yaş ile anlamlı korelasyon göstermedi. Bu arterde ilk 6 ayda arteryel çapın %87'sine ulaşıldığı izlendi. İKD arterlerinin 48 ay itibarıyla erişkin boylarının % 81-99'una ulaştığı görüldü. Bunun aksine ana iliak arter bu yaş gurubunda erişkin çapının sadece % 59'uydu. soN...

Background The characteristics and pathophysiological mechanisms involved in acute ischemic stroke in patients with COVID-19 infection have not been fully clarified. We prospectively studied the phenotypic and etiological features of acute stroke occurring in COVID-19 infection. Patients & Methods Within nine months starting from April-2020, the presence of COVID-19 infection was determined by thoracic CT and SARS-CoV-2 PCR in all acute stroke cases managed in a single tertiary center. Consecutive and prospective data on vascular risk factors/comorbidities, in-hospital quality metrics, discharge outcomes, etiological subclassification and blood markers of thrombosis / inflammation were compared in 44 COVID-19 positive cases (37 acute ischemic stroke, 5 TIA, 2 intracerebral hematoma) and 509 COVID-19 negative patients (355 ischemic, 105 TIA, 44 hematoma and 5 stroke mimic). Results COVID-19 positive patients had more severe strokes, delayed hospital admission, longer hospital stay, higher mortality rates, but had similar vascular risk factors/comorbidities frequency, thrombolysis/thrombectomy utilization rates, metrics, and stroke etiological subtype. They had significantly higher CRP, fibrinogen, ferritin, leukocyte count and lower lymphocyte count. No difference was detected in aPTT, INR, D-dimer, platelet, hemoglobin, homocysteine levels and ANA, anti-dsDNA antibody and ENA panel positivity rates. Anti-phospholipid antibodies have been studied in 70% of COVID-19 positive and all cryptogenic patients, but were never found positive. Tests for coagulation factor levels and hereditary thrombophilia did not show major thrombophilia in any of the stroke patients with COVID-19. Conclusion We documented that there is no significant difference in etiological spectrum in acute stroke patients with COVID-19 infection. In addition, cryptogenic stroke and antiphospholipid antibody positivity rates did not increase.

Bu yazıda, lunapark trenine (roller coaster) binmesini takiben iki taraflı internal karotid ve iki taraflı vertebral arter diseksiyonu ile beraber retinal arter oklüzyonu gelişen, bilgilerimize göre, literatürdeki ilk olguyu sunuyoruz. Otuz beş yaşında sağlıklı bir kadın hastada, lunapark trenine binmesini takiben, sağ taraflı boyun ağrısı ve frontal başağrı-sı gelişmiştir. Bundan beş gün sonra hastanın sağ gözünde 2 saat süren tam görme kaybını takiben, bu gözde görme düzelmiş fakat normale göre çok düşük düzeyde kalmış-tır. Hastanın ilk muayenesinde sağ gözde görmesi 20/200 ve sol gözde 20/20 düzeyinde bulunmuştur. Fundus muayenesinde üst temporal arter boyunca ödem izlenmiş, emboli görülmemiştir. Hastanın bunun dışında nörolojik muayenesi normaldi. Yapılan beyin anjiyografisinde, iki taraflı internal karotid ve iki taraflı vertebral arter diseksiyonu gö-rülmüştür. Hasta, konservatif tedavi ile stabil olarak kalmış ve görmesinde daha fazla düşme veya yeni nörolojik kayıp izlenmemiştir. Baş-boyun arter diseksiyonlarında prognoz çogunlukla iyidir, fakat olası komplikasyonların önlenme-si için erken teşhis çok önelidir. Lunapark treni gibi ani ve hızlı hareketlere maruz kalınmasını takiben başağrısı, boyun ağrısı, baş dönmesi gibi şikayetler gelişen hastalarda arteriyel diseksiyon için yüksek şüphe bulunmalıdır.Anahtar Sözcükler: Karotid arter; diseksiyon; retinal arter; vertebral arter.We present the first case of a woman with no significant medical history who developed dissections of bilateral carotid and bilateral vertebral arteries, as well as a retinal artery occlusion, after a roller coaster ride. A 35-year-old woman developed right-sided neck pain followed by a frontal headache immediately after a roller coaster ride. Five days after the incident, she developed complete loss of vision in her right eye for two hours. Subsequently, the vision improved but remained significantly decreased. On presentation, her visual acuity was 20/200 in the right and 20/20 in the left eye. Her fundus exam revealed retinal edema in the superotemporal retinal artery distribution without any visible emboli. Her neurological exam was otherwise normal. The cerebral angiogram showed bilateral internal carotid and vertebral artery dissections. The patient remained stable with conservative therapy without further worsening of vision or any new neurological deficits. Outcomes for cervicocephalic arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note any headache, neck pain or vertigo triggered by violent motion after leisure activities such as roller coaster rides.

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Cerebral deep penetrating/medullary subcortical small vessel involvement is the major form of neurovascular disease observed in Fabry's disease. Dilatative cerebral arteriopathy, mostly in vertebrobasilar circulation, is the most common and recognized angiographic finding of Fabry disease. We herein present angiographically-documented cerebral diffuse (left>right) "distal arteriopathy" in a case of Fabry disease. Awareness of possible occurrence of this type of neurovascular involvement in the Fabry disease spectrum is of value not only in terms of preventing false diagnoses such a primary cerebral vasculitic disorders, but also establishing the right specific treatment such as enzyme replacement in a timely fashion. FABRY HASTALIĞINDA SEREBRAL KÜÇÜK DAMAR HASTALIĞI: ANJİOGRAFİK DÖKÜMENTASYON ÖZETFabry hastalığında genel olarak serebral derin penetran/medüller küçük damar tutulumu izlenir. Daha çok vertebrobaziler dolaşımda olan dilatatif arteriopati en sık ve iyi bilinen anjiografi bulgusudur. Burada, anjiografi ile dökümente edilmiş serebral yaygın (sol>sağ) "distal arteriopati" saptanan bir Fabry olgusu sunulmaktadır. Bu tarz tutulumun Fabry hastalığı spektrumunda olduğunun bilinmesi yanlış tanı ve tedaviyi engelleme potansiyeli açısından değerlidir. Anahtar Sözcükler: Fabry hastalığı, arteriopati, vaskulit, lakün, küçük damar hastalığı.