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Objective: To evaluate the relationship between the incidence of the CT high-density area that appears immediately after endovascular treatment for acute ischemic stroke with postprocedural hemorrhagic transformation and its significance in the clinical outcome.Methods: Ten patients with ischemic stroke of the anterior circulation encountered between May 2014 and December 2015 in whom recanalization could be achieved within 8 hours after the onset were retrospectively analyzed. In addition, 695 patients presented in 13 reports were divided into thrombolysis and mechanical thrombectomy groups, and the postprocedural incidence of CT high-density areas was compared between the two groups.Results: Postprocedural CT high-density areas were observed in six (60%) of our patients. Hemorrhagic transformation occurred in three of them, but no exacerbation of neurological symptoms was noted. The incidence of postprocedural CT high-density areas was 43.1% (191/443) in the thrombolysis group and 71.8% (188/262) in the mechanical thrombectomy group including our patients, being significantly higher in the latter group (p <0.01). Conclusion:Although CT high-density areas appear more frequently after mechanical thrombectomy than after thrombolysis, they are considered to be infrequently developed into hemorrhagic transformation and exert relatively few negative effects on the neurological outcome.

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A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy.

Background: Intraosseous arteriovenous fistula (AVF) is a rare clinical entity that typically presents with symptoms from their effect on surrounding structures. Here, we report a case of intraosseous AVF in the sphenoid bone that presented with bilateral abducens palsy. Case Description: A previously healthy man presented with tinnitus for 1 month, and initial imaging suspected dural AVF of the cavernous sinus. Four-dimensional digital subtraction angiography (4D-DSA) imaging and a three-dimensional (3D) fused image from the bilateral external carotid arteries revealed that the shunt was in a large venous pouch within the sphenoid bone that was treated through transvenous coil embolization. His symptoms improved the day after surgery. Conclusion: This is a case presentation of intraosseous AVF in the sphenoid bone and highlights the importance of 4D-DSA and 3D fused images for planning the treatment strategy.