Rodents are frequently used for models that require surgical procedures. At our institution, laboratory rats are increasingly preferred for investigations of neurologic disorders, cardiovascular interventions, and assessment and treatment of addictive and depressive behaviors. For these types of studies, surgical preparations of the head and neck areas are necessary for catheterization and instrumentation. Based upon our former work in laboratory mice, we sought to improve rat surgery outcomes and confirm the efficacy of a waterless alcohol-based (WAB) antiseptic for skin disinfection prior to incision. In addition, we wanted to investigate whether active warming efforts improved perioperative body temperatures for rats to aid in return to consciousness. Prior to cranial surgical incision and placement in stereotactic equipment, rats were assessed after skin preparation with WAB and after thermal interventions, including prewarming cages for 30 min before anesthesia and delivery of warmed fluid (NaCl) supplementation. Core temperatures were recorded and aerobic culture swabs collected from surgical sites at multiple time points. As previously shown in mice, bacterial counts in rats were effectively diminished by WAB agents. Assessment of intraoperative body temperature trajectories did not identify appreciable differences between control rats and rats that were exposed to prewarming or warmed fluid supplementation or both. However, heavier male rats recovered more rapidly from isoflurane anesthesia than did lighter male and female rats. Although these thermal support measures did not significantly improve anesthetic recovery times in rats, animals warmed for 30 min trended toward a faster return to righting reflex after exposure to isoflurane. These findings confirm that WAB antiseptic is an acceptable option for skin preparation in rats and suggest that continued evaluation of thermal interventions remains of interest for improved outcomes in rat surgery.

Introduction: The authors present a prospective series of 4 consecutive patients with symptomatic acute spontaneous cervical vertebral artery dissection (VAD) in which a dynamic catheter cerebral angiogram conclusively demonstrated adverse near complete or complete occlusion of the dissected VA associated with rotation of the head. We present clinical and angiographic data and management of these patients not previously reported in the literature. Methods: From 2012 to 2014, we performed a prospective study of 4 consecutive patients with spontaneous acute cervical VAD. We reviewed initial and follow up clinical data and diagnostic imaging including magnetic resonance angiogram (MRA) or computed tomographic angiogram (CTA) of head and neck and dynamic catheter cerebral angiogram. Results: A total of 4 patients (Age 36 +/- 5.4; M=3, F=1) presented with acute cerebellar or brain stem stroke due to a total of 6 cervical VAD at the level of V3 (N=4) and V2 (N=2) segments diagnosed by CTA or MRA. Initial mRS and NIHSS scores on admission were 3 +/- 0.8 and 1.5 +/-1, respectively. Dynamic cerebral angiogram performed with patient’s head in neutral position showed VAD with average stenosis of 74.16 % +/- 20.59. Near complete or complete occlusion of the dissected VA was observed and associated with worsening neurological symptoms when the head was rotated beyond 45 degrees to the right side (N=3) and left side (N=3). All patients were treated with daily Aspirin and Plavix for at least 3 months and placed on cervical collar for one month to prevent rotational occlusion of VA. Repeat dynamic cerebral angiogram at 2.5 months +/- 1.91 showed resolution of the VAD. Clinical follow up evaluation at 11.5 months +/- 8.5 showed mRS score of 1.5 +/- 1.0 and NIHSS score of 0.75 +/- 0.96 with no recurrence of stroke. Conclusion: Patients with cervical VAD may be at risk of developing ischemic or embolic stroke associated with rotation of the head. Current diagnostic imaging studies are performed with the patient’s head in neutral position and fail to show dynamic changes of VAD. The authors emphasize the importance of performing dynamic cerebral angiogram during the evaluation of patient with VAD and consider changes in the Guidelines on the Diagnosis and Management of Cervical VAD.