No abstract

The characteristics of intracerebral hemorrhage (ICH) accompanying chronic liver disease (CLD) were investigated in ICH patients hospitalized between 1998 and 2008 divided into the CLD group (55 ICHs in 49 patients) and the idiopathic group without CLD (668 ICHs in 648 patients). The CLD group included a subgroup with liver cirrhosis (LC). Age, sex, history of hypertension, Glasgow Coma Scale (GCS) score on admission, and hematoma locations were reviewed. Outcomes on discharge and causes of inhospital death were also studied. Factors associated with life prognosis in CLD patients were investigated using uni-and multivariate analyses. History of hypertension and deep cerebral hemorrhage were less frequent in the LC subgroup compared to the idiopathic group. Distributions of GCS scores on admission were not significantly different, but incidence of in-hospital death was significantly higher in the CLD group than in the idiopathic group. LC was an independent prognostic factor for CLD patients, but hematoma enlargement was not. Death primarily due to ICH was less frequent in the CLD group than in the idiopathic group. In conclusion, hemostatic disorders seemed to be related to site of hemorrhage, but not to life prognosis in the CLD group. Prognosis was mainly worsened by non-neurological complications.

The monorail snare technique is a safe and easy technique for retrieving Onyx-encased microcatheter tips in the treatment of BAVM.

No abstract

： Carotid artery stenting (CAS)for severe internal carotid artery stenosis has recently been intro − duced as an a】 ternative to carotid endarterectomy ． Here ， we present an unusual clinical course of a patient after CAS using the Angioguard filter device ． Case ： We present the case of a 75 − year − 01d 皿 an who suffered f め m cerebral infarctiQn in the left thalalnus ． Three − dinlensional computed tomography confirmed asymptomatic stenosis (83％)in the lef し internal carotid arter ￥ Carotid artery stenting (CAS)was performed lls｛ ng a distal protection 丘1ter device (Angioguard ， Cordis ， Miarni Lakes ， FL ， USA) ． Following poststenting dilatat ｛ n ， the patient became drowsy and he developed left hemiplegia ． Cerebral angiography showed no slowing or stopping of blood flow ， and no delayed filling to the venous phase ． Diffusion − weighted magnetic resonance imaging (DW − MRI)demonstrated rnultiple tiny cortical infarctions in the left frontal − parietal lobes ipsilateral to the operated side ． The symptoms of the patient appeared more seri − ous than the DW − MRI findings suggested ． After CAS ， the patient showed good recovery after receiving medical treatments for about 2 weeks ． Conclusion ：We suspected that liquified microplaques (く 100μm)passed through the pores of the filter device and embolized cerebral arterioles or capillaries ， which might have caused the symptomatic cerebral infarction ． Although most cerebral infarctions following CAS are asymptomatic ， the filter device used here could not ensure complete absence of the development of symptomatic cerebral infarction ． Therefore ， f皿 ther improve − ment of the filter device is necessary in order to reduce the incidence of microembo1 ｛ sms causing symptomatic cerebral infarction ． Moreover， the characteristics of carotid plaques and the hemodynamics of the carotid artery must be evaluated before performing CAS ， and then the most appropriate treatment 丘om the various therapeutic options should be selected ．