We report an association of new technologies (the Onyx liquid embolic system and the Sonic microcatheter) for transarterial embolization through the anterior branch of the middle meningeal artery of a dural arteriovenous fistula (DAVF) of the anterior fossa. The place of endovascular treatment in anterior fossa DAVFs is reviewed, and its clinical implications discussed in light of the case of a patient whose management was modified by this association of new technologies.

The incidence of spontaneous intracerebral hemorrhage (sICH) and ischemic stroke vary across seasons. Most studies examining seasonal variation in sICH have been conducted in countries with significant climatic changes across seasons, whereas studies from the Mediterranean region, which has a relatively mild winter, are limited in number and have produced inconsistent results. Further studies from the region are called for, especially from countries where sICH seasonality has not yet been explored. A total of 974 patients with sICH between 1 January 2000 and 31 December 2014 were included in this study. The seasonal, monthly and weekday distribution of hospital admissions, in-hospital mortality, length of hospital stay and functional outcome at discharge were examined. We found that most hospital admissions due to sICH occurred in the winter (n = 286, 29%), whereas the fewest admissions occurred in the summer (n = 205, 21%; p = 0.0011). In terms of monthly distribution, most admissions were in January (n = 107, 11%), and the fewest admissions were in September (n = 60, 6%; p = 0.0004). There were no differences in the distribution of sICH between weekdays and weekends. Also, we found no significant weekday or seasonal variations in in-hospital mortality or functional outcome of sICH. Our results suggest that temporal patterns impact the natural course of sICH in northern Israel. The identification of factors, including biological ones, responsible for seasonal variation in regions with mild seasonal changes requires further research but could aid in the design of strategies for preventing sICH.

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Our study shows that CAD is an independent and significant causative factor for acute ischemic stroke. Therefore, diagnostic imaging is indicated to rule out CAD not only in young patients, but rather in all patients with acute ischemic stroke. The inverse correlation between common vascular risk factors (i.e. hypertension and hyperlipidemia) and CAD points to CAD as an independent nonatherosclerotic causative factor in the etiology of acute ischemic stroke.