Browsing by Author "Cunha, B"
Now showing 1 - 5 of 5
Results Per Page
Sort Options
- Acute Treatment of Isolated Posterior Cerebral Artery Occlusion: Single Center ExperiencePublication . Cunha, B; Baptista, M; Pamplona, J; Carvalho, R; Perry da Câmara, C; Alves, M; Papoila, AL; Nunes, AP; Reis, J; Fragata, IBackground and objectives: Randomized trials for mechanical thrombectomy (MT) excluded patients with ischemic strokes due to isolated posterior cerebral artery occlusion (IPCAO), and there is no evidence for best acute treatment strategy in these patients. We aimed to assess the effectiveness and safety of MT in acute IPCAO. Methods: We retrospectively analyzed consecutive patients with acute stroke due to IPCAO submitted to MT and/or intravenous thrombolysis (IVT), between 2015-2019. Effectiveness outcomes (recanalization rate, first-pass effect, NIHSS 24h improvement and 3-month Modified Ranking Scale - mRS) and safety outcomes (complications, symptomatic intracranial hemorrhage (SICH) and 3-month mortality) were described and compared between groups. Results: A total of 38 patients were included, 25 underwent MT and 13 had IVT alone. Successful and complete recanalization were achieved in 68% and 52% of MT patients, respectively. NIHSS improvement at 24h was found in 56% of MT patients versus 30.8% of patients submitted to IVT alone (OR [95% CI]=2.86 [0.69-11.82]) and excellent functional outcome at 3 months (mRS≤1) was achieved in 54.2% of MT patients versus 38.5% in the IVT group (OR [95% CI]=1.60 [0.41-6.32]). Complications occurred in 3 (12%) procedures and there were no SICH. Mortality at 3 months was 20% in the MT group and 15.4% in patients submitted to IVT alone. Conclusions: Our results reflect a real-world scenario in a single center and seem to support the recently growing literature showing that MT is a feasible and safe treatment in IPCAO, with favorable effectiveness.
- Cerebral Cavernous Malformations: Typical and Atypical Imaging CharacteristicsPublication . Kuroedov, D; Cunha, B; Pamplona, J; Castillo, M; Ramalho, JCavernous malformations (CMs) are benign vascular malformations that maybe seen anywhere in the central nervous system. They are dynamic lesions, growing or shrinking over time and only rarely remaining stable. Size varies from a few millimeters to a few centimeters. CMs can be sporadic or familial, and while most of them are congenital, de novo and acquired lesions may also be seen. Etiology is still unknown. A genetic molecular mechanism has been proposed since a cerebral cavernous malformation gene loss of function was found in both familial and sporadic lesions. Additionally, recent studies suggest that formation of CMs in humans may be associated with a distinctive bacterial gut composition (microbioma). Imaging is fairly typical but may vary according to age, location, and etiology. Follow-up is not well established because CMs patients have a highly unpredictable clinical course. Angiogenic and inflammatory mechanisms have been implicated in disease activity, as well as lesional hyperpermeability and iron deposition. Imaging and serum biomarkers of these mechanisms are under current investigation. Treatment options, including surgery or radiosurgery, are not well defined and are dependent upon multiple factors, including clinical presentation, lesion location, number of hemorrhagic events, and medical comorbidities. Our purpose is to review the imaging features of CMs based on their size, location, and etiology, as well as their differential diagnosis and best imaging approach. New insights in etiology will be briefly considered. Follow-up strategies, including serum and imaging biomarkers, and treatment options will also be discussed.
- Magnetic Resonance Diagnosis of Laryngeal Chondritis After Transoral Laser Microsurgery for Laryngeal CancerPublication . Cunha, B; Lancini, D; Rondi, P; Ravanelli, M; Maroldi, R; Paderno, A; Zigliani, G; Bertotto, I; Piazza, C; Farina, DObjective: Laryngeal chondritis (LC) is a rare complication of carbon dioxide transoral laser microsurgery (CO2 TOLMS) for laryngeal tumours and can pose a diagnostic challenge. Its magnetic resonance (MR) features have not been previously described. This study aims to characterise a cohort of patients who developed LC after CO2 TOLMS and describe its clinical and MR findings. Methods: Clinical records and MR images of all patients presenting with LC after CO2 TOLMS between 2008 and 2022 were reviewed. Results: Seven patients were analysed. Timing of LC diagnosis ranged from 1 to 8 months after CO2 TOLMS. Four patients were symptomatic. Abnormal endoscopic findings included suspected tumour recurrence in 4 patients. MR documented focal or extensive signal changes involving the thyroid lamina and para-laryngeal space with T2 hyperintensity, T1 hypointensity and intense contrast enhancement (n = 7), and minimally reduced mean apparent diffusion coefficient (ADC) values (1.0-1.5 x 10-3 mm2/s) (n = 6). A favourable clinical outcome was achieved in all patients. Conclusions: LC after CO2 TOLMS has a distinctive MR pattern. When tumour recurrence cannot be confidently excluded based on imaging, antibiotic therapy, close clinical and radiological follow-up and/or biopsy are recommended.
- Mecânica de Fluídos Computacional Aplicada ao Estudo do Impacto de Perfurações Septais na Fisiologia NasalPublication . Chantre, T; Oliveira, R; Burgos, MA; Cunha, B; Barroso, M; Oliveira, M; Barros, E; Sousa, HObjetivos: Utilização de mecânica de fluídos computacional (MFC) na compreensão do impacto do tamanho e localização das perfurações septais (SP) na fisiologia nasal. Desenho de estudo: Estudo de simulação computacional. Material e Métodos: O Software de MFC (Flowgy®) foi utilizado na criação de modelos digitais de fossas nasais através da reconstrução de tomografias computadorizadas (TC). Foi realizada cirurgia virtual com estabelecimento de PS anteriores (1 ou 2cm) e posteriores (1 ou 2cm). Resultados: Perfurações de maiores dimensões causaram maior alteração na alocação do fluxo de ar independente da localização, com desvio de ar da fossa nasal com maior fluxo para a de menor fluxo. A resistência nasal bilateral não foi significativamente alterada pela presença de PS. Conclusões: As tecnologias de MFC auxiliam na compreensão de como as PS alteram a fisiologia nasal. A alocação do fluxo de ar é alterada, com maior fluxo de ar pela fossa nasal de menor resistência, principalmente nas perfurações anteriores.
- Subpial Hemorrhage : A Distinctive Neonatal Stroke PatternPublication . Pinto, C; Cunha, B; Pinto, MM; Conceição, CBackground and purpose: Subpial hemorrhage is a rare form of neonatal stroke, still poorly understood. The aim of this study was to characterize a cohort of term and preterm neonates with subpial hemorrhages and contribute to a better knowledge of this condition. Material and methods: Clinical records and magnetic resonance (MR) imaging data of all neonates with subpial hemorrhage followed at a pediatric hospital between 2010 and 2020 were retrospectively reviewed. Results: A total of 10 patients were included in the analysis, 40% of whom were term neonates. Operative vaginal delivery was registered in 30%. Temporal was the most common location of subpial hemorrhage (70%), and all patients displayed underlying brain infarction. A characteristic yin-yang pattern was present in 90% of the study cohort, and ingurgitation of medullary veins on susceptibility weighted imaging in 80%. Cerebellar microbleeds were observed in 60% of neonates, both term and preterm. When available, MR angiography and venography were unremarkable. Patients' clinical outcome was variable, with early prematurity not associated to worse outcomes. Conclusion: Subpial hemorrhage has a distinctive MR pattern, with underlying parenchymal venous infarction, and can occur in term and preterm neonates. This study results suggest an association between subpial hemorrhage and cerebellar microbleeds but further studies are required to confirm it and better understand the pathophysiology of subpial hemorrhage.