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        Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies

        Alvin S. Das,Robert W. Regenhardt,Meike W. Vernooij,Deborah Blacker,Andreas Charidimou,Anand Viswanathana 대한뇌졸중학회 2019 Journal of stroke Vol.21 No.2

        Cerebral small vessel disease (CSVD) is a common group of neurological conditions that confer a significant burden of morbidity and mortality worldwide. In most cases, CSVD is only recognized in its advanced stages once its symptomatic sequelae develop. However, its significance in asymptomatic healthy populations remains poorly defined. In population-based studies of presumed healthy elderly individuals, CSVD neuroimaging markers including white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and cerebral microinfarcts are frequently detected. While the presence of these imaging markers may reflect unique mechanisms at play, there are likely shared pathways underlying CSVD. Herein, we aim to assess the etiology and significance of these individual biomarkers by focusing in asymptomatic populations at an epidemiological level. By primarily examining population-based studies, we explore the risk factors that are involved in the formation and progression of these biomarkers. Through a critical semi-systematic review, we aim to characterize “asymptomatic” CSVD, review screening modalities, and draw associations from observational studies in clinical populations. Lastly, we highlight areas of research (including therapeutic approaches) in which further investigation is needed to better understand asymptomatic CSVD.

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        Deconstructive repair of a traumatic vertebrovertebral arteriovenous fistula via a contralateral endovascular approach

        Nageshwaran Sathiji K.,Deng Francis,Regenhardt Robert W.,Das Alvin S.,Alotaibi Naif M.,Patel Aman B.,Stapleton Christopher J. 대한뇌혈관외과학회 2022 Journal of Cerebrovascular and Endovascular Neuros Vol.24 No.3

        Vertebrovertebral arteriovenous fistulas (VVAVFs) are rare entities that lack consensus guidelines for their management. Our case describes the successful treatment of a traumatic VVAVF via a contralateral deconstructive endovascular approach. A 64-year-old female presented following a traumatic fall. Computed tomography angiogram highlighted a 2 cm pseudoaneurysm of the right vertebral artery (VA) with epidural contrast enhancement and a hematoma with flow voids within the epidural space. Digital subtraction angiography showed a VVAVF at C2-3 with retrograde filling of the distal right VA. Having undergone several unsuccessful passes of the proximal dissection flap in the right VA, the patient underwent a contralateral deconstructive approach with correction of the VVAVF without complication. The remaining feeding branches had occluded after 1 week. The patient made a complete recovery without neurological sequelae at 3-month follow-up.

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