BACKGROUND: This case series describes the safety and efficacy of superselective intra-arterial (IA) cerebral infusion of teniposide for the treatment of patients with glioma, to provide new ideas and methods for the treatment of high grade gliomas.
METHODS: 12 patients with glioma who were previously treated with standard therapy were treated with superselective IA cerebral infusion of teniposide. Patients received at least two cycles of treatment (one cycle: 150 mg/time, used for 1 day, repeated at 28 day intervals) after blood-brain barrier disruption. Patients received individualized treatment on the tumor location. The ophthalmic artery was bypassed during the super-selective arterial infusion.
RESULTS: No significant differences in biochemical indexes and Karnofsky performance status (KPS) score were observed before and after treatment, and no evident adverse events occurred (P>0.05). In a recent response evaluation (August 2023), two (8%) patients presented with a complete response (16.7%), four had a partial response (33.3%), four had stable disease (33.3%), and two showed progressive disease (16.7%). The overall response rate and disease control rate were 50.0% and 83.3%, respectively. In addition, we described the detailed course of treatment in two patients. Case No 1 (recurrent tumor) and case No 2 (primary tumor) received six and three cycles of teniposide infusion, respectively. After treatment, the tumors of the patients were significantly reduced without evident adverse effects.
CONCLUSIONS: This small series suggests that superselective IA cerebral infusion of teniposide may be a safe and effective therapy in the multimodal treatment of malignant glioma and warrants further study in larger prospective investigations.

UNASSIGNED: Accurate definition of stroke etiology is crucial, as this will guide effective targets for treatment. Both antiphospholipid antibody syndrome (APS) and infective endocarditis (IE) can be independent risk factors for ischemic stroke in young adults. When an embolic stroke occurs with IE and APS simultaneously, the origin of the embolic source is difficult to identify.
UNASSIGNED: A 19-year-old man was admitted to the hospital for the onset of stroke. A diagnosis of APS accompanied by IE was made after a series of examinations. We identified aortic valve vegetation as the embolic source. Although both APS and IE can induce valve vegetation, we considered IE to be the primary cause according to the infective clues. Despite treatment with ampicillin, the patient\'s fever persisted, and surgical aortic valve replacement was performed urgently. The patient recovered without recurrence of stroke during the 1-year follow-up.
UNASSIGNED: A considerable challenge for physicians is evaluating all the signs suggestive of embolic sources in acute stroke and identifying the primary etiology when there are multiple causes. Early diagnosis and surgical intervention for bicuspid aortic valve (BAV) vegetation complicated by acute stroke may yield favorable clinical results.

Complete heart block, aortic root abscess and aortic valve regurgitation are well-recognized complications of infective endocarditis of the aortic valve. Splenic abscess and aorto-cavitary fistula are rarer phenomena and are indicative of calamitous infection. The authors present the case of an otherwise healthy 61-year-old man presenting with a 2-month history of non-specific symptoms, who developed suppurative endocarditis with a fistulating aortic root abscess, combined with severe sepsis, splenic embolization and complete heart block. Staphylococcus lugdunensis was the causative bacterium identified. The combination of these sequelae in the same patient is sparsely reported, is exceedingly rare and carries a significant risk of mortality.
Infective endocarditis is a condition caused by bacteria invading the body and damaging the heart, especially the heart valves. Usually, the infection is diagnosed relatively swiftly by blood tests and images of the heart. Rarely, if this condition isn\'t managed promptly, the infection can progress to cause further damage to the heart and can spread to other organs and lead to a plethora of complications. Here, the authors report a case of a single patient who sought medical attention after 2 months of feeling unwell. It transpired that the patient had infective endocarditis that had spread to the spleen, which caused a defect in the cardiac tissue and impaired its ability to maintain an adequate circulation.

BACKGROUND: Dural arteriovenous fistulas (DAVFs) may present unique challenges for treatment depending on the anatomy and pattern of venous drainage. If endovascular techniques are to be employed, the DAVF must be amenable to transvenous or transarterial therapy. When access of peripheral vasculature does not provide a straightforward path, less conventional options may be available. This case highlights a novel, technically simple, and effective approach for the treatment of a subset of DAVFs, with venous drainage through calvarial diploic veins, that would make endovascular treatment otherwise challenging or impossible.
METHODS: We present a case of a 66-yr-old female patient who was diagnosed with a symptomatic DAVF located along the sphenoid ridge with a large intraosseous channel containing the draining vein of the fistula. This lesion was successfully treated with transcranial endovascular embolization via direct intraosseous cannulation of the calvarial diploic vein. This novel approach obviated the need for a full-thickness craniotomy, afforded only minimal bone loss, and preserved the integrity of the dura. A 3-mo follow-up angiogram confirmed complete cure of the DAVF with no residual arteriovenous shunt. At 20 mo postembolization, the patient was symptom free, with no reported neurologic deficits. Complete diagnostic work-up, treatment planning in a multidisciplinary environment, and a novel approach for endovascular embolization utilizing a hybrid operating suite played key roles in the successful implementation of this technique.
CONCLUSIONS: This is the first report of direct intraosseous cannulation of a calvarial diploic vein for successful transcranial endovascular embolization of a symptomatic DAVF.

We report two serial neuroendovascular cases of hydrophilic polymer embolic complications, and highlight a unique case of a routine diagnostic cerebral angiogram that was complicated by delayed intracranial hemorrhage requiring surgical decompression. Histopathology specimens revealed organized intravascular thrombi with foci of non-polarizable, basophilic foreign material. Shavings from the hydrophilic coatings of a standard diagnostic catheter and guidewire share histologic characteristics with this intravascular foreign material, confirming the diagnosis of hydrophilic polymer emboli. While this phenomenon has been described for complex neurointerventional procedures, it is rare with routine diagnostic cerebral angiography. Along with a detailed literature review, these cases provides further evidence that even basic hydrophilic coated catheters and/or wires may contribute to the etiology of iatrogenic emboli in the neurovasculature with the potential for acute and subacute complications, requiring further investigation.

BACKGROUND: Abciximab is used to treat thromboembolic complications of neuroendovascular procedures, but outcomes of treatment are not well defined.
OBJECTIVE: To examine the angiographic and clinical outcomes based on route of abciximab administration and degree of vessel recanalization.
METHODS: A prospectively maintained database of neuroendovascular procedures performed between January 2004 and May 2015 was retrospectively reviewed to identify cases with thromboembolic complications treated with abciximab. In these cases, route of administration, degree of vessel recanalization, and presence or absence of infarction were determined. A meta-analysis of similar cases in the literature was also performed.
RESULTS: Abciximab was administered in 0.24% (47 of 19 566) of procedures to treat thromboemboli in 59 vessels. Angiographic improvement was seen in 94% after IA therapy and 79% after IV therapy (p=0.133). In our meta-analysis of 391 treated patients, angiographic improvement was greater after IA (91.7%) than IV (77.4%) treatment (p<0.001). Postprocedural infarction occurred more frequently with distal lesions (42%) than local lesions (12%) (p=0.014), and occlusive lesions (36%) than non-occlusive lesions (4.8%) (p=0.010). Infarction was significantly less common with complete angiographic resolution (0%) than with partial or no improvement (54%) (p<0.001). Symptomatic intracranial hemorrhage occurred in 2.1%.
CONCLUSIONS: Abciximab produces a high rate of angiographic improvement and a low incidence of postprocedural infarct in neuroendovascular procedures complicated by thromboemboli. IA abciximab produces greater angiographic improvement than IV treatment. Postprocedural infarction is less common in patients with complete angiographic response than in those with partial or no response.

BACKGROUND: The thyroid undergoes a variety of physiological changes during pregnancy. The relatively low iodine levels seen in pregnancy have been implicated in thyroid growth during this time. Management of thyroid cancer in pregnancy is not immediately apparent. Furthermore, acute suppurative thyroiditis is rare and this is attributed to the glands innate immunity. We thoroughly review the evidence regarding management of thyroid abscess and thyroid malignancy during pregnancy and illustrate it via an extremely rare case of an embolic thyroid abscess highlighting an underlying carcinoma in a pregnant woman.
METHODS: A 29-year old female was found to have a thyroid mass during an antenatal assessment. Following a wound infection from Caesarian section she developed a rapidly progressive thyroid abscess. Incision and drainage of the abscess, and subsequent histology revealed papillary carcinoma. She subsequently underwent both total thyroidectomy with level 6 dissection and radio-iodine ablation post-natally.
CONCLUSIONS: The literature is inconsistent regarding pregnancy as a risk factor for thyroid cancer, but overall it has been suggested as equally or slightly more frequent than in the non-pregnant population. Thyroid mass investigation should be as for the non-pregnant population. In the first trimester any endocrine surgery is associated with miscarriage, whereas these risks are reduced in second trimester. Importantly, there is no survival benefit in undergoing papillary carcinoma surgery in the third trimester versus early post partum and the risks of premature labour may outweigh any benefit gained by operating early. Most importantly, acute suppurative thyroiditis is rare entity and clinicians should have a low threshold for suspicion of underlying malignancy in these patients. This is especially true in the pregnant population who may be especially susceptible whilst undergoing hypertrophic thyroid changes.

Stroke is an extremely rare complication of congenital heart block in children. We report a 2-year-old girl with congenital complete heart block who presented with acute-onset right middle cerebral artery territory stroke. The congenital heart block was secondary to maternal lupus.

Although usually asymptomatic, a persistent trigeminal artery (PTA) can rarely be associated with a direct fistula to the cavernous sinus (ie, trigemino-cavernous fistula). We present three patients with trigemino-cavernous fistulas; two were subsequently treated using modern endovascular techniques while the third initially declined therapy. We then review the literature of reported cases of this unusual entity. The aberrant anatomy associated with a PTA presents unique challenges to the management of these lesions, and must be well delineated prior to treatment. Finally, conservative management of trigemino-cavernous fistulas, either de novo or recurrent, may be considered if they demonstrate no evidence of cortical venous reflux and patient symptoms are tolerable.