UNASSIGNED: This review aims to understand the value of a carotid Doppler scan (CDS) when managing patients with clinical/suspected ocular ischaemic syndrome (OIS); correlations between internal carotid artery (ICA) stenosis reports; subsequent patterns of referral to vascular experts; and subsequent decisions concerning surgical versus medical management.
UNASSIGNED: A retrospective review of 402 CDS requests by a single eye center over 4 years (2016-2019) for patients with a clinical suspicion of OIS was conducted. Data analysis included 344 patients who had reported CDS of both ICAs. We also studied referral patterns by ophthalmologists to other specialties.
UNASSIGNED: CDS requests were related to the retina (53.2%), neuro/TIA problems (31.1%), glaucoma (10.5%) and other issues (5.2%). The majority of patients (209/344, 60.8%) had normal CDA results. Of the 688 ICAs reported, 469 (68.2%) were normal, 219 (31.8%) had atheroma present, and only 83 (12.1%) had significant stenosis. Of 83 ICAs with stenosis, 23 (27.7%) had ≥70% stenosis, 24 (28.9%) had 50-69% stenosis, and 25 (30.1%) had <50% stenosis. A total of 60/344 (17.4%) patients were referred to vascular/stroke teams: 15/60 (25%) referred had bilateral disease, and only 2/60 (3.3%) were offered carotid endarterectomy. All referred patients commenced statins and low-dose aspirin.
UNASSIGNED: Our cohort showed a low incidence of ICA stenosis according to CDS reports in patients with suspected OIS. There were very low rates of vascular and endarterectomy referral. Commencement of conservative treatment (mini aspirin+statin) by ophthalmologists could be beneficial even in the early stage of presenting clinical evidence of OIS.
Ocular ischemic syndrome (OIS) covers a wide spectrum of eye problems resulting from reduced blood flow to the eyes. OIS is commonly known to be a rapidly blinding disease due to late diagnosis. A high index of suspicion can lead to early investigation and perhaps prevent blindness with timely intervention. The fluorescein angiogram is a reliable eye test to confirm OIS disease affecting the retina. If reduced retina perfusion is confirmed, a carotid Doppler artery scan (CDS) is the next investigation to detect blood vessel lumen narrowing primarily affecting carotid arteries (neck arteries). The presence of carotid artery disease can indicate risk of stroke; hence, confirmed carotid artery disease merits a referral to vascular surgeons to consider carotid artery surgery aiming to unblock the artery and improve blood flow and hopefully reverse OIS. Our study aimed to investigate the prevalence of suspected OIS patients referred for carotid Doppler scans, correlations between carotid artery stenosis results and clinical OIS, and subsequent offers of carotid artery surgery versus conservative medical management. Our study showed that carotid artery disease severity defined by CDS has a poor correlation with clinical diagnosis of OIS. Conservative treatment is advised for all patients with carotid artery disease, whereas surgical options for carotid stenosis are rarely offered. Hence, this study questions the benefit of pursuing CDS tests in OIS patients, since the results do not change their management. Finally, we highlight the need for better guidance on carotid artery stenosis referral for carotid surgery.

BACKGROUND: Trans-radial (TRA) access has become increasingly prevalent in neurointervention. Nonetheless, mediastinal hematoma after TRA is an infrequent yet grave complication associated with a notably elevated mortality rate. While our review found no reported mediastinal hematoma cases managed conservatively within neuro-interventional literature, similar complications are documented in cardiac and vascular interventional radiology, indicating its potential occurrence across disciplines.
METHODS: Carotid computed tomography angiography (CTA) showed calcified plaques with stenosis (Left: Severe, Right: Moderate) in the bilateral internal carotid arteries (ICAs) of an 81-year-old male presented with paroxysmal weakness in the right upper limb. Dual antiplatelet therapy with aspirin and clopidogrel was administered. On day 7, DSA of the bilateral ICAs was performed via TRA. Post-DSA, the patient experienced transient loss of consciousness, chest tightness, and other symptoms without ECG or MRI abnormalities. Hemoglobin level decreased from 110 g/L to 92 g/L. Iodinated contrast-induced laryngeal edema was suspected, and the patient was treated with intravenous methylprednisolone. Neck CT indicated a possible mediastinal hemorrhage, which chest CTA confirmed. The patient\'s treatment plan involved discontinuing antiplatelet medication as a precautionary measure against the potential occurrence of an ischemic stroke instead of the utilization of a covered stent graft and surgical intervention. Serial CTs revealed hematoma absorption. Discharge CT showed a reduced hematoma volume of 35 × 45 mm.
CONCLUSIONS: This case underscores the need for timely identification and precise manipulation of guidewires and guide-catheters through trans-radial access. The critical components of successful neuro-interventional techniques include timely examination, rapid identification, proper therapy, and diligent monitoring.

Hemoglobin (Hb) and lipid metabolism are critical in the pathophysiology of moyamoya disease (MMD), and Hb and triglycerides (TGs) both play roles in the development of cerebrovascular illness. However, there is little evidence of a link between Hb and TGs in patients with MMD. This study aimed to determine the association between Hb and TGs in patients who had recently been diagnosed with MMD. From March 2013 to December 2018, 337 patients clinically diagnosed with MMD were admitted to our hospital. Among these, 235 were selected for analysis in this retrospective, cross-sectional study. Each patient\'s clinical features were documented. For analysis, we used univariate analysis, smoothed-curve fitting, and multivariable, piecewise linear regression. Overall, the mean±standard deviation patient age was 48.14 ± 11.24 years, 44.68% were men, and the mean Hb concentration was 135.72 ± 18.99 g/L. After controlling for relevant confounders, smoothed-curve fitting revealed a nonlinear association between the Hb and TG concentrations (P = 0.0448). When the Hb concentration was below 141 g/L, multivariate piecewise linear regression analysis revealed a significant association between the Hb and TG concentrations [β: 0.01, 95% confidence interval (CI): 0.00, 0.01; P = 0.0182], although the association disappeared above this threshold (β:-0.00, 95% CI:-0.01, 0.01; P = 0.4429). In individuals newly diagnosed with MMD, there is a significant correlation between Hb and TGs, which may be connected to MMD pathogenesis.

Moyamoya disease (MMD) is a rare idiopathic cerebrovascular disease most common among the Asian population. Studies have shown that patients with MMD are at increased risk for developing psychiatric complications. We present a patient with hemorrhagic MMD (RNF213 gene mutation) who developed depression and catatonia over time following MMD-related strokes. While no guidelines exist for the management of such an uncommon scenario, it at least requires an interdepartmental approach. Our report highlights the medical complications of untreated MMD and its neuropsychiatric association with depression and catatonia.

BACKGROUND: Bilateral carotid artery dissection secondary to severe trauma is rare and can be potentially life -threatening if not diagnosed and treated properly.
METHODS: We report a 29-year-old female who was admitted to the emergency department after a car accident. The patient was conscious at the time of admission and presented with an initial Glasgow Coma Scale (GCS) of 15 presenting normal vital signs. The patient developed motor dysphasia with right upper limb paresis a few hours after the admission. Magnetic resonance imaging (MRI) revealed a bilateral cervical internal carotid artery (ICA) occlusion in addition to left frontal lobe infarct in a subacute phase. Medical management was successful and the patient was discharged from the hospital two weeks after the admission.
CONCLUSIONS: Noninvasive vascular imagining modalities are merging as the gold standard in the early detection of carotid artery dissection (CAD). Typical pathognomonic findings on MRI include double lumen and intimal flap. The management with systemic anticoagulation or antiplatelet therapy is aimed to prevent the development of ischemic stroke. In case of medical therapy being ineffective or in case of complication or any disorders suffered by a patient, endovascular treatment is performed.
CONCLUSIONS: With early detection and proper management, traumatic dissection of cervical carotid artery can have a benign outcome. As for the current patient, medical treatment with anticoagulation was sufficient and surgical management was therefore not required. Improvement in the patients\' speech was observed; nevertheless the continuation of speech therapy was indicated.

The aim of this project was to study how the morphology of the incoming and outgoing arterial components of the cerebral basal arterial network influence the blood flow to the brain. The cerebral basal arterial network consists of the circulus arteriosus cerebri anteriorly and the basilar artery posteriorly. Diameters of inflow vessels (bilateral vertebral and internal carotid arteries), connecting vessels (anterior communicating, basilar and bilateral posterior communicating arteries) and outflow vessels (anterior, middle and posterior cerebral arteries) were measured and cross-sectional areas calculated in 51 cadaveric brain specimens. The individual and the average cross-sectional areas of inflow arteries (51.43 mm2 ) were significantly bigger than the major outflow arteries (37.76 mm2 ) but smaller than the combined cross-sectional areas of outflow (37.76 mm2 ) and connecting (25.33 mm2 ) arteries. The difference in the size of arterial cross-sectional area and the presence of the connecting arteries in the cerebral basal arterial network provides a mechanism for lowering peaks in pressure, and demonstrates a function of the cerebral basal arterial network.

A systematic meta-regression analysis of the effects of acute hypoxia on the performance of central executive and non-executive tasks, and the effects of the moderating variables, arterial partial pressure of oxygen (PaO2) and hypobaric versus normobaric hypoxia, was undertaken. Studies were included if they were performed on healthy humans; within-subject design was used; data were reported giving the PaO2 or that allowed the PaO2 to be estimated (e.g. arterial oxygen saturation and/or altitude); and the duration of being in a hypoxic state prior to cognitive testing was ≤6days. Twenty-two experiments met the criteria for inclusion and demonstrated a moderate, negative mean effect size (g=-0.49, 95% CI -0.64 to -0.34, p<0.001). There were no significant differences between central executive and non-executive, perception/attention and short-term memory, tasks. Low (35-60mmHg) PaO2 was the key predictor of cognitive performance (R2=0.45, p<0.001) and this was independent of whether the exposure was in hypobaric hypoxic or normobaric hypoxic conditions.