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Tudor Jovin

Publications and source records attributed to Tudor Jovin.

12 recordsLinked to original sources
PubMed2006

Quantitative perihematomal blood flow in spontaneous intracerebral hemorrhage predicts in-hospital functional outcome.

BACKGROUND AND PURPOSE: Few data on xenon computed tomography-based quantitative cerebral blood flow (CBF) in spontaneous intracerebral hemorrhage have been reported. We correlated perihematomal CBF in a retrospective series of 42 subacute spontaneous intracerebral hemorrhage patients undergoing xenon computed tomography with in-hospital discharge status and mortality. METHODS: We calculated 3 area-weighted mean CBF values: (1) within the computed tomography-visible rim of perihematomal edema, (2) within a 1-cm marginal radius around the hematoma, and (3) all cortical regions of interest immediately adjacent to the hematoma. Primary outcomes were in-hospital mortality and discharge status (ordinally as 0=home, 1=acute rehabilitation, 2=nursing home, 3=death). Discharge status was used as a surrogate for in-hospital functional outcome. RESULTS: Median hematoma volume was 14.4 cm(3) (range, 2 to 70). Median perihematomal (low-attenuation rim) CBF was 21.9 cm(3).100 g(-1).min(-1) (range, 6.1 to 81.1), and the median 1-cm marginal radius CBF was 26.8 cm(3).100 g(-1).min(-1) (range, 10.8 to 72.8). The median regional cortical CBF was 26.7 cm(3).100 g(-1).min(-1) (range, 6.9 to 72.6). Eight patients had 1-cm marginal radius or regional cortical CBF values <20 cm(3).100 g(-1).min(-1). Hematoma volume (odds ratio [OR], 1.68 per 10-cm(3) volume; P=0.036) and intraventricular hemorrhage (OR, 1.88 per grade of intraventricular hemorrhage; P=0.036) predicted mortality. Two CBF measures, hydrocephalus, and IVH predicted poor in-hospital functional outcome in bivariate analysis. Each CBF measure (OR, 0.34 to 0.43; P<0.001 to 0.003) and intraventricular hemorrhage (OR, 3.42; P<0.001) predicted in-hospital functional outcome in multivariable analyses. CONCLUSIONS: Most spontaneous intracerebral hemorrhage patients lack perihematomal penumbra. Perihematomal CBF independently predicts in-hospital discharge status but not in-hospital mortality. Further studies are warranted to determine whether perihematomal CBF predicts long-term functional outcomes.

Aged↗
PubMed2006

Clinical and anatomic outcomes after endovascular coiling of middle cerebral artery aneurysms: report on 30 treated aneurysms and review of the literature.

BACKGROUND: Endovascular treatment of middle cerebral artery (MCA) aneurysms has not been extensively studied. We report our experience on a select group of patients that underwent coil embolization of an MCA bifurcation aneurysm. METHODS: From August 1999 to January 2005, 29 patients harboring 30 MCA aneurysms were treated with coil embolization. These patients were felt to have favorable characteristics for endovascular therapy including absence of thrombus in the aneurysm, absence of an efferent artery off of the aneurysm, and ability to reconstruct the wide neck with stent reconstruction. We retrospectively reviewed their records and angiographic images to evaluate for technical result and complications. RESULTS: The mean age of our cohort was 59 +/- 13 years with 19 patients presenting with a ruptured aneurysm. Complete obliteration was achieved in 24 (80%) of 30 of aneurysms on postprocedural angiography and no patient showed aneurysm regrowth at 6-month follow-up. Twenty-seven (93%) of 29 patients had no change in baseline neurological function post-embolization. There were two procedural-related complications: one intraprocedural rupture of an aneurysm and one thromboembolic stroke in the ipsilateral MCA territory. CONCLUSIONS: Coil embolization of MCA bifurcation aneurysms has a high rate of complete obliteration with acceptable morbidity in our selected group of patients.

Aged↗
PubMed2006

Cell transplantation for ischemic stroke.

Cell replacement therapy has been evaluated as a regenerative strategy for patients with fixed neurologic deficits after ischemic stroke. Animal models have identified specific cell lines which lead to regeneration and improvement in behavior and motor function after implantation into areas of ischemic injury. This has led to the development of pilot studies in humans, which have mainly investigated the safety and pilot efficacy of such approaches with promising early results. As research in this area progresses, further prospective trials are necessary not only to demonstrate clinical efficacy but also to understand the mechanisms underlying the early positive experiences, to select appropriate patients for cell replacement therapy, and to elucidate the optimal timing and mode of cell delivery.

Animals↗
PubMed2006

Intra/extra-aneurysmal stent placement for management of complex and wide-necked- bifurcation aneurysms: eight cases using the waffle cone technique.

OBJECTIVE: To describe a novel application of the Neuroform stent (Boston Scientific-Target, Fremont, CA) for the management of eight wide-necked aneurysms. METHODS: All patients were treated using a single Neuroform stent placed partially into the aneurysm and into the afferent artery. The portion of the stent protruding into the aneurysm fundus provided neck support for the subsequent successful coiling. CONCLUSION: The Neuroform stent is a versatile device that can be used in a variety of ways to assist in the coiling of wide-necked aneurysms. The technique described here may be used for bifurcation aneurysms in lieu of using two stents in a Y configuration.

Aged↗
PubMed2005

Differentiating hemodynamic compromise by the OEF response to acetazolamide in occlusive vascular disease.

Identification of increased stroke risk in a population of symptomatic patients with occlusive vascular disease (OVD) is presently accomplished by measurement of oxygen extraction fraction (OEF) or cerebrovascular reserve (CVR). However, many regions identified by compromised CVR are not identified by OEF. Our aim was to determine whether the response of OEF to acetazolamide, namely, oxygen extraction fraction response (OEFR) would identify those hemispheres in hemodynamic compromise with normal OEF. Nine patients symptomatic with transient ischemic attacks and strokes, and with occlusive vascular disease were studied. Anatomical MRI scans and T2-weighted images were used to identify and grade subcortical white matter infarcts. PET cerebral blood flow (CBF) and OEF were measured after acetazolamide. The relationship between CVR and oxygen extraction fraction response (OEFR) showed that positive OEFR occurred after acetazolamide despite normal baseline OEF values. The two hemispheres with positive OEFR were also associated with severe (> 3 cm) subcortical white matter infarcts. We found that the OEFR was highly correlated with CVR and identified hemispheres that were hemodynamically compromised despite normal baseline OEF.

Acetazolamide↗
PubMed2005

Emergent basilar artery and bilateral posterior cerebral artery angioplasty, urokinase thrombolysis, and stenting for acute basilar artery occlusion secondary to diagnostic cardiac catheterization: case presentation.

This case presentation describes the use of emergent neurointerventional procedures to revascularize a patient who developed a symptomatic stroke during coronary artery angiography. Rapid identification of a neurologic deficit in the coronary angiography suite and notification of a skilled neurointerventionalist permit for early revascularization and improved patient outcomes.

Acute Disease↗
PubMed2005

Neurotransplantation for patients with subcortical motor stroke: a phase 2 randomized trial.

OBJECT: No definitive treatment exists to restore lost brain function following a stroke. Transplantation of cultured neuronal cells has been shown to be safe and effective in animal models of stroke and safe in a Phase 1 human trial. In the present study the authors tested the usefulness of human neuron transplantation followed by participation in a 2-month stroke rehabilitation program compared with rehabilitation alone in patients with substantial fixed motor deficits associated with a basal ganglia stroke. METHODS: Human neuronal cells (LBS-Neurons; Layton BioScience, Inc.) were delivered frozen and then thawed and formulated on the morning of surgery. The entry criteria in this randomized, observer-blinded trial of 18 patients included age between 18 and 75 years, completed stroke duration of 1 to 6 years, presence of a fixed motor deficit that was stable for at least 2 months, and no contraindications to stereotactic surgery. Patients were randomized at two centers to receive either 5 or 10 million implanted cells in 25 sites (seven patients per group) followed by participation in a stroke rehabilitation program, or to serve as a nonsurgical control group (rehabilitation only; four patients). The surgical techniques used were the same at both centers. All patients underwent extensive pre- and postoperative motor testing and imaging. Patients received cyclosporine A for 1 week before and 6 months after surgery. The primary efficacy measure was a change in the European Stroke Scale (ESS) motor score at 6 months. Secondary outcomes included Fugl-Meyer, Action Research Arm Test, and Stroke Impact Scale scores, as well as the results of other motor tests. Nine strokes were ischemic in origin and nine were hemorrhagic. All 14 patients who underwent surgery (ages 40-70 years) underwent uncomplicated surgeries. Serial evaluations (maximum duration 24 months) demonstrated no cell-related adverse serological or imaging-defined effects. One patient suffered a single seizure, another had a syncopal event, and in another there was burr-hole drainage of an asymptomatic chronic subdural hematoma. Four of seven patients who received 5 million cells (mean improvement 6.9 points) and two of seven who received 10 million cells had improved ESS scores at 6 months; however, there was no significant change in the ESS motor score in patients who received cell implants (p = 0.756) compared with control or baseline values (p = 0.06). Compared with baseline, wrist movement and hand movement scores recorded on the Fugl-Meyer Stroke Assessment instrument were not improved (p = 0.06). The Action Research Arm Test gross hand-movement scores improved compared with control (p = 0.017) and baseline (p = 0.001) values. On the Stroke Impact Scale, the 6-month daily activities score changed compared with baseline (p = 0.045) but not control (p = 0.056) scores, and the Everyday Memory test score improved in comparison with baseline (p = 0.004) values. CONCLUSIONS: Human neuronal cells can be produced in culture and implanted stereotactically into the brains of patients with motor deficits due to stroke. Although a measurable improvement was noted in some patients and this translated into improved activities of daily living in some patients as well, this study did not find evidence of a significant benefit in motor function as determined by the primary outcome measure. This experimental trial indicates the safety and feasibility of neuron transplantation for patients with motor stroke.

Adult↗
PubMed2004

Successful management of post-tumor resection middle cerebral artery thrombosis with stent-assisted angioplasty and thrombolytic therapy: case report.

OBJECTIVE AND IMPORTANCE: To describe successful endoluminal revascularization of an acute M1 occlusion 4 days after craniotomy and tumor resection. CLINICAL PRESENTATION: A 16-year-old right-handed girl presented with a 1-month history of daily headaches. The neurological examination was normal. Magnetic resonance imaging and computed tomography demonstrated a mass consistent with an epidermoid tumor compressing the left upper pons, left cerebral peduncle, and mesial left temporal lobe. INTERVENTION: A combination of low-dose antiplatelet agents administered intra-arterially and stent-assisted angioplasty was used. Successful endoluminal revascularization was achieved. Acute complications such as intracranial stent-thrombosis and/or intracranial hemorrhage were successfully avoided. CONCLUSION: In the acute postoperative period, most current chemical thrombolytic protocols are contraindicated because of the prohibitive risk of iatrogenic intracranial hemorrhage. With an understanding of the pharmacokinetics of the currently available antiplatelet drugs, combined chemical and mechanical thrombolysis may be used in the acute postoperative setting for endoluminal recanalization.

Adolescent↗
PubMed2002

Bow hunter's syndrome in the setting of contralateral vertebral artery stenosis: evaluation and treatment options.

STUDY DESIGN: A case report. OBJECTIVE: To illustrate a rare case of bow hunter's syndrome in a patient with significant contralateral vertebral artery (VA) occlusive disease. SUMMARY OF BACKGROUND DATA: Bow hunter's syndrome is an uncommon condition in which the VA is symptomatically occluded during neck rotation. This case is interesting in that the patient had what appeared to be a normal right VA and occluded left VA when the head was in the neutral position. When the head was rotated 45 degrees to the left, the patient's right VA was occluded (bow hunter's finding), and it became apparent that the left VA was not completely occluded (as it appeared in the neutral position angiogram) but rather was 90% stenosed. The complete occlusion appearance in the neutral position was an angiographic phenomenon caused by competitive flow through the open right VA. When the patient rotated his head to the left, he occluded his right VA and had insufficient blood flow through the left VA, thus creating a symptomatic ischemic state. METHODS: This case was studied using dynamic computed tomography imaging, single-photon emission computed tomography, transcranial Doppler ultrasound, brain stem auditory evoked potentials, and dynamic range-of-motion cerebral angiography. RESULTS: The patient demonstrated bow hunter's syndrome as documented on clinical examination and history. Transcranial Doppler studies, dynamic computed tomography scanning, and cerebral/cervical angiography confirmed the diagnosis and revealed an interesting angiographic pattern, which explained the patient's symptoms and findings only when angiographic flow patterns were taken into consideration. CONCLUSIONS: Bow hunter's syndrome should be suspected when a patient presents with reproducible vertebrobasilar symptoms on rotating the neck. Quantitative documentation using imaging and electroneurophysiologic tests is important when assessing this subjective process. Careful evaluation of the angiographic imagescan often help explain an odd flow pattern and provide the physician with a range of treatment options.

Blood Flow Velocity↗
PubMedDate not supplied

De novo development of a remote arteriovenous fistula following transarterial embolization of a carotid cavernous fistula: case report and review of the literature.

We report a case of a patient who developed a remote dural arteriovenous fistula involving the left sigmoid sinus 4 months after successful transarterial embolization of a carotid cavernous fistula. This rare occurrence has been reported after transvenous embolization, but this represents the first case, to our knowledge, after transarterial coil embolization. We present our findings along with a brief review of the literature.

Carotid Artery, External↗