Editor’s Choices

Closed-Cell Stent for Coil Embolization of Intracranial Aneurysms: Clinical and Angiographic Results • A.K. Wakhloo, I. Linfante, C.F. Silva, E.A. Samaniego, G. Dabus, V. Etezadi, G. Spilberg, and M.J. Gounis
Because recanalization is observed in 20–40% of endovascularly treated aneurysms, these authors report their experience using a closed-cell stent. They treated 161 wide-neck ruptured or unruptured aneurysms with the device and found a nearly 5% death rate and a 3.5% incidence of neurologic deficits. Of the ones available for follow-up, 10% of patients showed recanalization and 6% required retreatment. In-stent stenosis was seen in only 1 instance. Treatment of ruptured aneurysms and premature termination of antiplatelet medication were associated with increased morbidity and mortality but overall these stents were considered to be safe and effective.

The Characteristics and Risk Factors of Headache Development after the Coil Embolization of an Unruptured Aneurysm • G. Hwang, E.-A. Jeong, J.H. Sohn, H. Park, J.S. Bang, S.-C. Jin, B.C. Kim, C.W. Oh, and O.-K. Kwon
Little is known about headaches post-aneurysm coiling. These authors treated 90 patients with unruptured aneurysms and no headaches. Nearly 56% developed headaches within 72 hours of treatment and all headaches resolved shortly thereafter. Only coil-packing attenuation was associated with presence of headaches. The authors concluded that though headaches were common, these were nearly always benign and resolved spontaneously. High packing attenuation may induce stretching of the aneurysm and inflammation that can result in headaches.

Elevated Mean Diffusivity in the Left Hemisphere Superior Longitudinal Fasciculus in Autism Spectrum Disorders Increases with More Profound Language Impairment • L.M. Nagae, D.M. Zarnow, L. Blaskey, J. Dell, S.Y. Khan, S. Qasmieh, S.E. Levy, and T.P.L. Roberts
The cause of autism continues to be uncertain and conventional imaging is not helpful. These investigators used DTI to study the language-related white matter tracts in a subset of patients with autism and language impairments. Eighteen patients were compared with 25 controls and showed abnormal DTI parameters in the superior longitudinal fasciculus, particularly in its temporal portion and on the left side. Thus, the white matter subserving language in these patients was abnormal.

Fellows’ Journal Club

Subarachnoid Hemorrhage Incidence in the United States Does Not Vary with Season or Temperature • R.J. McDonald, J.S. McDonald, J.P. Bida, D.F. Kallmes, and H.J. Cloft
Is subarachnoid hemorrhage related to changes in barometric pressure and temperature? This short article addresses this issue. The authors correlated onset of spontaneous SAH in over 52,000 patients with month of occurrence and local average monthly temperatures. They found no significant monthly or temperature-related effect in the incidence of SAH, but differences in its incidence in certain climate zones were present. Most differences were probably due to regional demographic factors and not meteorologic effects.

The Fate of Injured Corticospinal Tracts in Patients with Intracerebral Hemorrhage: Diffusion Tensor Imaging Study • Y.J. Jung and S.H. Jang
We all know that chronic injury of the CST results in Wallerian degeneration and atrophy and that DWI may show this process early on, but little is known about the ultimate fate of the injured CST. Here, the authors used DTI to assess the CST in 45 patients after hemorrhage. They studied their subjects acutely within 30 days and again after 3 months and the CSTs were categorized as preserved around the hematoma (type A), interrupted around the hematoma (type B), or did not reach the hematoma (type C). Type A had the best motor function acutely and type C the worst. However, 14% changed from type A to B, 92% changed from B to A, and 16% changed from C to A. The CST may change from the acute to chronic stages during motor function recovery and DTI may predict regeneration or degeneration.

Hemorrhage/Contrast Staining Areas after Mechanical Intra-Arterial Thrombectomy in Acute Ischemic Stroke: Imaging Findings and Clinical Significance • G. Parrilla, B. García-Villalba, M. Espinosa de Rueda, J. Zamarro, E. Carrión, F. Hernández-Fernández, J. Martín, R. Hernández-Clares, A. Morales, and A. Moreno
CT may show hyperdense areas after intra-arterial thrombolysis due to contrast accumulation and/or hemorrhage and these are considered negative prognostic signs. The authors studied 48 patients at 24 and 72 hours after procedures. Of 15 patients with an occluded ICA or MCA, recanalization was achieved in 12 and hyperdense regions were seen in all (subarachnoid = 6, brain = 4, and both = 5). All hyperdense regions were considered to be clinically asymptomatic and thus did not carry a worse prognosis.