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This study aimed to clarify the risk factors of treatment for unruptured cerebral aneurysms (UCAs) in elderly patients by comparing the morbidity at discharge between surgical clipping and endovascular coiling in nonelderly (<65 years) and elderly (≥65 years) patients based on a national database in Japan. A total of 36,017, including 15,671 patients with UCA after exclusion of unknown location, were registered in the Diagnosis Procedure Combination, the nationwide database, from 2010 to 2015 in Japan. Outcome of Barthel Index at discharge was investigated and multivariate logistic regression analysis identified risk factors for morbidity of Barthel Index <90 at discharge in nonelderly and elderly patient groups. Risk factors for morbidity at discharge were basilar artery aneurysm compared with internal carotid artery (ICA), diabetes mellitus (odds ratio [OR], 2.0–2.5; 95% confidence interval [CI], 1.6–3.7), antiplatelet drug, and anticoagulation drug; however, highest hospital volume compared with lowest was an inverse risk factor in both age groups. Endovascular coiling (OR, 0.4; 95% CI, 0.3–0.5) was a significantly inverse risk in the elderly group. Anterior communicating artery aneurysm compared with ICA was a significant risk (OR, 1.6; 95% CI, 1.0–2.6) in the nonelderly group; on the other hand, anterior communicating artery aneurysm (OR, 0.7; 95% CI, 0.5–0.95) and middle cerebral artery aneurysm (OR, 0.6; 95% CI, 0.5–0.8) compared with ICA were significantly inverse risks in the elderly group. Endovascular coiling after control of diabetes mellitus was recommended for the treatment of UCA in elderly patients. The ICA location of aneurysm in the elderly should be paid attention as the treatment risk. [ABSTRACT FROM AUTHOR]

Introduction: Fenestrations of cerebral arteries are most common in the vertebrobasilar (VB) system, and magnetic resonance (MR) angiographic studies of these variations are sparse. Methods: We retrospectively reviewed MR angiographic images of 3,327 patients; images were obtained using two 1.5-T imagers and picked up fenestrations of the intracranial vertebral artery (VA), VB junction, and basilar artery (BA) for evaluation. Results: In 92 patients, we found 93 fenestrations (2.80%), which included 18 of the intracranial VA (0.54% prevalence), 6 of the VB junction (0.18%), and 69 of the BA (2.07%). Most VA fenestrations were large, and the posterior inferior cerebellar artery arose from the fenestrated segment in 10 patients (56%). Fenestrations of the VB junction were small and triangular. Sixty-five (94%) of the 69 BA fenestrations were located at the proximal segment and had small slit-like configurations. The anterior inferior cerebellar artery arose from the fenestrated segment in 27 patients (37%). We found 18 cerebral aneurysms in 16 (17%) of the 92 patients with fenestration but detected only one aneurysm at the fenestration. Conclusion: The overall prevalence of fenestrations of the intracranial VB system was 2.77%. We found associated cerebral aneurysms relatively frequently but rarely at the fenestration. [ABSTRACT FROM AUTHOR]

Background and Purpose- Stroke is the most frequent severe clinical event in patients with Fabry disease. We aimed to evaluate the cerebral magnetic resonance imaging findings of patients with Fabry disease and assess their association with future stroke risk after enzyme replacement therapy (ERT) induction. Methods- We retrospectively reviewed the magnetic resonance imaging findings of 25 patients with Fabry disease. Of these, 12 adult patients without prior stroke or ERT were enrolled to evaluate the association between baseline magnetic resonance imaging findings and stroke occurrence after ERT initiation. We assessed white matter hyperintensities, periventricular hyperintensities, and basilar artery diameter as neuroimaging markers. Results- The mean age of participants was 38.8±16.8 years. Fourteen patients (56.0%) were women. White matter hyperintensities and periventricular hyperintensities were observed in 15 and 13 cases, respectively. The mean basilar artery diameter was 3.2±0.55 mm. Two patients demonstrated old infarct lesions. Three of 12 patients in whom ERT was initiated had symptomatic stroke after baseline magnetic resonance imaging. Of these, 2 developed stroke within 6-month post-ERT initiation. The baseline basilar artery diameter was larger in patients who developed stroke than in those who did not (4.0±0.40 versus 2.9±0.49 mm, P=0.02). Conclusions- Basilar artery diameter may be associated with stroke risk after ERT initiation among Japanese patients with Fabry disease.

Background Dilatation of the basilar artery ( BA ) has been recognized as a predictor of cardiovascular events ( CVE s). However, it is unclear if the longitudinal change in BA diameter (Δ BA ) is associated with CVE s. Methods and Results In a cohort of Japanese participants with vascular risk factors in an observational study, we evaluated the relationship of Δ BA to CVE s and the time course of the BA diameter. The short axis of the BA diameter was measured at the midpons level in T2-weighted images. Brain magnetic resonance imaging measurements included cerebral small-vessel disease, lacunars, and white matter hyperintensities. First, 493 patients were analyzed by the time-dependent Cox proportional hazards model to evaluate the association between Δ BA and CVE s, with adjustment for age, sex, vascular risk factors, and magnetic resonance imaging parameters. Second, we assessed the longitudinal Δ BA in 164 patients who underwent long-term follow-up magnetic resonance imaging, by linear regression analysis. In the mean follow-up of 8.7 years, 105 patients developed CVE s. A smaller Δ BA was independently associated with the high incidence of CVE s (hazard ratio, 0.36; 95% CI, 0.16-0.78; P=0.010; n=493). After a mean interval of 9.4 years, the average Δ BA was 0.41±0.46 mm (excluding patients with fetal-type circle of Willis). Progression of BA dilatation was associated with men but inversely associated with initial BA diameter and fetal-type circle of Willis (n=164). Conclusions BA diameter increased over time (excluding the patients with fetal-type circle of Willis), whereas Δ BA was inversely associated with the incidence of CVE s.

Objective: The goals of this study were to evaluate the relationship between postoperative oculomotor nerve palsy and other clinical factors and to improve preoperative estimations of the risk. Such an evaluation has not been previously described in the literature., Methods: Patient records for 77 basilar tip aneurysm cases and 28 basilar superior cerebellar artery aneurysm cases treated between 1981 and 1997 were reviewed. Clinical and radiological parameters were separately analyzed using the chi2 test, and then multiple-regression analysis was used., Results: Postoperative oculomotor palsy occurred in 25 (32%) patients with basilar tip aneurysms and 11 (39%) patients with basilar superior cerebellar artery aneurysms, in addition to 2 patients with basilar tip aneurysms and 3 patients with basilar superior cerebellar artery aneurysms who exhibited oculomotor palsy before surgery. For both type of aneurysms, the size and direction of the aneurysms were closely related to oculomotor nerve palsy. The complication also tended to occur in early surgery cases, in younger patients, and in patients of poor-clinical grade status., Conclusion: In this study, some clinical and radiological factors were found to be associated with postoperative oculomotor nerve palsy.

Twenty-one cases of Japanese patients exhibiting recurrent attacks of vertigo are reported. Fifteen of the cases are females. The mean age of onset of the vertigo is 30.8 years. In 11 patients, the duration of attacks is less than 10 min. Caloric responses are normal in all patients. Although two patients demonstrate hearing loss, the rest of the patients exhibit no hearing loss. Headaches have been reported in all patients. Eighteen of the patients experience headaches associated with the vertiginous attacks. The clinical features observed in our cases are consistent with a diagnosis of benign recurrent vertigo. Four patients exhibit cranial nerve symptoms which are features of basilar artery migraine. Basilar artery migraine is attributed to a migrainous disturbance of the basilar artery. Benign recurrent vertigo is also ascribed to a migrainous disorder affecting the vestibular system, thus it is a localized clinical manifestation of basilar artery migraine.