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      Risk Factors of Transient Cortical Blindness After Cerebral Angiography: A Multicenter Study

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          Abstract

          Background: Although transient cortical blindness is a rare complication following cerebral angiography, identification of risk factors for the development of transient cortical blindness after cerebral angiography is an important clinical issue.

          Material and methods: Between January 2008 and April 2018, 5,126 patients at five high-volume medical centers who underwent cerebral angiography procedures were enrolled in this multicenter cohort study. Patient baseline characteristics and surgery-related factors were analyzed. We used multivariate logistic regression to examine factors associated with transient cortical blindness.

          Results: Eighteen patients (0.35%) in the total cohort of 5,126 suffered transient cortical blindness. After univariate statistical analysis, no significant differences were determined between the transient cortical blindness group and the control group regarding gender ( p = 0.454), age ( p = 0.872), smoking ( p = 0.170), diabetes ( p = 0.800), and hypertension ( p = 0.100). Compared with the control group, the transient cortical blindness group weighed less ( p = 0.020), and had a larger dose of contrast agent ( p = 0.034) and more instances of contrast agent injected into the posterior circulation ( p < 0.001). Logistic regression analysis identified contrast agent dose and contrast agent injected into posterior circulation as independent predictive factors for transient cortical blindness ( P < 0.05).

          Conclusion: Larger doses off contrast agent and contrast agent injected into the posterior circulation are potential independent predictive factors for transient cortical blindness following cerebral angiography.

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          Most cited references25

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          Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema.

          Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state accompanied by a unique brain imaging pattern typically associated with a number of complex clinical conditions including: preeclampsia/eclampsia, allogeneic bone marrow transplantation, solid organ transplantation, autoimmune diseases and high dose cancer chemotherapy. The mechanism behind the developing vasogenic edema and CT or MR imaging appearance of PRES is not known. Two theories have historically been proposed: 1) Severe hypertension leads to failed auto-regulation, subsequent hyperperfusion, with endothelial injury/vasogenic edema and; 2) vasoconstriction and hypoperfusion leads to brain ischemia and subsequent vasogenic edema. The strengths/weaknesses of these hypotheses are reviewed in a translational fashion including supporting evidence and current available imaging/clinical data related to the conditions that develop PRES. While the hypertension/hyperperfusion theory has been most popular, the conditions associated with PRES have a similar immune challenge present and develop a similar state of T-cell/endothelial cell activation that may be the basis of leukocyte trafficking and systemic/cerebral vasoconstriction. These systemic features along with current vascular and perfusion imaging features in PRES appear to render strong support for the older theory of vasoconstriction coupled with hypoperfusion as the mechanism.
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            Posterior reversible encephalopathy syndrome in infection, sepsis, and shock.

            The cause of "posterior reversible encephalopathy syndrome" (PRES) is not established. We recently encountered several patients who developed PRES in the setting of severe infection. In this study, we comprehensively reviewed the clinical and imaging features in a large cohort of patients who developed PRES, with particular attention to those with isolated infection, sepsis, or shock (I/S/S). The clinical/imaging features of 106 patients who developed PRES were comprehensively evaluated. In 25 of these patients, PRES occurred in association with severe I/S/S separate from transplantation. The clinical/imaging features (computer tomography, MR imaging, and MR angiography [MRA]) of the patients with I/S/S were further evaluated, including organ/tissue/blood culture results, mean arterial blood pressure (MAP) at toxicity, extent of cerebral edema, and presence of vasospasm. PRES occurred in association with I/S/S in 25 of 106 patients (23.6%), in addition to 4 other major clinical settings, including cyclosporine/FK-506 (post-transplant) neurotoxicity (46.2%), autoimmune disease (10.4%), postchemotherapy (3.7%), and eclampsia (10.4%). In the 25 patients with I/S/S, available cultures demonstrated a predominance of gram-positive organisms (84%). Blood pressure was "normal" at toxicity in 10 patients (MAP, 95 mm Hg); "severe" hypertension was present in 15 patients (MAP, 137 mm Hg). Extent of brain edema graded on imaging studies was greater in the normal MAP group compared with the severe hypertension group (P < .05). MRA demonstrated vasospasm in patients with severe hypertension and vessel "pruning" in the normal MAP group. Infection/sepsis/shock may be an important cause of PRES, particularly in relation to infection with gram-positive organisms.
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              Osmotic opening of the blood-brain barrier: principles, mechanism, and therapeutic applications.

              1. Osmotic opening of the blood-brain barrier by intracarotid infusion of a hypertonic arabinose or mannitol solution is mediated by vasodilatation and shrinkage of cerebrovascular endothelial cells, with widening of the interendothelial tight junctions to an estimated radius of 200 A. The effect may be facilitated by calcium-mediated contraction of the endothelial cytoskeleton. 2. The marked increase in apparent blood-brain barrier permeability to intravascular substances (10-fold for small molecules) following the osmotic procedure is due to both increased diffusion and bulk fluid flow across the tight junctions. The permeability effect is largely reversed within 10 min. 3. In experimental animals, the osmotic method has been used to grant wide access to the brain of water-soluble drugs, peptides, antibodies, boron compounds for neutron capture therapy, and viral vectors for gene therapy. The method also has been used together with anticancer drugs to treat patients with metastatic or primary brain tumors, with some success and minimal morbidity.
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                Author and article information

                Contributors
                Journal
                Front Neurol
                Front Neurol
                Front. Neurol.
                Frontiers in Neurology
                Frontiers Media S.A.
                1664-2295
                18 September 2019
                2019
                : 10
                : 1005
                Affiliations
                [1] 1Department of Neurosurgery, The China-Japan Union Hospital of Jilin University , Changchun, China
                [2] 2Department of Neurosurgery, The Second Hospital of Jilin University , Changchun, China
                [3] 3Department of Neurosurgery, Jilin Central Hospital , Jilin, China
                [4] 4Department of Neurosurgery, Siping Central Hospital , Siping, China
                [5] 5Department of Neurosurgery, Tianjin Fifth Central Hospital , Tianjin, China
                [6] 6Department of Neurology, The China-Japan Union Hospital of Jilin University , Changchun, China
                Author notes

                Edited by: Diogo C. Haussen, Emory University, United States

                Reviewed by: Waldo Rigoberto Guerrero, Aurora St. Luke's Medical Center, United States; Moisey Aronov, Federal Medical and Biological Agency, Russia

                *Correspondence: Jie Wang wangjie77@ 123456163.com

                This article was submitted to Endovascular and Interventional Neurology, a section of the journal Frontiers in Neurology

                Article
                10.3389/fneur.2019.01005
                6759592
                31620076
                b5c72f8b-2cc8-4862-95cc-5f9a09aee29a
                Copyright © 2019 Li, Liang, Liu, Liu, Zheng, Shi and Wang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 26 May 2019
                : 03 September 2019
                Page count
                Figures: 1, Tables: 2, Equations: 0, References: 26, Pages: 5, Words: 3694
                Funding
                Funded by: National Natural Science Foundation of China 10.13039/501100001809
                Award ID: 81220108007
                Award ID: 81371315
                Award ID: 81471167
                Award ID: 81671139
                Categories
                Neurology
                Original Research

                Neurology
                transient cortical blindness,cerebral angiography,contrast agent dose,weight,digital subtraction angiography

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