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The standard of care for treating acute large vessel occlusion is endovascular therapy. The most frequent cause of occlusion is either embolic occlusion or in situ thrombotic occlusion. However, occlusion resulting from intracranial dissection is extremely rare, especially in the middle cerebral artery. Prior to a thrombectomy or endovascular therapy, understanding and interpreting the angiographic findings is crucial for planning the appropriate treatment and preventing complications.

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INTRODUCTION: The association between within-visit blood pressure variability (BPV) and all-cause and stroke mortality remains uncertain. The aim of our study was to assess the association of within-visit BPV with all-cause and stroke mortality. METHODS: The study was conducted among participants from Thai Epidemiologic Stroke Study, which is a prospective community-based cohort study that recruited participants from the general population from five regions of Thailand. This study included 19,614 participants aged 45-80 years, who were free of stroke and had three blood pressure (BP) measurements, taken 1 min apart, at baseline. Within-visit systolic blood pressure (SBP) and diastolic blood pressure (DBP) variability were expressed as the maximum absolute difference (MAD) between any two readings among the three repeated sequential measurements of SBP and DBP, respectively. The participants were followed up for mortality. Cox regression analysis was used to identify the association of within-visit BPV with all-cause and stroke mortality. Hazard ratio (HR) and 95% confidence intervals were used to illustrate the associations. Sensitivity analysis restricted to participants with mean SBP above 130 mm Hg and mean DBP above 90 mm Hg (n = 1,895) was performed. RESULTS: During a median follow-up of 11.1 years, 305 participants died of stroke, and 3,173 participants died of nonstroke cause. In unadjusted analyses, high within-visit MAD of SBP was significantly associated with all-cause (HR, 1.19; 95% CI, 1.09-1.31; p < 0.001) and stroke mortality (HR, 1.87; 95% CI, 1.35-2.59; p < 0.001); high within-visit MAD of DBP was also significantly associated with all-cause mortality (HR, 1.19; 95% CI, 1.08-1.31; p < 0.001), in quartile 4 versus quartile 1. These associations did not persist after further adjustment for sex, age, and other potential confounders including mean BP. However, sensitivity analysis showed some inconsistent results regarding associations of within-visit MAD of SBP and DBP with all-cause and stroke mortality, respectively. CONCLUSION: In general population, within-visit systolic BPV and within-visit diastolic BPV do not have prognostic significance on stroke mortality and all-cause mortality, respectively.

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On findings of restricted diffusion in a bilateral pontine infarct, imaging solely may not predict a poor clinical outcome as a full motor recovery is possible. Hence, recanalization of an acutely occluded basilar artery should be carefully considered on a case by case basis.

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We describe a patient with multiple cranial dural arteriovenous fistulas (DAVFs) presenting with thalamic dementia. A 52-year-old man experienced progressive dementia and behavioral change for 1 month. Cranial computed tomography scan and magnetic resonance imaging (MRI) showed bilateral thalamic edema with subsequent hemorrhagic transformation. Cerebral angiography demonstrated multiple cranial DAVFs at the straight sinus and posterior part of the superior sagittal sinus. The symptomatic fistula was the straight sinus DAVF, Cognard Type II a + b, supplied by meningeal branches of the left superior cerebellar artery, the left ascending pharyngeal artery originating from the left occipital artery, and multiple tiny branches of the left occipital artery with retrograde venous drainage into the straight sinus and vein of Galen. In addition, there was probable thrombosis at the middle part of the straight sinus associated with anatomical variation of the dural venous sinuses at the torcular herophili. The patient underwent successfully endovascular treatments in a two-staged embolization using liquid embolic materials. The patient has gradually recovered and could get back to the activities of daily living at home within 2 months. Follow-up MRI of the brain at 6 months revealed nearly complete resolution of the bilateral thalamic congestion. Cerebral angiography, obtained 1 year after endovascular treatment, confirmed complete obliteration of both DAVFs. We also reviewed the literature of thalamic dementia caused by intracranial DAVFs.