Notes

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The role of the dural venous sinus system in cerebrovascular pathology and the understanding of normal developmental patterns and sizes of the dural venous sinus system continue to expand. The purpose of this study was to review MR venograms to elucidate developmental patterns and diameters of the major dural venous sinuses from 0 to 20 years of age.

All available MR venograms of patients 0-20  years of age who presented to our institution were retrospectively reviewed. Patient age at the time of image acquisition was noted, and measurements were taken of the diameters of the major dural venous sinuses. The presence of embryonic sinuses including the persistent falcine sinus and the occipital sinus was noted. Dominance patterns of the transverse sinus system were determined. Mean diameters of each sinus were plotted as a function of age. Akti-1/2 of persistent prenatal sinuses and transverse sinus-dominance patterns was compared across ages.

A total of 429 MR venograms from 429 patients were reviewed. All dural venous sinuses demonstrated a maximal growth rate from 0 to 7 years of age and reached maximal diameters around 5-10 years of age. The prevalence of falcine sinuses and occipital sinuses trended downward across increasing age categories (
= .09 and, <.0001, respectively).

Dural venous sinuses demonstrate maximal growth between 0 and 7 years of age and reach adult size around 5-10 years of age. Involution of the prenatal sinuses continues to take place after birth into childhood but is largely absent in early adulthood.
Dural venous sinuses demonstrate maximal growth between 0 and 7 years of age and reach adult size around 5-10 years of age. Involution of the prenatal sinuses continues to take place after birth into childhood but is largely absent in early adulthood.
The pseudophlebitic pattern is an increasingly recognized angiographic manifestation of chronic venous congestion in the setting of a cranial dural arteriovenous fistula. We sought to study the clinical and radiologic manifestations of patients with the pseudophlebitic pattern.

We retrospectively reviewed a cohort of patients with dural arteriovenous fistulas evaluated at our institution from 2008 to 2020. Angiograms were reviewed to classify dural arteriovenous fistulas and document the presence or absence of a pseudophlebitic pattern, defined as the presence of serpiginous and tortuous collateral, bridging, and cortical veins with an associated delay in circulation time of the normal brain. We then studied the association between the pseudophlebitic pattern and clinical presentation and MR imaging findings.

Two hundred one patients were included. Patients with a pseudophlebitic pattern had more hemorrhage (22.8% versus 8.4%,
= .005), gait changes and ataxia (6.0% versus 0.0%,
= 0.002), cognitive changes (6.9% versus 1.4%,
= .04), and seizures (8.6% versus 2.1%,
= .03). On MR imaging, the pseudophlebitic pattern was associated with higher rates of cerebral edema (70.9% versus 2.9%,
< .0001), chronic hemosiderin deposition and microhemorrhage (17.3% versus 2.2%,
= .0002), and dilated transmedullary veins (47.1% versus 0.0%,
< .0001). When we considered only patients with malignant fistulas, there was no difference in hemorrhage at presentation between the 2 groups (22.6% versus 22.8%,
= .99). Patients with a pseudophlebitic pattern did have higher rates of nonhemorrhagic neurologic deficits (24.1% versus 9.4%,
= .03).

The pseudophlebitic pattern was associated with high rates of brain parenchymal changes and neurologic symptoms in this cohort of patients with dural arteriovenous fistulas.
The pseudophlebitic pattern was associated with high rates of brain parenchymal changes and neurologic symptoms in this cohort of patients with dural arteriovenous fistulas.Otalgia is very common, and when the cause of ear pain is not identified on otoscopy and physical examination, cross-sectional imaging is routinely used to evaluate for potential sources of referred ear pain (secondary otalgia). Innervation of the ear structures is complex, involving multiple upper cervical, lower cranial, and peripheral nerves, which transit and innervate a large anatomic territory involving the brain, spine, skull base, aerodigestive tract, salivary glands, paranasal sinuses, face, orbits, deep spaces of the neck, skin, and viscera. Interpreting radiologists must be familiar with these neural pathways and potential sources of secondary otalgia. The purposes of this review are to detail the currently proposed mechanisms of referred ear pain, review the salient neuroanatomy of the complex pathways responsible for secondary otalgia, highlight important benign and malignant etiologies of referred ear pain, and provide a structured search pattern for approaching these challenging cases on cross-sectional imaging.
Endovascular therapy for acute ischemic stroke is often performed with the patient under conscious sedation. Emergent conversion from conscious sedation to general anesthesia is sometimes necessary. #link# The aim of this study was to assess the functional outcome in converted patients compared with patients who remained in conscious sedation and to identify predictors associated with the risk of conversion.

Data from 368 patients, included in 3 trials randomizing between conscious sedation and general anesthesia before endovascular therapy (SIESTA, ANSTROKE, and GOLIATH) constituted the study cohort. Twenty-one (11%) of 185 patients randomized to conscious sedation were emergently converted to general anesthesia.

Absence of hyperlipidemia seemed to be the strongest predictor of conversion to general anesthesia, albeit a weak predictor (area under curve = 0.62). Sex, hypertension, diabetes, smoking status, atrial fibrillation, blood pressure, size of the infarct, and level and side of the occlusion were not significantly associated with conversion to general anesthesia. Neither age (mean age, 71.3   ± 13.8 years for conscious sedation versus 71.6  ± 12.3 years for converters,
= .58) nor severity of stroke (mean NIHSS score, 17 ± 4 versus 18 ± 4, respectively,
= .27) were significantly different between converters and those who tolerated conscious sedation. The converters had significantly worse outcome with a common odds ratio of 2.67 (
= .015) for a shift toward a higher mRS score compared with the patients remaining in the conscious sedation group.

Patients undergoing conversion had significantly worse outcome compared with patients remaining in conscious sedation. No factor was identified that predicted conversion from conscious sedation to general anesthesia.
Patients undergoing conversion had significantly worse outcome compared with patients remaining in conscious sedation. No factor was identified that predicted conversion from conscious sedation to general anesthesia.
Although developmental venous anomalies have been frequently studied in adults and occasionally in children, data regarding these entities are scarce in neonates. We aimed to characterize clinical and neuroimaging features of neonatal developmental venous anomalies and to evaluate any association between MR imaging abnormalities in their drainage territory and corresponding angioarchitectural features.

We reviewed parenchymal abnormalities and angioarchitectural features of 41 neonates with developmental venous anomalies (20 males; mean corrected age, 39.9 weeks) selected through a radiology report text search from 2135 neonates who underwent brain MR imaging between 2008 and 2019. Fetal and longitudinal MR images were also reviewed. Neurologic outcomes were collected. Statistics were performed using χ
, Fisher exact, Mann-Whitney
, or
tests corrected for multiple comparisons.

Developmental venous anomalies were detected in 1.9% of neonatal scans. link2 These were complicated by parenchymal/ventricular . Neuroimaging and neurologic outcomes were favorable in most cases, suggesting a benign, self-limited nature of these vascular anomalies. link3 A congenital origin could be confirmed in one-quarter of cases with available fetal MR imaging.
Various patterns of leukoencephalopathy have been described in coronavirus disease 2019 (COVID-19). In this article, we aimed to describe the clinical and imaging features of acute disseminated leukoencephalopathy in critically ill patients with COVID-19 and the imaging evolution during a short-term follow-up.

We identified and reviewed the clinical data, laboratory results, imaging findings, and outcomes for 8 critically ill patients with COVID-19 with acute disseminated leukoencephalopathy.

All patients demonstrated multiple areas of white matter changes in both cerebral hemispheres; 87.5% (7/8) of patients had a posterior predilection. Four patients (50%) had short-term follow-up imaging within a median of 17 days after the first MR imaging; they developed brain atrophy, and their white matter lesions evolved into necrotizing cystic cavitations. All (8/8) patients had inflammatory cytokine release syndrome as demonstrated by elevated interleukin-6, D-dimer, lactate dehydrogenase, erythrocyte sedimentcytokine storm, or thrombotic microangiopathy.
India has high mortality rates from cardiovascular disease (CVD). Understanding the trends and identifying modifiable determinants of CVD risk factors will guide preventive strategies and policy making.

CVD risk factors (obesity, central obesity, and type 2 diabetes (T2D), hypertension, hypercholesterolemia and hypertriglyceridemia) prevalence and incidence were estimated in 962 (male 519) non-migrant adults from Vellore, South India, studied in (1) 1998-2002 (mean age 28.2 years) and (2) 2013-2014 (mean age 41.7 years). Prevalence was compared with the Non-Communicable Disease Risk Collaboration (global) data. Incidence was compared with another Indian cohort from New Delhi Birth Cohort (NDBC). Regression analysis was used to test baseline predictors of incident CVD risk factors.

The prevalence at 28 and 42 years was 17% (95% CI 14% to 19%) and 51% (95% CI 48% to 55%) for overweight/obesity, 19% (95% CI 17% to 22%) and 59% (95% CI 56% to 62%) for central obesity, 3% (95% CI 2% to 4%) and 16% (95% CI 14iddle income countries, with rural rates catching up with urban estimates. Adiposity predicted higher incident CVD risk, but the prevalence of hypertension and T2D was higher given a relatively low obesity prevalence. Preventive efforts should target both rural and urban India and should start young.
Allostatic load (AL) defines cardiometabolic, inflammatory, and neuroendocrine changes in the body in response to internal and external stressors. It is largely unknown whether gestational diabetes mellitus (GDM) alters maternal and fetal AL, which in turn affects GDM outcomes. Whether dietary intakes and quality can modify AL and thus influence GDM progression is also unknown.

In this study, we recruited 35 GDM and 30 non-GDM women in gestational week 25-33. Fasting blood samples were collected at enrollment, and cord venous blood samples were collected at delivery for the measurement of a series of AL biomarkers to calculate the composite AL index. Three-day dietary recalls were conducted at enrollment.

Results suggest that GDM women had 60% higher composite AL index scores (p value=0.01). Maternal AL index was associated with shorter duration of gestation (β=-0.33, p value=0.047) and higher fetal AL index (β=0.47, p value=0.006) after adjusting for GDM status. Dietary intake of monounsaturated fatty acids was negatively associated with maternal AL index (β=-0.
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