Explore the vast range of titles available.

Abstract BACKGROUND More than a million Americans harbor a cerebral cavernous angioma (CA), and those who suffer a prior symptomatic hemorrhage have an exceptionally high rebleeding risk. Preclinical studies show that atorvastatin blunts CA lesion development and hemorrhage through inhibiting RhoA kinase (ROCK), suggesting it may confer a therapeutic benefit. OBJECTIVE To evaluate whether atorvastatin produces a difference compared to placebo in lesional iron deposition as assessed by quantitative susceptibility mapping (QSM) on magnetic resonance imaging in CAs that have demonstrated a symptomatic hemorrhage in the prior year. Secondary aims shall assess effects on vascular permeability, ROCK activity in peripheral leukocytes, signal effects on clinical outcomes, adverse events, and prespecified subgroups. METHODS The phase I/IIa placebo-controlled, double-blinded, single-site clinical trial aims to enroll 80 subjects randomized 1-1 to atorvastatin (starting dose 80 mg PO daily) or placebo. Dosing shall continue for 24-mo or until reaching a safety endpoint. EXPECTED OUTCOMES The trial is powered to detect an absolute difference of 20% in the mean percent change in lesional QSM per year (2-tailed, power 0.9, alpha 0.05). A decrease in QSM change would be a signal of potential benefit, and an increase would signal a safety concern with the drug. DISCUSSION With firm mechanistic rationale, rigorous preclinical discoveries, and biomarker validations, the trial shall explore a proof of concept effect of a widely used repurposed drug in stabilizing CAs after a symptomatic hemorrhage. This will be the first clinical trial of a drug aimed at altering rebleeding in CA.

[LANGUAGE=”English”]Tufted angioma (TA) is an uncommon benign vascular tumor that manifests as erythematous macules, plaques, and nodules and progresses slowly. It is histopathologically characterized by tufts of endothelial cells in a cannonball pattern in the dermis. It primarily affects children and adolescents. A 12-year-old child presented to us with a single, painful, sizeable annular plaque on the right side of his neck that had been there since he was 5 years old. Lupus vulgaris, borderline tuberculoid Hansen, annular elastolytic giant cell granuloma, acquired hemangioma, and benign vascular tumors were all evaluated as differential diagnoses. Ultrasound of the neck revealed an ill-defined hypoechoic region on the right side of the neck with no extension into the deeper plane. TA was diagnosed based on histopathology. We report this case because of its uncommon clinical form of TA, which presented as a single large erythematous annular plaque resembling a granulomatous lesion, which was later confirmed by histological features.[LANGUAGE=”Turkish”]Tufted anjiyom (TA), eritematöz maküller, plaklar ve nodüller şeklinde ortaya çıkan ve yavaş ilerleyen nadir bir benign vasküler tümördür. Histopatolojik olarak, dermiste cannonball paterni oluşturan endotel hücre demetleri ile karakterizedir. Öncelikle çocukları ve ergenleri etkiler. On iki yaşındaki bir çocuk, 5 yaşından beri var olan, sağ boynunda tek, ağrılı ve büyük boyutlu halka şeklinde bir plak ile bize başvurdu. Lupus vulgaris, borderline tüberküloid Hansen, halka şeklinde elastolitik dev hücreli granülom, edinilmiş hemanjiyom ve benign vasküler tümörler ayırıcı tanılar olarak değerlendirildi. Boyun ultrasonunda, sağ boyunda derin plana uzanımı olmayan, belirsiz sınırlı hipoekoik bir bölge tespit edildi. TA, histopatolojik bulgulara dayanarak teşhis edildi. Bu olguyu, histolojik bulgularla doğrulanan ve granülomatöz bir lezyonu andıran tek, büyük, eritematöz halka şeklinde bir plak olarak ortaya çıkan nadir bir TA klinik formu olması nedeniyle sunuyoruz.

Abstract BACKGROUND: Despite many publications about cerebral cavernous malformations (CCMs), controversy remains regarding diagnostic and management strategies. OBJECTIVE: To develop guidelines for CCM management. METHODS: The Angioma Alliance (www.angioma.org), the patient support group in the United States advocating on behalf of patients and research in CCM, convened a multidisciplinary writing group comprising expert CCM clinicians to help summarize the existing literature related to the clinical care of CCM, focusing on 5 topics: (1) epidemiology and natural history, (2) genetic testing and counseling, (3) diagnostic criteria and radiology standards, (4) neurosurgical considerations, and (5) neurological considerations. The group reviewed literature, rated evidence, developed recommendations, and established consensus, controversies, and knowledge gaps according to a prespecified protocol. RESULTS: Of 1270 publications published between January 1, 1983 and September 31, 2014, we selected 98 based on methodological criteria, and identified 38 additional recent or relevant publications. Topic authors used these publications to summarize current knowledge and arrive at 23 consensus management recommendations, which we rated by class (size of effect) and level (estimate of certainty) according to the American Heart Association/American Stroke Association criteria. No recommendation was level A (because of the absence of randomized controlled trials), 11 (48%) were level B, and 12 (52%) were level C. Recommendations were class I in 8 (35%), class II in 10 (43%), and class III in 5 (22%). CONCLUSION: Current evidence supports recommendations for the management of CCM, but their generally low levels and classes mandate further research to better inform clinical practice and update these recommendations. The complete recommendations document, including the criteria for selecting reference citations, a more detailed justification of the respective recommendations, and a summary of controversies and knowledge gaps, was similarly peer reviewed and is available on line www.angioma.org/CCMGuidelines.

Background: Cavernous angiomas (CAs) are abnormal, congenital, vascular malformations, which often grow in size over the course of life. Conservative treatment, microsurgical resection, and stereotactic radiosurgery are the three main options for treatment of CA. Radiological studies play a key role in diagnosis, with magnetic resonance (MR) being the method of choice. Objective: The aim of this study was to establish the prevalence of cavernous angiomas, the size, appearance, that is, the type of CAs and to determine visualization of cavernous angiomas by magnetic resonance. Methods: The study included all patients who underwent an MR of the brain in the period from January 2011 to the end of December 2017 at the Radiology Clinic of Tuzla University Clinical Centre, and in whom MR examination verified one or more CAs. Results: The prevalence of cavernous angioma in the study was 0.57%, and men and women were equally represented. The number of cavernous angiomas per patient was between 1 and 79 ; the average diameter was 11mm, and the most common type at ≥ 3mm was equivalent to Type II, whilst the largest number of cavernous angiomas, regardless of the size and visualization on individual sequences, were equivalent to Type IV. No significant difference was found in sensitivity between spin echo sequence and T2W gradient echo sequence in the group comprised of cavernous angiomas ≥ 3mm, whilst in the group comprised of punctiform cavernomas < 3mm, T2W* was a significantly more sensitive sequence than spin echo, that is, spin echo sequence had significantly lower sensitivity in the detection of punctiform CAs. Conclusion: The prevalence of CAs was in line with the results of other studies. T2W* sequence is significantly more sensitive in comparison with spin echo only in the detection of punctiform CAs, and is important in the detection of multiple familiar CAs.

Abstract BACKGROUND Cerebral cavernous angioma (CA) is a capillary microangiopathy predisposing more than a million Americans to premature risk of brain hemorrhage. CA with recent symptomatic hemorrhage (SH), most likely to re-bleed with serious clinical sequelae, is the primary focus of therapeutic development. Signaling aberrations in CA include proliferative dysangiogenesis, blood-brain barrier hyperpermeability, inflammatory/immune processes, and anticoagulant vascular domain. Plasma levels of molecules reflecting these mechanisms and measures of vascular permeability and iron deposition on magnetic resonance imaging are biomarkers that have been correlated with CA hemorrhage. OBJECTIVE To optimize these biomarkers to accurately diagnose cavernous angioma with symptomatic hemorrhage (CASH), prognosticate the risk of future SH, and monitor cases after a bleed and in response to therapy. METHODS Additional candidate biomarkers, emerging from ongoing mechanistic and differential transcriptome studies, would further enhance the sensitivity and specificity of diagnosis and prediction of CASH. Integrative combinations of levels of plasma proteins and characteristic micro-ribonucleic acids may further strengthen biomarker associations. We will deploy advanced statistical and machine learning approaches for the integration of novel candidate biomarkers, rejecting noncorrelated candidates, and determining the best clustering and weighing of combined biomarker contributions. EXPECTED OUTCOMES With the expertise of leading CA researchers, this project anticipates the development of future blood tests for the diagnosis and prediction of CASH to clinically advance towards precision medicine. DISCUSSION The project tests a novel integrational approach of biomarker development in a mechanistically defined cerebrovascular disease with a relevant context of use, with an approach applicable to other neurological diseases with similar pathobiologic features. Graphical Abstract Graphical Abstract

Introduction The Flash‐lamp pulsed dye laser (FPDL) is nowadays considered the most precise laser currently on the market for treating superficial vascular lesions. In this study, we gathered data from 10 years of experience regarding dye laser treatment of patients presenting vascular malformations such as telangiectasia, rhinophyma, port‐wine stain, cherry and spider angioma and vascular tumours. Methods Subjects were enrolled from 2013 to 2023 based on the vascular anomalies they presented. They underwent different treatment sessions with the FPDL device. Results The age‐range distribution by vascular anomaly confirmed that haemangiomas are typical in children while rhinophyma is a condition very common in older adults. A difference in sex distribution showed that pathologies such as telangiectasias typically affect women whereas rhinophyma is more frequent in men. Most of the treatments interested the face area but no permanent side effects were registered. Conclusions Our 10 years of experience with FPDL demonstrated good results in a wide range of applications for the treatment of different vascular anomalies. The absence of long‐term side effects and bearable pain during the treatment makes it a valuable solution for the resolution of benign tumours also in very young patients.

Spinal cavernous angiomas are uncommon vascular malformations in the spine accounting for 5%-12% of all spinal vascular lesions. When present in an intradural extra-medullary location, these usually present with radicular pain and neurological deficits due to mass effect (myelopathy). Herein, we present an atypical presentation of cavernous angioma in a 54-year-old man with tinnitus, headache and sensorineural hearing loss. We have also reviewed 51 cases of intradural extramedullary cavernous angiomas including our case with respect to demographic and clinical profile. A 54-year-old man presented with tinnitus in the left ear and occipital headache with neck pain and slight weakness of left-hand grip along with atrophy of thenar muscles. His pure tone audiometry (PTA) test reveled mild left sensorineural hearing loss. Magnetic resonance imaging (MRI) of cervical spine showed T2WI heterogeneously hyperintense left intradural extramedullary lesion at C7 vertebral body level. It was avidly enhancing with contrast. The patient underwent C7 laminectomy with a midline durotomy and complete excision of the lesion under neuromonitoring with sacrifice of the C8 sensory root. His symptoms improved following the surgery. The diagnosis of a cavernoma in an unusual location in the presence of cranial nerve dysfunction needs a high degree of diagnostic suspicion. Most of these cavernomas have a nerve root origin or attachment. The optimal treatment is microsurgical en bloc resection which leads to an effective resolution of both the symptoms.

Background Venous angiomas, also known as developmental venous anomalies (DVAs), are congenital vascular malformations that typically do not cause neurological symptoms. However, in rare cases, they can present with headaches, seizures, and even hemorrhages. This report highlights a rare case of a brain hemorrhage secondary to a venous angioma in the right parietal lobe without the common association with a cavernoma. Case presentation A 41-year-old woman experienced a sudden and severe headache, dizziness, left-sided hemihypoesthesia followed by seizures. Initial brain CT scans and MRI revealed a right parietal lobe bleed with a nodular hyperintense lesion on T1 and T2 sequences with lobulated borders and a hemosiderin halo on gradient echo sequences, initially suspected to be a cavernoma. Subsequently, the lesion was surgically resected using neuronavigation. The neuropathologic evaluation confirmed a venous angioma. Postoperatively, the patient was managed with antiepileptic medication and remained with left-sided hemihypoesthesia. Follow-up imaging showed stable residual gliosis and no active vascular anomalies. Conclusions This case underscores the importance of thorough pathological assessment and advanced imaging in accurately diagnosing DVAs. While typically benign, DVAs can present significant clinical challenges when symptomatic. This case is particularly notable for the absence of an associated cavernoma, which is more commonly seen and often responsible for hemorrhagic presentations.

A 16-year-old male teenager presented with multiple, erythematous, progressively increasing red spots on the face, trunk and oral cavity for 3 years. On examination, there were multiple telangiectasias over the lip and buccal mucosae, soft and hard palates, face and the trunk (figure 1A–C).