Interventional Stroke Neurologist @JJHospitalMumbai @DCNSNeuro
Mumbai, India
Joined October 2009
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Shashank Nagendra retweeted
Does automated CTP improve ASPECTS or collateral score reliability in late-window LVO stroke?
In this JNIS study, adding perfusion maps did not improve inter- or intra-rater reliability, nor correlation with EVT decisions.
NCCT + CTA alone remained reliable for EVT triage.
@AnassBenomarMD @DanniDiestro @RaceToTheBrain @vitorpereiracan @CarmenPFarinas @nishita_singh3 @CMHawkes @karlnarvacan @SmhNeuroVasc @UofTStroke @UofT
Read more: bit.ly/4cWm2Ou
Shashank Nagendra retweeted
Forty 40% of LVO pts with successful recanalization (TICI >2B) experience a spontaneous SBP drop (>40 mm Hg over <1 hr) over the next 24 hours.
These drops are associated with poor 90-day functional outcome and early neuro deterioration (22% bs 13%).
Unclear if the lower BP is driving the neuroworsening, or a biomarker of a fading pressor response due to adequate reperfusion.
neurology.org/doi/10.1212/WN…
Shashank Nagendra retweeted
Degree of narrowing is not the whole story. High-risk plaque features—intraluminal thrombi, webs, and dissections—are strongly linked to ipsilateral stroke in nonstenotic carotid disease. @Katha_MD @hankshas @AlmekhlafiMa @draravindganesh @nishita_singh3 ahajrnls.org/4kC5Wxc
Shashank Nagendra retweeted
🚨Nonstenotic carotid disease is often seen in stroke. In this @ActRrct paper led by @Katha_MD @nishita_singh3 we show that in such patients, intraluminal thrombi, webs, dissections & rim sign are strongly assoc with ipsilateral stroke @JAHA_AHA @DCNSNeuro ahajournals.org/doi/full/10.…
ALT Representative computed tomography angiographic images for purely hypodense plaque (A, sagittal), mixed hypodense and calcified plaque (B, sagittal), irregular plaque (C, sagittal), carotid web (D, sagittal), carotid dissection and ulceration (E, sagittal) and intraluminal thrombus (F, axial).
Shashank Nagendra retweeted
Time to give birth to a new idea!
Need a way to remember the neuro complications in pregnancy?
Try this baby step to help you remember the most common Neuro complications in pregnancy that we see on imaging!
Just remember the four “P”s of “P”regnancy!
They are..
▶️Palsy (Bell’s)
▶️PRES
▶️Plugged up venous sinuses
▶️Pituitary apoplexy
Of course, there are many other neuro complications in pregnancy, but these are the classic ones you always need to think about
Hopefully, now the four P’s will give birth to a new era for you when it comes to imaging pregnant patients!
35 yr F presenting with a single focal seizure, no headache with CT showing focal edema in the right frontal cortex. DSA showing an isolated thrombosed vein of Trolard with intact Supr Sagittal sinus. What is the natural history and optimal duration of anticoaguln?
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A variation not seen very often. Prominent anterior meningeal artery in a non operated individual.
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Young male with progressive vision loss and headache since 2 months,venogram showing thrombosed sinuses. Intrasinus thrombolysis with Tenecteplase and balloon venoplasty resulted in resolution of headache and improvement in visual symptoms. Long term anticoagulation was continued
ALT Diffuse sinus thrombosis involving posterior part of SSS with bilateral sigmoid sinus thrombosis
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Shashank Nagendra retweeted
Great learning case. A recent ear of the Lynx caught by @hankshas in an advanced case.
Shashank Nagendra retweeted
1/Time to rupture all your misconceptions about aneurysms!
When you see an aneurysm on imaging, do you know it’s risk of rupture?
Do you know which features make one aneurysm more likely to rupture?
Here’s a short thread to teach you which aneurysms are bursting with risk!
Shashank Nagendra retweeted
New from @JNIS_BMJ: bit.ly/48Ko4xe @CSC_Stroke @CanadianNeuroIR 🇨🇦CULVO study shows: 1) 1 in 5 decisions for late-window EVT will change with perfusion imaging vs without 2) Reliability of EVT decisions with or without perfusion imaging is not significantly different
ALT Figure 1 How does neuroimaging affect endovascular thrombectomy (EVT) decisions? A mosaic plot with a contingency table overlay is used to display the distribution of 870 cases (30 patients x 29 raters) and the corresponding decisions for or against EVT) between two imaging protocols. All percentages are based on the denominator of 870. All box sizes are proportional to the magnitude of decisions. For instance, the lower left box represents the 10.1% (88/870) of all decisions. In this box, EVT was not recommended on non-perfusion neuroimaging but recommended on perfusion neuroimaging. Conversely the upper right quadrant of the plot signifies cases where EVT was recommended based on non-perfusion neuroimaging but not on perfusion neuroimaging (11.3%, 98/870). Figure 2 Inter-rater agreement for endovascular thrombectomy between two surveys.
Shashank Nagendra retweeted
1/Correlate clinically!
It’s harder than you think in THALAMUS—where its size is small & but the clinical symptoms are large.
Here’s a thread to help you remember the main thalamic syndromes & their locations!
Shashank Nagendra retweeted
1/Talk about twisting your back!
Do spine vascular lesions make your brain feel as tangled as the dilated vessels you see?
Want some information on malformations?
Here’s a thread on spine vascular anatomy to give you durable knowledge on dural arteriovenous fistulas (dAVF)
Shashank Nagendra retweeted
1/Haunted by questions about stroke imaging?
Don’t stand a ghost of chance w/perfusion imaging?
Do you know what a ghost infarct core is?
Strokes can’t vanish! Or can they?
Find out in this week’s @TheAJNR SCANtastic thread!
ajnr.org/content/early/2024/…
27 year old with 4 episodes of left hemispheric anterior circulation strokes. What makes the arteries of the left hemisphere go from this(left) to this(right) in the space of 2 months? Right hemisphere and posterior circulation totally normal
ALT Left ICA shoot
ALT Left ICA shoot
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An interesting cause of young stroke
An 18-year-old male presented with occipital headache, vomiting, and ataxia. MRI/MRA brain revealed acute infarcts involving the bilateral cerebellar hemispheres and narrowing of the V2 segment. Learn more in the latest #NeurologyRF Video e-Pearl: bit.ly/47O4Zdi
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Shashank Nagendra retweeted
An 18-year-old male presented with occipital headache, vomiting, and ataxia. MRI/MRA brain revealed acute infarcts involving the bilateral cerebellar hemispheres and narrowing of the V2 segment. Learn more in the latest #NeurologyRF Video e-Pearl: bit.ly/47O4Zdi
Shashank Nagendra retweeted
Knowing spinal arterial anatomy is a given
Knowing spinal venous anatomy is next level!
Vertebral venous plexus can be both good & evil
Good for collaterals, bad for tumor spread, infxn & spinal CSF fistulas!
Here’s the anatomy you MUST know if you are doing spine
3 rings: internal, anterior & posterior plexus
--Internal is the epidural plexus. It drains the basivertebral veins from the vertebral body
--Anterior drains the basivertebral veins & foraminal or intervertebral veins.
--Posterior drains the veins from the deep paraspinous musculature.
Internal plexus connects the anterior & posterior plexuses via foraminal veins along the nerve root
Foraminal veins are site of CSF venous fistulas & target for transvenous embolization!
