The cerebral vascular system stringently regulates cerebral blood flow (CBF). The components of the blood–brain barrier (BBB) protect the brain from pathogenic infections and harmful substances, efflux waste, and exchange substances; however, diseases develop in cases of blood vessel injuries and BBB dysregulation. Vascular pathology is concurrent with the mechanisms underlying aging, Alzheimer’s disease (AD), and vascular dementia (VaD), which suggests its involvement in these mechanisms. Therefore, in the present study, we reviewed the role of vascular dysfunction in aging and neurodegenerative diseases, particularly AD and VaD. During the development of the aforementioned diseases, changes occur in the cerebral blood vessel morphology and local cells, which, in turn, alter CBF, fluid dynamics, and vascular integrity. Chronic vascular inflammation and blood vessel dysregulation further exacerbate vascular dysfunction. Multitudinous pathogenic processes affect the cerebrovascular system, whose dysfunction causes cognitive impairment. Knowledge regarding the pathophysiology of vascular dysfunction in neurodegenerative diseases and the underlying molecular mechanisms may lead to the discovery of clinically relevant vascular biomarkers, which may facilitate vascular imaging for disease prevention and treatment.

Object: Currently, the effectiveness of minimally invasive evacuation of intracerebral hemorrhage (ICH) utilizing the endoscopic method is uncertain and the technique is considered investigational. The authors analyzed their experience with this method in terms of case selection, surgical technique, and long-term results. Methods: The authors performed a retrospective analysis of the clinical and radiographic data obtained in 68 patients treated with endoscope-assisted ICH evacuation. Rebleeding, morbidity, and mortality were recorded as primary end points. Hematoma evacuation rate was calculated by comparing the pre- and postoperative CT scans. Glasgow Coma Scale scores and scores on the extended Glasgow Outcome Scale (GOSE) were recorded at the 6-month postoperative follow-up. The technical aspect of this report explains details of the procedure, the instruments that are used, the methods for hemostasis, and the role of hemostatic agents in the management of intraoperative hemorrhage. The pertinent literature was reviewed and summarized. Results: All surgeries were performed within 12 hours of ictus, and 84% of the surgeries were performed within 4 hours. The mortality rate was 5.9%, and surgery-related morbidity occurred in 3 cases (4.4%). The hematoma evacuation rate was 93% overall—96% in the putaminal group, 86% in the thalamic group, and 98% in the subcortical group. The rebleeding rate was 1.5%. The mean operative time was 85 minutes, and the average blood loss was 56 ml. The mean GOSE score was 4.9 at 6-month follow-up. The authors acknowledge the limitations of these preliminary results in a small number of patients. Conclusions: The data suggest that early endoscope-assisted ICH evacuation is safe and effective in the management of supratentorial ICH. The rebleeding, morbidity, and mortality rates are low compared with rates reported in the literature for the traditional craniotomy method. This study also showed that early and complete evacuation of ICH may lead to improved outcomes in selected patients. However, the safety and efficacy of endoscope-assisted ICH evacuation should be further investigated in a large, prospective, randomized trial.

Background and Purpose We attempted to evaluate the location of vascular lesions in cases of cerebrovascular steno-occlusive diseases in Chinese persons living in Taiwan. Methods With three-dimensional time-of-flight magnetic resonance angiography (MRA) as a screening tool, 108 symptomatic patients with cerebrovascular steno-occlusive diseases were examined. Cardioembolic disease and cerebral hemorrhage cases were excluded. The degrees of stenosis of bilateral cervical carotid arteries and their major intracranial tributaries were recorded. They were categorized as nonsignificant stenosis (0% to 49%), significant stenosis (50% to 99%), and total occlusion. Results Our data revealed that 32.4% of the cases were normal in either cervical carotid arteries or their intracranial tributaries. In 24.1% of the cases, significant extracranial-carotid stenosis or occlusion was the only finding on MRA. In 25.9% of the cases, only significant intracranial-tributary stenosis was found. In 17.6% of them, significant lesions were found in both extracranial and intracranial carotid artery tributaries. Conclusions A racial difference between Chinese and white patients in location of lesion in cerebrovascular steno-occlusive diseases was confirmed. About one third of symptomatic Chinese patients living in Taiwan showed small-vessel disease. Approximately 24% of patients had only extracranial carotid disease, and about 26% had only intracranial carotid tributary disease. We need a larger series of patients to confirm these findings. However, MRA might be a good screening tool for steno-occlusive cerebrovascular diseases, especially in persons of a race with more intracranial carotid disease, such as the Chinese.

Background: Postconcussion symptoms (PCS) (such as dizziness, headache, irritability, fatigue, and impaired memory) are common in patients who sustain a mild traumatic brain injury (mTBI). However, few studies have systematically investigated the association between PCS and clinical outcomes in mTBI patients. Therefore, the present study attempted to examine PCS during the disease course and to determine whether PCS adversely affect outcome. Methods: This was a prospective, cohort and controlled study of 115 mTBI patients. The PCS checklist was used to identify PCS and the Glasgow Outcome Scale and the Glasgow Outcome Scale-Extended were used to investigate clinical outcomes. All patients were evaluated four times: at 1 week, 2 weeks, 4 weeks, and 8 weeks after the injury. Results: Physical symptoms such as dizziness and headache were prominent in the early after injury stage (1 and 2 weeks). On the other hand, the psychosocial symptoms, such as depression and irritability, were significant at the late after injury stage (4 and 8 weeks). Dizziness adversely affected clinical outcome at both the early and late stages of the disease, whereas the impact of intracranial lesions and depression on outcome was greatest early and late, respectively. Conclusions: The results show that PCS during the disease course and the relationship between PCS and clinical outcome can be systematically evaluated. In fact, different postconcussion symptom domains should be monitored while the disease is progressing.

A conservative attitude toward unruptured arteriovenous malformations (AVMs) has been based on the belief that surgical resection is too risky and that their natural history is benign. We have operated on 103 patients with a cerebral AVM. In the 49 patients with unruptured AVMs, there was no mortality, and the morbidity was 14.2%. Similarly, low surgical morbidity has been reported from several centers during the last few years. The chance of hemorrhage for both ruptured and unruptured AVMs is about 3% per year, and the combined morbidity and mortality of each hemorrhage is at least 40%. All patients with an AVM should be individually considered for possible surgical resection, whether or not they have bled.