1/90. Intra-arterial infusion of fasudil hydrochloride for treating vasospasm following subarachnoid haemorrhage.In this pilot study we treated cerebral vasospasm in patients with subarachnoid haemorrhage to assess intra-arterial fasudil hydrochloride. We analysed effects of intra-arterial infusion on angiographically evident cerebral vasospasm in 10 patients including 3 with symptoms of vasospasm. Over 10 to 30 min 15 to 60 mg was administered via the proximal internal carotid artery or vertebral artery following standard angiography, without superselective techniques. A total of 24 arterial territories (21 internal carotid, 3 vertebral) were treated. Angiographic improvement of vasospasm was demonstrated in 16 arterial territories (local dilation in 2, diffuse dilation in 14) in 9 patients. In 2 symptomatic patients, intra-arterial fasudil hydrochloride was associated with resolution of symptoms without sequelae. In the third symptomatic patient the benefit of fasudil hydrochloride was only temporary, and a large cerebral infarction occurred. All asymptomatic patients showed no progression of angiographic to symptomatic vasospasm after treatment with intra-arterial fasudil hydrochloride. No adverse effect was encountered.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/90. Ruptured distal anterior choroidal artery aneurysm presenting with casting intraventricular haemorrhage.This report describes a rare case of a distal anterior choroidal artery aneurysm which developed intraventricular haemorrhage without subarachnoid haemorrhage as shown on computerized tomographic (CT) scan. A 69-year-old hypertensive man suddenly became unconscious. An emergency CT scan showed a severe intraventricular haemorrhage and a small round low-dense lesion within the haematoma at the right trigone. The haematoma with obstructive hydrocephalus made the lateral ventricles larger on the right than on the left. CT scan could not detect any subarachnoid haemorrhage. Right interal carotid angiography revealed a saccular aneurysm at the plexal point of the right anterior choroidal artery. We approached the aneurysm and the small round lesion through the trigone via a right temporo-occipital corticotomy. We could clip the aneurysmal neck and remove the intraventricular haematoma and the papillary cystic mass (corresponding to the small round lesion on CT scan) totally in one sitting. Histological examination revealed the aneurysm to be a true one and the papillary cystic mass to be a choroid plexus cyst.- - - - - - - - - - ranking = 2.0421602269822keywords = haemorrhage, haematoma (Clic here for more details about this article) |
3/90. Sudden death in an infant caused by rupture of a basilar artery aneurysm.Ruptured aneurysms of the cerebrovasculature in infancy and early childhood, except for "giant" aneurysms and arteriovenous malformations, are rare. seizures, loss of consciousness, and apnea are the usual presenting signs in infancy; symptoms such as headache or visual disturbances and signs such as cranial nerve compression or meningeal irritation commonly found in older children or adults are absent in infants. However, the morphologic findings (i.e., subarachnoid and retinal hemorrhage, and occasionally subdural hemorrhage) may be mistaken for inflicted trauma, especially if the aneurysm is not identified. Sudden death caused by rupture of a cerebral aneurysm has not been previously described in an infant. This report outlines the investigation and autopsy findings in a 7-month-old infant who died unexpectedly as a result of rupture of a complex basilar artery aneurysm.- - - - - - - - - - ranking = 0.1497604891499keywords = subdural (Clic here for more details about this article) |
4/90. Intracystic hemorrhage of the middle fossa arachnoid cyst and subdural hematoma caused by ruptured middle cerebral artery aneurysm.We report a case of a cerebral aneurysm arising from the bifurcation of the left middle cerebral artery that ruptured into a left middle cranial fossa arachnoid cyst, associated with acute subdural hematoma. We discuss the relationships of aneurysm, arachnoid cyst, and subdural hematoma.- - - - - - - - - - ranking = 0.89856293489942keywords = subdural (Clic here for more details about this article) |
5/90. Ruptured aneurysm at the trunk of the accessory middle cerebral artery.We present a 32-year-old woman with intracranial haemorrhage due to rupture of a saccular aneurysm arising from the trunk of an accessory middle cerebral artery. This is the first report of an aneurysm arising distally to the anomalous vessel's origin from the A1 segment of the anterior cerebral artery.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
6/90. Traumatic intracranial aneurysms following penetrating stab wounds to the head: two unusual cases and review of the literature.Two patients with rare complications of traumatic intracranial aneurysms following penetrating cranial stab wounds are described. One patient had a good outcome despite a secondary rupture of a traumatic proximal middle cerebral artery aneurysm, while the second patient had a traumatic basilar bifurcation artery aneurysm. To our knowledge neither the survival from a secondary rupture of a traumatic intracranial aneurysm, nor the development of a basilar bifurcation aneurysm secondary to a transcranial stab wound has been described previously. Furthermore, this is the first report of the technique of deep hypothermic cardiac arrest utilized to treat a traumatic false aneurysm. Traumatic intracranial aneurysms are a rare clinical entity, most often diagnosed after rupture and often resulting in fatal haemorrhage. A high index of suspicion needs to be maintained when managing patients with transcranial stab wounds. Early surgical intervention improves outcome by preventing initial aneurysmal rupture or rebleeding.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
7/90. radiation-induced aneurysm and moyamoya vessels presenting with subarachnoid haemorrhage.A rare case of a ruptured internal carotid artery (ICA) aneurysm, with ICA stenosis and moyamoya vessels, was diagnosed in a young female patient after radiotherapy for optic glioma. Retrospective analysis revealed that an extraordinarily high dose of radiation (110 Gy) had been delivered to the area around the ICA in two therapeutic sessions. Clipping and wrapping of the aneurysm were performed and the patient made a good recovery. A review of the literature suggested that rupture of radiation-induced aneurysms is a rare event, but may be fatal. Considerable care must therefore be taken when delivering high-dose radiation to cerebral arteries. We suggest that the incidence of radiation-induced moyamoya vessels is higher in younger patients.- - - - - - - - - - ranking = 0.8keywords = haemorrhage (Clic here for more details about this article) |
8/90. Ruptured intracranial mycotic aneurysm presenting as cerebral haemorrhage in an infant: case report and review of the literature.A 2-month-old male infant presented with intracranial haemorrhage caused by ruptured intracranial mycotic aneurysm. Computed tomography and cerebral selective angiography revealed a large haematoma in the left sylvian fissure and a mycotic aneurysm of a peripheral branch of the middle cerebral artery. Despite the successful surgical removal, the child did not recover from the initial brain injury and died 2 months later. There have been fewer than 10 reported cases of infantile mycotic aneurysms and its occurrence in the absence of infectious endocarditis is exceptionally rare.- - - - - - - - - - ranking = 1.1473867423274keywords = haemorrhage, haematoma (Clic here for more details about this article) |
9/90. Distal anterior choroidal artery aneurysm associated with an arteriovenous malformation. Intraoperative localization and treatment.BACKGROUND: Distal anterior choroidal artery aneurysms are rare. The outcome of patients with distal anterior choroidal artery aneurysms has been poor, and the treatment of such aneurysms is surgically challenging. CASE DESCRIPTION: The authors describe the case of an 8-year-old girl with a ruptured distal anterior choroidal artery aneurysm associated with an arteriovenous malformation (AVM). The patient experienced sudden onset of headache and vomiting. Computed tomography revealed an intraventricular haemorrhage, and cerebral angiography demonstrated an aneurysm arising from the distal portion of the right anterior choroidal artery. The patient also had an AVM in the ipsilateral temporal lobe fed by the branches of the middle cerebral artery. A right frontotemporal craniotomy was performed with the aid of intraoperative angiography to eliminate both the AVM and the aneurysm. Intraoperative angiography was helpful in confirming the complete removal of the AVM and in accurate localization of the small and deeply placed distal anterior choroidal artery aneurysm. Both the AVM and the aneurysm were successfully treated and the patient was discharged without any neurological deficits. CONCLUSION: This case is the youngest reported patient with a distal anterior choroidal artery aneurysm. This report is also the first to describe an association of such an aneurysm with an AVM. The etiology of the aneurysm formation in this case and surgical strategy for deeply placed vascular lesions are discussed.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
10/90. Interhemispheric subdural hematoma caused by a ruptured internal carotid artery aneurysm: case report.BACKGROUND: Interhemispheric subdural hematoma (ISH) usually occurs after head trauma; nontraumatic ISH is extremely rare. CASE DESCRIPTION: The authors describe a 62-year-old male presenting with severe headache and ptosis on the left side. Computed tomography (CT) and magnetic resonance imaging disclosed a hematoma in the interhemispheric subdural space without subarachnoid hemorrhage. cerebral angiography revealed an aneurysm arising from the left internal carotid-posterior communicating artery (IC-PC) junction. The patient underwent emergency clipping of the aneurysm and was discharged without neurological deficit. CONCLUSION: Ruptured aneurysms resulting in ISH without subarachnoid hemorrhage have been reported in only a few cases; this is the second case to describe the association of a ruptured IC-PC aneurysm with an ISH. The etiology of ISH formation due to ruptured aneurysms and the diagnosis are discussed.- - - - - - - - - - ranking = 0.89856293489942keywords = subdural (Clic here for more details about this article) |
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