1/67. Late hemorrhage from persistent pseudoaneurysm in vertebral artery dissection presenting with ischemia: case report.BACKGROUND: vertebral artery dissection lesions tend to resolve spontaneously, but abnormal findings such as aneurysmal-dilatation occasionally persist. However, the clinical features and pathological findings in such cases have never been verified. CASE DESCRIPTION: A 62-year-old man presented with left cerebellar infarction. angiography showed the "pearl and string sign" in the left vertebral artery, and he was diagnosed as having left vertebral artery dissection. Repeated angiography showed persistent aneurysmal dilatation with irregular stenosis. Eleven years after the cerebellar infarction, the patient presented with a subarachnoid hemorrhage from an aneurysm of the left vertebral artery, and the lesion was explored via the left suboccipital approach. The vertebral artery was firm, making the placement of a clip impossible, so the lesion was treated by coating of the bleeding point. The patient died of pneumonia and hyperglycemia on postoperative day 15. Postmortem examination revealed an organized intramural hematoma, thickening of the intima, and fibrous degeneration of the media of the vertebral artery, a fusiform, distended thin arterial wall with intimal disruption at the aneurysmal dilatation, and arteriosclerosis of all cerebral arteries. CONCLUSION: This case indicates that persistent aneurysmal dilatation of a dissection is a pseudoaneurysm prone to rupture, and that healing of the affected vessels might be severely compromised in the presence of pathological conditions such as arteriosclerosis and disturbed intraluminal blood flow in the dissected lesions.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
2/67. Beneficial effect of piracetam monotherapy on post-ischaemic palatal myoclonus.A 70-year-old hypertensive woman suffered a subarachnoid haemorrhage followed by delayed vasospasm in the basal cerebral arteries. This resulted in multiple ischaemic lesions in the right middle cerebral artery region and contralateral post-ischaemic palatal myoclonus. In this setting, piracetam administered in high doses (24-36 g/day), abolished the myoclonus observed in this patient. Although there is evidence from case reports and clinical trials of the therapeutic efficacy of piracetam in patients with skeletal myoclonus of various causes, to our knowledge this is the first report indicating the beneficial effect of piracetam monotherapy on post-ischaemic palatal myoclonus.- - - - - - - - - - ranking = 8.8277137916972keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |
3/67. Perceiving left and imagining right: dissociation in neglect.Signor Piazza, a patient with a left parieto-occipital haemorrhage and a right thalamic stroke, showed severe right personal neglect (e.g. touching own body parts) and right perceptual neglect in tasks with (e.g. cancelling tasks) or without (e.g. description of a complex picture) motor response. He had also right-sided neglect dyslexia (including single words), without language impairments. However, the patient also presented with a clear left-sided deficit in the representational domain (e.g. imagery tasks). Signor Piazza's pattern of performance suggests dissociation between imagery and perception within the neglect syndrome.- - - - - - - - - - ranking = 0.25370356980483keywords = haemorrhage (Clic here for more details about this article) |
4/67. Dissecting aneurysm of the peripheral posterior inferior cerebellar artery.Dissecting aneurysms of intracranial posterior circulation have recently been shown to be less uncommon than previously thought. However, those involving the posterior inferior cerebellar artery (pica) and not vertebral artery at all are extremely rare. We report here a case of a patient with a dissecting aneurysm of the lateral medullary segment of pica which presented as subarachnoid haemorrhage. The aneurysm was treated by trapping surgery and the distant pica was anastomosed to the occipital artery. The patient showed a slight ataxia immediately after surgery but recovered fully. Recovery from immediately postoperative cerebellar symptoms due to intra-operative ischemia seemed to be due largely to recovery of flow in the region of cortical branches of pica.- - - - - - - - - - ranking = 8.8277137916972keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |
5/67. brain tissue PO(2), PCO(2), and pH during cerebral vasospasm.BACKGROUND: The purpose of the present study was to assess brain tissue monitoring for detection of ischemia due to vasospasm in aneurysmal subarachnoid hemorrhage (SAH) patients. methods: After obtaining informed consent, a burr hole was made in 10 patients and a Neurotrend 7 probe was inserted ipsilateral to the region of SAH. In eight patients the probe was inserted during surgery for clipping the aneurysm and in two patients the probe was inserted in the neurosurgery ICU. brain tissue gases and pH were collected over 6-hour periods for 7 to 10 days until the termination of monitoring. The onset of vasospasm was confirmed by angiography and xenon computed tomography (Xe/CT) cerebral blood flow studies. RESULTS: Seven patients did not develop vasospasm during monitoring and were considered as controls. In this group, brain tissue oxygen pressure (PO(2)) remained above 20 mmHg, carbon dioxide pressure (PCO(2)) stabilized at 40 mmHg and pH remained between 7.1 and 7.2. In three patients who developed vasospasm during monitoring, PO(2) was not different from the control group. However, PCO(2) increased to 60 mmHg and pH decreased to 6.7 (p < 0.001). CONCLUSION: In this study, patients with SAH who developed vasospasm had significantly lower brain tissue pH and higher PCO(2) compared to controls. However, there was no significant change in PO(2) levels associated with vasospasm. brain tissue monitoring can provide an indication of ischemia during vasospasm.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
6/67. classification of venous ischaemia with MRI.PURPOSE: Venous ischaemia is diagnosed by angiography and estimated with SPECT and PET. But venous ischaemia presents different features due to aetiology, type of onset, time course and collateral circulation. The purpose of this study was to analyse and to classify VI with MRI. methods: An analysis of 12 cases of dural arteriovenous fistula (DAVF) with venous ischaemia, 4 cases of sinus thrombosis, and a case of cortical venous thrombosis was performed. Venous ischaemia is classified with MRI as Type 1: no abnormality, Type 2: T2WI showed high signal intensity area and Gd-MRI showed no enhancement, Type 3: T2WI showed high signal intensity area and Gd-MRI showed enhancement, Type 4: venous infarction or haemorrhage. RESULTS: Type 1 was 8 cases. Type 2 was 3 cases and indicated cytotoxic oedema. Type 3 was 2 cases and indicated vasogenic oedema because of the destruction of blood brain barrier. Type 4 was 4 cases. CONCLUSIONS: The classification may be a useful indicator of severity of venous ischaemia and treatment.- - - - - - - - - - ranking = 0.25370356980483keywords = haemorrhage (Clic here for more details about this article) |
7/67. Functional methods for evaluation the occurrence of delayed ischemic deficit in patients with subarachnoid hemorrhage.Detection of early circulatory and electrophysiologic changes due to vasospasm (VS) after subarachnoid hemorrhage (SAH) is a necessity for in-time and adequate therapeutic management. The aim of the present case report is to describe and demonstrate the results of transcranial Doppler (TCD) monitoring and brainstem auditory evoked potentials (BAEPs) examination, which indicate the development of combined circulatory insufficiency in two vascular systems. On the 14th day after SAH, TCD showed accelerated velocities in the territory of middle cerebral artery (MCA) and basilar artery (BA). BAEPs, after ipsilateral stimulation, performed on the same day verified changes of potentials on the left side with abnormal I/V amplitude ratio. These results were suggestive of brainstem dysfunction. The CT examination of the next day revealed infarction in the posterior parietal borderline zone of the left hemisphere. The patient had clinical signs of sensory aphasia, which resolved completely after one-week treatment with nimodipine.- - - - - - - - - - ranking = 5keywords = subarachnoid (Clic here for more details about this article) |
8/67. Neurometabolic changes during treatment with moderate hypothermia in a patient suffering from severe middle cerebral artery infarction.microdialysis is a means of measuring neurochemical changes in the extracellular space and has been applied in acute brain trauma, subarachnoid hemorrhage and stroke patients. In this study, we monitored neurochemical changes in the extracellular space using microdialysis in a patient with left-sided hemispheric infarction treated with moderate hypothermia (33 degrees C). microdialysis probes were obtained from the infarcted and noninfarcted hemisphere during hypothermia and rewarming. Concentrations of extracellular substances in the infarcted hemisphere (glutamate, glycerine, lactate/pyruvate) decreased with hypothermia and remained stable (glutamate) or increased (glycerine, lactate/pyruvate) during rewarming. Concentrations of these substances in the noninfarcted hemisphere remained at normal levels. microdialysis monitoring of therapeutic hypothermia in severe hemispheric infarction might be a useful additional monitoring tool to assess the status of the brain and to predict further deterioration.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
9/67. Increases in GABA concentrations during cerebral ischaemia: a microdialysis study of extracellular amino acids.OBJECTIVES: Increases in the extracellular concentration of the excitatory amino acids glutamate and aspartate during cerebral ischaemia in patients are well recognised. Less emphasis has been placed on the concentrations of the inhibitory amino acid neurotransmitters, notably gamma-amino-butyric acid (GABA), despite evidence from animal studies that GABA may act as a neuroprotectant in models of ischaemia. The objective of this study was to investigate the concentrations of various excitatory, inhibitory and non-transmitter amino acids under basal conditions and during periods of cerebral ischaemia in patients with head injury or a subarachnoid haemorrhage. methods: Cerebral microdialysis was established in 12 patients with head injury (n=7) or subarachnoid haemorrhage (n=5). Analysis was performed using high performance liquid chromatography for a total of 19 (excitatory, inhibitory and non-transmitter) amino acids. patients were monitored in neurointensive care or during aneurysm clipping. RESULTS: During stable periods of monitoring the concentrations of amino acids were relatively constant enabling basal values to be established. In six patients, cerebral ischaemia was associated with increases (up to 1350 fold) in the concentration of GABA, in addition to the glutamate and aspartate. Parallel increases in the concentration of glutamate and GABA were found (r=0.71, p<0.005). CONCLUSIONS: The results suggest that, in the human brain, acute cerebral ischaemia is not accompanied by an imbalance between excitatory and inhibitory amino acids, but by an increase in all neurotransmitter amino acids. These findings concur with the animal models of ischaemia and raise the possibility of an endogenous GABA mediated neuroprotective mechanism in humans.- - - - - - - - - - ranking = 17.655427583394keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |
10/67. Reversal of radiographically impending stroke with multiple intraarterial papaverine infusions in severe diffuse cerebral vasospasm induced by subarachnoid hemorrhage.BACKGROUND: Selective intraarterial infusion of papaverine is used in the treatment of symptomatic cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage (SAH). Delays in instituting therapy for vasospasm can lead to irreversible cerebral infarction and a devastating outcome. Endovascular papaverine treatment of vasospasm in the presence of low-attenuation lesions on computed tomography (CT) is controversial, because of the fear of reperfusion hemorrhage in completed infarcts. METHOD: Two patients with aneurysmal SAH who subsequently developed severe diffuse vasospasm were identified. In both patients, large areas of low-attenuation change suggesting impending cerebral infarction were seen on CT scans. The patients received multiple infusions of intraarterial papaverine in an effort to treat vasospasm refractory to medical management. FINDINGS: After multiple intermittent administrations of papaverine, which initially appeared to increase the low-attenuation changes, there was dramatic reversal of the radiographic findings. There was also improvement in circulation time, transcranial Doppler velocities, and clinical outcome. INTERPRETATION: These findings suggest that in some patients, intraarterial infusions of papaverine initiated in the earliest stages of ischemia may exacerbate the radiographic appearance of low-attenuation changes, but may ultimately reverse the evolution of cerebral infarction.- - - - - - - - - - ranking = 5keywords = subarachnoid (Clic here for more details about this article) |
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