1/11. Late detection of supraclinoid carotid artery aneurysm after traumatic subarachnoid hemorrhage and occlusion of the ipsilateral cervical internal carotid artery.BACKGROUND AND PURPOSE: We report the first case of traumatic aneurysm of the supraclinoid internal carotid artery (ICA), which we speculate may have developed or grown after traumatic occlusion of the ipsilateral cervical ICA. CASE DESCRIPTION: A 26-year-old man presented with severe traumatic subarachnoid hemorrhage (SAH) and occlusion of the right cervical ICA after a motor vehicle accident. Three-dimensional CT angiography on admission showed no aneurysm. However, cerebral angiography 3 weeks after the injury showed a large aneurysm of the right supraclinoid ICA. The aneurysm was trapped, and pathological examination showed that it was a traumatic aneurysm. CONCLUSIONS: In this case we cannot be sure that the aneurysm was not present on admission. In view of the significant SAH, a lesson of this case may be to suspect such an aneurysm early on and perform early diagnostic cerebral angiography.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
2/11. Identification of an arteriovenous fistula in a child. Case report and review of the literature.BACKGROUND: A 6-year-old girl sustained a subarachnoid hemorrhage after a mild head injury and was discovered to have an arteriovenous fistula (AVF). INVESTIGATIONS AND TREATMENT: The etiology of subarachnoid hemorrhage was not evident on the initial brain CT. Brain CT with CT angiography identified the lesion. The AVF was further imaged with brain MRI followed by cerebral angiography and successfully embolized. OUTCOME: The child did not suffer any neurological sequelae.- - - - - - - - - - ranking = 0.51091110427157keywords = cerebral, brain (Clic here for more details about this article) |
3/11. Mycotic cerebral vasculitis in a paediatric cardiac transplant patient excludes misadventure.We present the case of a 10-year-old girl with cardiomyopathy who received a heart transplant. Due to organ rejection, the dosage of immunosuppressive agents was increased postoperatively. The patient complained of intermittent headaches in the following days and developed a haemorrhagic necrosis of the left thalamus. A week later, an oral dose of cyclosporin A was accidentally given intravenously, and 2 weeks later a recurrent subarachnoid haemorrhage of unknown origin was diagnosed. The clinical course was then characterised by progressive deterioration resulting in coma, fluctuating brain stem symptoms and the development of a massive cerebral oedema with subsequent brain death. A coroner's autopsy was instigated to investigate a claim of medical misadventure. Neuropathological investigations found a focal infiltration of fungal hyphae in the left posterior cerebral artery resulting in necrosis of the vascular wall and thus explaining the source of the recurrent subarachnoid haemorrhage which eventually resulted in the girl's death. Medical misadventure due to the administration of cyclosporin was not directly responsible for the death of this patient. This case illustrates that it is of paramount importance to copiously sample and investigate the basal cerebral arteries in cases of subarachnoid haemorrhage of unknown origin, in particular in a medico-legal context.- - - - - - - - - - ranking = 86.951628883059keywords = haemorrhage, cerebral, brain (Clic here for more details about this article) |
4/11. Assessment of prognostic factors in severe traumatic brain injury patients treated by mild therapeutic cerebral hypothermia therapy.This study analyzed the predictable factors of outcome such as neuro-parameters and systemic complications to elucidate the indications for therapeutic hypothermia. In our institute, 35 patients with severe head injury (Glasgow coma Scale 3-7) were treated with mild hypothermia therapy (33 degrees-35 degrees C). Twenty-two of these 35 patients underwent complete neuromonitoring and outcome assessments by glasgow outcome scale (GOS) at three months after injury. GOS of hypothermia group was significantly better than another patient group which was treated without mild hypothermia therapy. The hypothermia group was divided into two groups: good outcome (GOOD) (good recovery or moderate disability; n = 9, 40.9%) and poor outcome (POOR) (severe disability, vegetative state, or death; n = 13, 59.1%). The mean age (mean 30.2 years, range 9-46) was significantly lower in GOOD than in POOR (mean 45.2 years, range 17-62). patients aged over 50 years had poor outcome. CPP was significantly higher in GOOD during hypothermia. All patients with thrombocytopenia had poor outcome. hypothermia therapy can improve outcome in patients with traumatic brain injury who are younger than 50 years old, without severe brain damage, and if improvement of cerebral perfusion is expected. Systemic complications must be prevented as far as possible by combination with other therapies.- - - - - - - - - - ranking = 2.5327333128147keywords = cerebral, brain (Clic here for more details about this article) |
5/11. papaverine angioplasty to treat cerebral vasospasm following traumatic subarachnoid haemorrhage.The management of vasospasm associated with traumatic subarachnoid haemorrhage presents many challenges. We present a 20-year-old male admitted after sustaining a closed head injury complicated by a Fisher grade III traumatic subarachnoid haemorrhage. Despite treatment with intravenous nimodipine he developed a delayed ischaemic neurological deficit due to cerebral arterial vasospasm. The vasospasm was successfully managed with serial papaverine angioplasty.- - - - - - - - - - ranking = 169.38143555758keywords = haemorrhage, cerebral (Clic here for more details about this article) |
6/11. Traumatic basal subarachnoid haemorrhage caused by the impact of a golf ball: a case report.A 50-year-old male was hit by a high-speed golf ball on the left lateral side of his neck. He collapsed immediately and was sent to hospital, where he was pronounced dead. The autopsy showed an extensive basal subarachnoid haemorrhage. Careful gross and histological examinations disclosed a rupture of the right vertebral artery at a site very close to the bifurcation. It was estimated that the impact of the golf ball on the left side of his neck resulted in the rupture of the contralateral vertebral artery, owing to its hyperextension. Although there are many reports on traumatic basal subarachnoid haemorrhage, the present type of trauma seems rare to our knowledge.- - - - - - - - - - ranking = 166.88143555758keywords = haemorrhage (Clic here for more details about this article) |
7/11. Hyperextension and rotation of head causing internal carotid artery laceration with basilar subarachnoid hematoma.Hyperextension of the head can cause injury to the vessels at the base of the brain. These lacerations are believed to be caused by stretching of the vessels due to the abrupt movement of the head and rotational acceleration of the brain within the cranium, and they usually occur in the intracranial portions of the vessels, producing a subarachnoid hemorrhage. This is the case of a 35-year-old man who received a blow to the face that forcefully hyperextended and rotated his head to the left. autopsy revealed an intracranial right internal carotid laceration extending from a calcified atherosclerotic plaque. This unusual injury may be due to a combination of blunt force applied to the head and the alteration of the vessel's structural and functional capacities secondary to atherosclerosis.- - - - - - - - - - ranking = 0.010911104271572keywords = brain (Clic here for more details about this article) |
8/11. Successful resection of a left insular cavernous angioma using neuronavigation and intraoperative language mapping.Despite recent literature advocating the surgical removal of symptomatic Cavernous Angiomas (CA), even in critical brain areas, very few observations of insular CA surgery have been described, particularly in the left hemisphere. We report the case of a successful resection of a CA located in the dominant insula, using both neuronavigation and intra-operative functional mapping. This 33-year-old right-handed man harbored a left insular CA, revealed by generalized seizures following a bleed confirmed on MRI. The preoperative examination was normal. A stereotactic-guided surgery was performed under local anesthesia, with intra-operative functional mapping using direct cortico-subcortical electrical stimulation in the awake patient--allowing the surgeon to achieve total resection of both CA and pericavernomatous gliosis, as shown on repeated postoperative MRIs. There was no postsurgical deficit, nor any seizure without treatment (follow-up: 4.5 years). The diagnosis of CA was confirmed by histological examination. Taking account of the risk of morbidity due to the natural history of CA, particularly in eloquent brain regions, we suggest to routinely consider the possibility of a surgical treatment in cases of symptomatic (left dominant) insular CA, using combined intra-operative anatomical and physiological localization methods.- - - - - - - - - - ranking = 0.010911104271572keywords = brain (Clic here for more details about this article) |
9/11. Superficial siderosis of the central nervous system following cervical nerve root avulsion: the importance of early diagnosis and surgery.Superficial siderosis (SS) of the central nervous system is an insidious, progressive, irreversible and debilitating neurological disorder caused by recurrent haemorrhage within the subarachnoid space. The subsequent deposition of haemorrhagic breakdown products in the spinal cord and nervous tissues leads to the loss of neurones and myelin, and to the development of a neurological deficit. In a small number of patients, the source of haemorrhage is related to traumatic cervical nerve root avulsion occurring several years prior to the onset of symptoms. Surgical ablation of the source has been shown to halt the progression of the disease, at least in the short term. We review the literature on SS secondary to cervical nerve root avulsion and report a further case in which surgical management was successful in halting disease progression. We emphasize that early detection and recognition of the initial non-progressive symptoms related to this poorly known disease, coupled with timely surgical management, minimizes the degree of neurological disability.- - - - - - - - - - ranking = 55.627145185858keywords = haemorrhage (Clic here for more details about this article) |
10/11. Anomalous internal carotid anastomosis to contralateral anterior cerebral artery.BACKGROUND: Many anomalies and variants in vascular anatomy have been reported in relation to the anterior cerebral artery (ACA). patients AND methods: We encountered an apparently novel anomaly in a 30-year-old man admitted for disturbance of consciousness following a traffic accident. Computed tomography revealed an acute subdural hematoma and subarachnoid hemorrhage. RESULTS AND CONCLUSIONS: No vascular abnormalities related to the hemorrhage were detected by conventional angiography, so we concluded that the bleeding was of traumatic origin. Anomalous origin of the ACA was disclosed incidentally, with both A1 segments arising from the right internal carotid artery; no normal A1 segment of the left ACA was visualized. We discuss possible bases for this anomalous origin.- - - - - - - - - - ranking = 2.5keywords = cerebral (Clic here for more details about this article) |
| | Next -> |