1/19. Acute traumatic posteroinferior cerebellar artery aneurysms: report of three cases.OBJECTIVE AND IMPORTANCE: Posterior fossa subarachnoid hemorrhage secondary to blunt head trauma is rarely associated with traumatic aneurysms of the posterior circulation. CLINICAL PRESENTATION: We present three cases of posterior fossa subarachnoid hemorrhage from ruptured posteroinferior cerebellar artery (pica) aneurysms after blunt head trauma. In each case, there was no associated penetrating injury or cranial fracture. All three patients presented with acute hydrocephalus requiring ventriculostomy. Two of the three patients had a proximal pica aneurysm visible on emergent angiography. The remaining patient's aneurysm, although not visible on his initial angiogram, was detected on a subsequent angiogram 72 hours later. INTERVENTION: All patients underwent successful surgical clipping of their aneurysms. Two cases required sacrificing of the parent vessels because of the friable nature of the false aneurysms. In each case, severe symptomatic vasospasm occurred, requiring angioplasty. All three patients also required a ventriculoperitoneal shunt for persistent hydrocephalus. CONCLUSION: Features of these three cases and similar cases reported in the literature support the theory that vascular ruptures and traumatic aneurysms of the proximal pica may be related to anatomic variability of the pica as it transverses the brainstem. This variability predisposes individuals to vascular lesions, which occur in a continuum based on the severity of the injury. Posterior fossa subarachnoid hemorrhage after head injury requires a high index of suspicion and warrants aggressive diagnostic and therapeutic interventions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/19. The nature of the disorder underlying the inability to retrieve proper names.Two patients with the syndrome of proper name anomia were investigated. Both patients were only able to produce around 50% of the names of contemporary celebrities, but performed significantly better on a task calling for naming of historical figures. The names of relatives and friends were spared in one patient, while the other retrieved names of people known since childhood much better than those of people familiar to him since the age of 25. Geographical names, names of monuments and masterpieces were preserved. The above dissociations are taken to imply that in moderately impaired patients, a temporal gradient effect concurs to modulate the severity of the naming block. A similar impairment was found in both patients when they attempted to retrieve or relearn familiar telephone numbers. This finding suggests that the core of the disorder resides in the inability to gain access to words used to identify a single entity, regardless of whether they belong to the class of proper or common names.- - - - - - - - - - ranking = 4keywords = nature (Clic here for more details about this article) |
3/19. Is the rupture of cerebral berry aneurysms influenced by the perianeurysmal environment?PURPOSE: To evaluate contact between cerebral berry aneurysms and the perianeurysmal environment and to study the influence this contact has on aneurysm rupture. MATERIALS AND methods: In a series of 76 consecutive patients, pre- and post-contrast CT images of 87 aneurysms were evaluated. aneurysm locations were identified and aneurysms were divided into two different groups depending on whether they had ruptured or not. Contact between aneurysms and the perianeurysmal environment was studied when present, and considered to be balanced or unbalanced according to symmetry of contact and type of contact interface, i.e. with bone, dura, etc. RESULTS: rupture occurred in 47 aneurysms at an average maximum dome size of 7.4 mm. There was contact with elements of the perianeurysmal environment in 38 (81%) of ruptured cases and no evidence of contact in 7 (15%). The nature of contact was unclear in 2 (4%) ruptured aneurysms. In the aneurysms with contact, the nature of contact was unbalanced in 34 (72%) and balanced in 4 (9%). Unbalanced aneurysms ruptured at significantly smaller sizes (average: 7.7 mm) than balanced aneurysms (average: 11.4 mm). Seven aneurysms of small size (3.3-6.9 mm, average: 4.8 mm) were found to have ruptured, despite the fact that they were too small to exhibit contact with the perianeurysmal environment. In 40 unruptured aneurysms (average size: 6.3 mm), contact with the perianeurysmal environment was found in 15 aneurysms, for which balanced contact was found in 11 (27.5%) and unbalanced contact in 4 (10%), and no contact in 25 (62.5%). The average size of the aneurysms without contact (3.7 mm) was significantly smaller than that with balanced contact (10.3 mm) or with unbalanced contact (11.3 mm). CONCLUSION: Aneurysms exhibit contact with their perianeurysmal environment as soon as they reach a size that exceeds their allowance given by the local subarachnoid space. The contact with the environment was found to be an additional determinant parameter in the evolution of cerebral berry aneurysms and their risk to rupture.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
4/19. Perimesencephalic nonaneurysmal subarachnoid hemorrhage in the pediatric population: case report and review of the literature.In approximately 15% of children with atraumatic subarachnoid hemorrhage (SAH), the cause of the hemorrhage cannot be determined despite detailed imaging studies. Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSH) is well recognized as a distinct type of SAH in the adult population and may account for up to two thirds of these SAHs of unknown cause. PNSH in the pediatric population, however, is not well recognized. In this report, we confirm the existence of PNSH in the pediatric population by describing a 4-year-old boy who presented with acute SAH in the perimesencephalic cisterns and subsequently had two negative angiograms with a benign clinical course. Recognition of PNSH in the pediatric population is important, especially in view of its benign nature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/19. Blunt basal head trauma: rupture of posterior inferior cerebellar artery.Two cases are reported of rupture of posterior inferior cerebellar artery (pica) from blunt basal head trauma. The anatomy at the site of rupture is discussed as a prerequisite for rupture. The rapid fatal course is also discussed. The authors propose that the forensic term "traumatic subarachnoid haemorrhage" ought to be abandoned and replaced by the nature and localization the source of bleeding, analogous to clinical practice at the spontaneous haemorrhage from rupture of aneurysm.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/19. An investigation of the effects of prospective memory training.A within-subject operant design was used to evaluate the efficacy of prospective memory training in a 51-year-old brain-injured male with a severe memory impairment. Training consisted of repetitive administration of prospective memory tasks whereby the subject was given actions to perform at specified future times. The length of time between task administration and task execution was systematically lengthened. Probes were taken evaluating generalization to performance on naturalistic, real-life prospective memory tasks and to performance on retrospective memory or recall measures. Results suggested a significant and steady increase in the subject's prospective memory ability over time; however, changes were not experimentally controlled, thus the data are descriptive in nature. Methodological limitations and issues pertinent to the future investigation of prospective memory are discussed at length, in the hope of encouraging further evaluation of this preliminary, promising technique.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/19. Urgent treatment of severe subarachnoid hemorrhage caused by ruptured traumatic aneurysm of the cavernous internal carotid artery using coil embolization followed by superficial temporal artery-middle cerebral artery anastomosis: a case report.BACKGROUND: Traumatic aneurysm of the cavernous internal carotid artery (ICA) with extension into the subarachnoid space is associated with increased risk of fatality especially when it is accompanied by severe subarachnoid hemorrhage (SAH). Only cases of patients who survived the acute stage and who were treated in a delayed setting have been reported. There has been no successfully treated case immediately after an injury. CASE DESCRIPTION: We encountered a 48-year-old man who presented with dense SAH immediately after being involved in a motor vehicle accident. Emergent angiography revealed traumatic aneurysm of the left cavernous ICA with extension beyond the superior wall of the cavernous sinus into the subarachnoid space and concomitant direct high-flow carotid cavernous fistula. Detachable platinum coil occlusion of the cavernous ICA followed by superficial temporal artery-middle cerebral artery anastomosis on day 0 and aggressive therapy to SAH, including ventriculocisternal irrigation and drainage, was performed. The patient eventually made a good recovery. CONCLUSION: Considering the extremely poor prognosis and unstable nature of a ruptured traumatic aneurysm with extensive SAH in the acute stage, definitive and immediate prevention of rebleeding in conjunction with proper revascularization would be warranted, such as in the present case.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/19. Peduncular hallucinations following subarachnoid haemorrhage.We describe the case of a 56-year-old woman who suffered vivid visual hallucination following subarachnoid haemorrhage (SAH). These occurred from day 9 to day 28 after the haemorrhage. An association with sleep disturbance, clinical findings, and the nature of the hallucinations suggested peduncular hallucinosis. Putative mechanisms in this case are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/19. diffuse axonal injury associated with multiple traumatic aneurysms of the distal anterior cerebral artery--case report.A rare case of multiple traumatic aneurysms, arising from the distal anterior cerebral artery (ACA), associated with a diffuse axonal injury is presented. An 18-year-old male sustained a frontal impact injury in a traffic accident on February 19, 1988. He immediately lost consciousness and was transported to a local hospital where his glasgow coma scale score was 6. A computed tomographic scan showed a traumatic subarachnoid hemorrhage extending from the corpus callosum to the left parietal lobe. With conservative treatment, he gradually regained consciousness and was referred to our hospital 12 days later. skull x-rays revealed no fracture. A right common carotid angiogram revealed multiple aneurysmal dilatations on the right distal ACA. A left frontoparietal craniotomy was then performed to determine the nature of the aneurysmal dilatation, and to evacuate the intracerebral hematoma because his right hemiparesis persisted. Two aneurysmal dilatations on the distal ACA were tightly surrounded by clots and a hematoma extended from the corpus callosum to the parietal lobe. The ACA was trapped proximal and distal to the aneurysmal dilatations. The postoperative course was uneventful.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/19. Internal carotid artery dorsal wall aneurysm with configurational change: Are they all false aneurysms?BACKGROUND: Aneurysms arising from nonbranching sites of the ICA, so-called dorsal wall aneurysm, are rare entity, and present as blister type or saccular type. Occasionally configurational changes have been observed on serial cerebral angiography: a small blister-like bulge on ICA wall on initial angiography progressing to a saccular appearance within a few weeks. Such aneurysm showing configurational change has been regarded as a false aneurysm with fragile wall just like blister-type aneurysm, and direct surgical approach has been considered highly risky. CASE DESCRIPTION: A 42-year-old woman with a subarachnoid hemorrhage revealed small "blister-like" aneurysm at the medial wall of the ICA on initial angiography. After 12 days, the following angiograms demonstrated increased aneurysmal size and change of shape into a saccular configuration. Direct surgical approach was performed. The aneurysm had a relatively firm neck, and was successfully clipped without intraoperative rupture. The dome of aneurysm was resected after clipping and the histologic examination revealed it as a true aneurysm. CONCLUSIONS: This case suggests that all dorsal wall aneurysms with configurational change are not false aneurysms, and that angiographic findings do not always correlate with the nature of the aneurysmal wall; therefore, we should give more credence to direct surgical observation rather than preoperative angiographic findings when considering the most suitable surgical option.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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