1/120. Typical presentation of intramural aortic haemorrhage (IAH) with evidence of intimal tear at MRI and angiography.A typical appearance of IAH was evidenced by CT and TEE in a 56-year-old hypertensive female suspected of developping classical acute aortic dissection (AAD). Further examination with MRI and aortography showed unequivocally the presence of an intimal tear in the aortic arch. This coexistence of intimal tear has never been evidenced preoperatively in patients with IAH. This observation demonstrates at the outset that IAH is part of the spectrum of AAD.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/120. Primary aortoduodenal fistula.The aortoenteric fistula is a well-known but uncommon cause of gastrointestinal haemorrhage. It is usually secondary to previous reconstructive surgery of an abdominal aortic aneurysm. Primary aortoenteric fistula is a rare disorder which predominantly occurs in the duodenum. We report the case of a 76-year-old patient who presented with melaena and hypovolaemic shock due to a primary aortoduodenal fistula. Pathogenesis, diagnostic procedures and postmortem pathologic examination of this condition are discussed. The value of computed tomography in establishing the diagnosis is emphasized.- - - - - - - - - - ranking = 0.25keywords = haemorrhage (Clic here for more details about this article) |
3/120. Fusiform vertebral artery aneurysms as a cause of dissecting aneurysms. Report of two autopsy cases and a review of the literature.Two autopsy cases of angiographically determined fusiform aneurysms of the vertebral arteries (VAs) are reported and the appropriate literature is reviewed to investigate the pathological characteristics of both fusiform and dissecting VA aneurysms and the pathogenesis of dissecting aneurysms. One patient had suffered a subarachnoid hemorrhage (SAH) due to dissection of a previously documented incidental fusiform aneurysm. The other patient had harbored incidental fusiform aneurysms coexistent with a ruptured aneurysm of the posterior inferior cerebellar artery. The location and pathological features of the aneurysms were similar in the two cases. The aneurysms in both cases displayed intimal thickening, disruption of the internal elastic lamina, and degeneration of the media. A mural hemorrhage and patchy calcification were also found in the case that included SAH. Based on their pathological investigation of these two cases and a review of reported cases, the authors propose that incidental fusiform aneurysms in the VAs are characterized by weakness in the internal elastic lamina and, therefore, have the potential to become dissecting aneurysms, resulting in a fatal prognosis. This suggests that long-term control of blood pressure is mandatory in patients with incidental fusiform aneurysms in the VAs.- - - - - - - - - - ranking = 1.9695490664943keywords = subarachnoid (Clic here for more details about this article) |
4/120. subarachnoid hemorrhage from intracranial dissecting aneurysms of the anterior circulation. Two case reports.Two rare cases of intracranial dissecting aneurysms of the anterior circulation associated with subarachnoid hemorrhage (SAH) are described. A 56-year-old female presented with a dissecting aneurysm in the proximal segment of the left middle cerebral artery. Proximal occlusion of the affected artery and a superficial temporal artery-middle cerebral artery anastomosis were performed, but the outcome was poor. A 61-year-old male presented with a dissecting aneurysm in the proximal segment of the left anterior cerebral artery. Clipping was enhanced by a piece of fascia lata, allowing patency of the affected artery with a satisfactory outcome. Dissecting aneurysm of the carotid system should be considered in a patient with SAH but no evidence of berry aneurysm.- - - - - - - - - - ranking = 1.9695490664943keywords = subarachnoid (Clic here for more details about this article) |
5/120. Dissecting vertebral artery aneurysm: diagnosis and coil embolization.Dissecting aneurysm of the intradural vertebral artery, a rare cause of stroke and sub-arachnoid haemorrhage, is associated with a poor neurological outcome if the disease is unrecognized and remains untreated. Clinical manifestations may be delayed or overlooked and non-invasive radiological investigations demonstrate little or no abnormality. We describe the diagnosis and successful endovascular occlusion of a dissecting vertebral artery aneurysm using detachable microcoils; a novel technique that has advantages over conventional therapeutic procedures.- - - - - - - - - - ranking = 0.25keywords = haemorrhage (Clic here for more details about this article) |
6/120. Serial angiography and endovascular treatment of dissecting aneurysms of the anterior cerebral and vertebral arteries. Case report.This 47-year-old man was admitted to the hospital with disturbance of consciousness due to subarachnoid hemorrhage caused by a ruptured dissecting aneurysm of the left anterior cerebral artery (ACA). Conservative treatment resulted in improvement in the patient's consciousness; however, repeated rupture occurred during the chronic stage. Endovascular coil embolization of the parent artery was successful. Serial angiography demonstrated all stages in the development of the aneurysm. Follow-up angiography demonstrated an incidental dissecting aneurysm of the right vertebral artery. This aneurysm was also treated by endovascular embolization. No new neurological deficit appeared during or after the treatment. Multiple dissecting aneurysms are rare, especially those involving both supra- and infratentorial regions. A ruptured dissecting aneurysm of the ACA is also an uncommon vascular disorder. This case shows that rebleeding may occur, even during the chronic stage, and thus appropriate treatment for the prevention of subsequent bleeding is essential. Incidental dissecting aneurysms can be treated using the endovascular technique, but further study is necessary.- - - - - - - - - - ranking = 1.9695490664943keywords = subarachnoid (Clic here for more details about this article) |
7/120. Dissecting aneurysm of basilar artery presenting with recurrent subarachnoid hemorrhage.Spontaneous basilar dissecting aneurysms secondary to subarachnoid hemorrhage are rare, usually presenting with ischemia rather than a subarachnoid hemorrhage (SAH). A 63-year-old man who had SAH repeatedly from a ruptured basilar dissecting aneurysm was treated with endovascular occlusion of the unilateral vertebral artery. Postoperative angiograms 1 month after the procedure showed complete obliteration of the aneurysm. The clinical follow-up at 20 months showed no evidence of recurrent hemorrhage.- - - - - - - - - - ranking = 11.817294398966keywords = subarachnoid (Clic here for more details about this article) |
8/120. subarachnoid hemorrhage from vertebrobasilar dissecting aneurysm treated with staged bilateral vertebral artery occlusion: the importance of early follow-up angiography: technical case report.OBJECTIVE AND IMPORTANCE: Vertebrobasilar dissecting aneurysms are an uncommon but increasingly recognized cause of subarachnoid hemorrhage (SAH). We describe a patient with SAH caused by a dissecting aneurysm involving both vertebral arteries as well as the basilar trunk. The patient was treated successfully with proximal occlusion of the vertebral arteries using endovascular balloon occlusion in two stages. The importance of early follow-up angiography to document progression or resolution of untreated dissections is emphasized. This approach is suggested as definitive treatment for vertebrobasilar dissection in appropriate circumstances. CLINICAL PRESENTATION: A 41-year-old man presented with SAH from spontaneous vertebrobasilar dissection. angiography revealed aneurysmal dilation of the right vertebral artery and basilar trunk and occlusion of the left vertebral artery. INTERVENTION: The dissecting aneurysm was treated with balloon occlusion of the right vertebral artery. Repeat angiography 2 weeks later demonstrated resolution of the left vertebral occlusion, with restoration of antegrade flow in the basilar trunk and increased filling of the right vertebral and basilar dissecting aneurysms. balloon occlusion of the left vertebral artery led to aneurysm thrombosis and excellent clinical outcome. CONCLUSION: Bilateral vertebrobasilar dissecting aneurysms are an uncommon cause of SAH. If unilateral proximal vertebral artery occlusion is chosen as the initial treatment, it is essential to document the status of the contralateral vessel using follow-up angiography. Staged bilateral vertebral artery occlusion should be considered in the event of recurrent or progressive aneurysm enlargement. Endovascular balloon occlusion has advantages over proximal clipping of the parent vessel: cranial nerve manipulation is avoided, test occlusion in the awake patient can be performed at the site of permanent occlusion, and therapeutic levels of anticoagulation can be maintained throughout and after the procedure, thus diminishing the likelihood of thromboembolic complications.- - - - - - - - - - ranking = 1.9695490664943keywords = subarachnoid (Clic here for more details about this article) |
9/120. 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 = 1.9695490664943keywords = subarachnoid (Clic here for more details about this article) |
10/120. Postpartum dissecting aneurysm of the superior cerebellar artery--case report.A 37-year-old female with toxemia of pregnancy suffered sudden headache and loss of consciousness on the day following a cesarean delivery. Computed tomography revealed subarachnoid hemorrhage (SAH). Vertebral angiography revealed a fusiform dilatation near the origin of the right superior cerebellar artery (SCA) with distal luminal narrowing. She underwent surgery within 24 hours of the ictus. A SAH clot was carefully removed from the prepontine cistern, and subadventitial discoloration was seen in the wall of the right SCA just distal to the aneurysmal protuberance (rupture site). The dissecting aneurysm was treated with body clipping by directly clipping the rupture site and with additional wrapping of the proximal SCA, including the aneurysmal protuberance and discolored site. The postoperative clinical course was uneventful. Postoperative angiography revealed complete obliteration of the aneurysm and patency of the SCA. Therapeutic intervention should be considered for patients with ruptured dissecting aneurysm who present with recurrent SAH.- - - - - - - - - - ranking = 1.9695490664943keywords = subarachnoid (Clic here for more details about this article) |
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