1/7. A case of segmental mediolytic arteriopathy involving both intracranial and intraabdominal arteries.Segmental mediolytic arteriopathy (SMA) is an uncommon nonatherosclerotic and nonvasculitic arteriopathy. This disease is characterized by lytic degeneration of the arterial media, intramural dissection and thrombosed or ruptured aneurysm. SMA mainly involves the intraabdominal arterial system, resulting in intraabdominal and retroperitoneal hemorrhage. However, only a few cases of SMA with involvement of intracranial arteries have been reported. Here, we present a case of SMA developing subarachnoid hemorrhage due to dissection of the internal carotid and vertebral arteries. This patient was a 48-year-old male who died 13 days after admission for sudden loss of consciousness. Computed tomography showed subarachnoid hemorrhage. At autopsy, the affected vessels included the right vertebral, left internal carotid, superior mesenteric, bilateral renal and left external iliac arteries. Histopathologically, the arteries showed segmental lytic degeneration and disappearance of medial smooth muscle cells, medial dissection and formation of pseudo-aneurysms, the wall of which consisted of a thin membrane of the adventitia. These histopathological features mimicked an entire wall dissection type of intracranial dissecting aneurysm, which exclusively affects the vertebro-basilar system. Thus, SMA should be considered a possible underlying disease in patients with spontaneous dissection of intracranial arteries.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
2/7. Carotid stenting of chronic cervical dissecting aneurysm: a report of two cases.Stent implantation was performed on two patients to treat chronic dissecting aneurysms of the upper cervical internal carotid artery. Treatment was decided because of the youth of the patients, their medical history of subarachnoid hemorrhage, and the angiographic findings associated with the dissection. Normal arteriographic morphology was obtained after deployment of a single self-expandable stent.- - - - - - - - - - ranking = 0.5keywords = subarachnoid (Clic here for more details about this article) |
3/7. Ruptured dissecting aneurysm of the vertebral artery associated with occlusive internal carotid artery dissection--case report.A 64-year-old male presented with subarachnoid hemorrhage. Angiography showed a dissecting aneurysm of the right vertebral artery (VA), and severe stenosis of the right internal carotid artery (ICA). He was treated conservatively in the early stage. Repeat angiography showed enlargement of the dissecting aneurysm of the VA and partial resolution of the stenosis of the right ICA. Intraaneurysmal coil embolization with proximal coil occlusion was performed following a balloon occlusion test. The postoperative course was uneventful. Based on the neuroradiological findings, the stenotic lesion of the right ICA was considered to be due to dissection. Analysis of serial changes in dissecting lesions in the craniocervical arteries is important for the correct choice of treatment, especially in patients with multi-vessel dissections. The surgical options should be determined on an individual basis.- - - - - - - - - - ranking = 0.5keywords = subarachnoid (Clic here for more details about this article) |
4/7. Upper cranial nerve palsy resulting from spontaneous carotid dissection.INTRODUCTION : Upper cranial nerve palsy has a variety of causes such as cerebral and nerve ischemia, diabetes, infectious and non-infectious meningitis, subarachnoid hemorrhage and intracranial aneurysm. CASE 1 : A 45-year-old man suffered from holocephalic headaches and a right-sided neck pain for two weeks. He presented to our emergency department because of a sudden ptosis of the right eye. On admission neurological examination revealed a right sided Horner's syndrome and hypesthesia of the right side of the face. magnetic resonance angiography identified a circumscribed dissection of the right extracranial internal carotid artery originating from the carotid bifurcation. Conventional angiography 2 weeks later showed a nearly recanalized artery. CASE 2 : A 55-year-old previously healthy man without cardiovascular risk factors developed right sided neck pain when loading a seeder with several sacks of crop. A few hours later he noticed a left-sided weakness. On admission a severe left sided hemiparesis and a mild neglect were present. Duplex sonography revealed a right-sided distal internal carotid artery (ICA) occlusion. The next morning the patient complained of double vision; he had a right-sided pupil-sparing oculomotor palsy. The diagnosis of ICA dissection was confirmed by conventional angiography, at that time showing a partially recanalized ICA without involvement of the cavernous region by the dissection. CONCLUSION : ICA dissection must be included in the differential diagnosis of upper cranial nerve palsy and should be assessed by duplex ultrasound and magnetic resonance imaging. A possible explanation is nerve ischemia due to a transient or permanent interruption of the blood supply by compression of the vasa nervorum originating from the intracranial carotid artery.- - - - - - - - - - ranking = 0.5keywords = subarachnoid (Clic here for more details about this article) |
5/7. Aortic dissection mimicking subarachnoidal hemorrhage.In this report we describe a comatose patient with proximal aortic dissection who presented with the signs of subarachnoidal hemorrhage. Shortly before losing consciousness, the patient complained of an excruciating headache. Upon initial examination, neck stiffness and opisthotonos were present. The cardiovascular examination, chest radiograph, and cerebral computed tomography were normal. Eight hours later, the aortic dissection was verified by a thoracic computed tomography. This case shows that aortic dissection, which causes severe pain and possibly transient malperfusion of the carotid arteries, may present with the misleading signs of subarachnoidal hemorrhage but without classical symptoms of aortic syndromes.- - - - - - - - - - ranking = 3keywords = subarachnoid (Clic here for more details about this article) |
6/7. Extracranial vertebral and carotid dissection occurring in the course of subarachnoid hemorrhage.The pathogenesis of both intracranial aneurysms and spontaneous cervical artery dissection may be related to an underlying vasculopathy. Seven cases of spontaneous cervical artery dissection in the course of ruptured berry aneurysms are reported here.- - - - - - - - - - ranking = 2keywords = subarachnoid (Clic here for more details about this article) |
7/7. 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 = 0.5keywords = subarachnoid (Clic here for more details about this article) |