1/36. Intrameatal aneurysm successfully treated by meatal loop trapping--case report.A 77-year-old female presented with a rare intrameatal aneurysm manifesting as sudden onset of headache, hearing loss, tinnitus, and vertigo associated with subarachnoid hemorrhage. Meatal loop trapping was performed. After surgery, the patient's functions recovered almost completely, probably because of the preservation of the 7th and 8th cranial nerves and the presence of effective collaterals in the area supplied by the anterior inferior cerebellar artery.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
2/36. Acute posterior fossa syndrome following lumbar drainage for treatment of suboccipital pseudomeningocele. Report of three cases.The authors report on a series of patients who underwent lumbar drainage of cerebrospinal fluid (CSF) for treatment of posterior fossa pseudomeningoceles and who subsequently developed an acute posterior fossa syndrome. These patients were found to have similar radiological findings demonstrating acute mass effect secondary to movement of CSF from the pseudomeningocele into the cerebellar parenchyma. Discontinuation of lumbar drainage resulted in symptomatic and radiological improvement in all patients. From these cases the authors infer that not all pseudomeningoceles communicate directly with the subarachnoid space. A readily recognizable appearance on magnetic resonance imaging that is useful in diagnosing this reversible complication of treatment for posterior fossa pseudomeningocele is also illustrated.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
3/36. Stereotactic radiosurgery for tentorial dural arteriovenous fistulae draining into the vein of Galen: report of two cases.OBJECTIVE AND IMPORTANCE: Treatment of tentorial dural arteriovenous fistulae (DAVFs) primarily draining into the vein of Galen remains a therapeutic challenge. We present two cases of ruptured galenic DAVFs that were successfully treated with gamma knife radiosurgery. CLINICAL PRESENTATION: Patient 1, a 66-year-old woman, experienced a sudden onset of headache and loss of consciousness. neuroimaging studies revealed intraventricular hemorrhage and a DAVF with aneurysmal dilation of the vein of Galen. The DAVF was supplied by tentorial branches of the right meningohypophyseal artery and bilateral supracerebellar arteries, which drained directly into the vein of Galen. Patient 2, a 64-year-old woman, experienced subarachnoid hemorrhage. cerebral angiography revealed a galenic DAVF at the falcotentorial junction, which was supplied by bilateral supracerebellar arteries. This patient had an aneurysm at the origin of the left supracerebellar artery. INTERVENTION: Both patients were treated with gamma knife radiosurgery. In each case, the fistula was exclusively targeted and a dose of more than 20 Gy was delivered. Complete obliteration of the fistula was confirmed 27 and 29 months after radiosurgery for patients 1 and 2, respectively, whereas the normal venous structures of the galenic system were preserved. CONCLUSION: Gamma knife radiosurgery is an effective treatment modality for DAVFs primarily draining into the vein of Galen. Irradiation doses of more than 20 Gy, strictly limited to the fistulae, seem to be sufficient for successful obliteration of these high-risk vascular lesions, with minimal invasiveness.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
4/36. Cerebellar hemorrhage after coil embolization for a ruptured vertebral dissecting aneurysm.BACKGROUND: We present a case of ruptured vertebral dissecting aneurysm that exhibited cerebellar hemorrhage after successful embolization of the vertebral artery including the dissected site. CASE PRESENTATION: A 59-year-old man suffered a sudden onset of severe occipital headache when he looked up. Computed tomography demonstrated subarachnoid hemorrhage. Angiography revealed a right vertebral dissecting aneurysm distal to the posterior inferior cerebellar artery. Endovascular embolization of the aneurysm was performed with preservation of the posterior inferior cerebellar artery. The next day, the patient suffered a cerebellar hemorrhage in the vermis. The intracranial pressure was controlled by external ventricular drainage. The patient was discharged with mild cerebellar ataxia and bilateral abducens nerve palsy. CONCLUSION: In a case of vertebral dissecting aneurysm distal to the posterior inferior cerebellar artery, blood circulation in the vertebral arterial system may change after embolization of the aneurysm. In our case, the preserved posterior inferior cerebellar artery might have been hemodynamically stressed postoperatively, resulting in cerebellar hemorrhage. Therefore, strict control of blood pressure is essential in the acute stage after occlusion of the aneurysm.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
5/36. A craniocervical injury-induced syringomyelia caused by central canal dilation secondary to acquired tonsillar herniation. Case report.The authors report on a 19-year-old man with an acquired tonsillar herniation caused by a craniocervical junction injury in which serial magnetic resonance (MR) images demonstrated patent and isolated segments of the central canal participating in the dilation and then formation of a cervical syrinx. The patient was involved in a motor vehicle accident; he developed tonsillar herniation as a complication of subarachnoid and epidural hemorrhage, predominantly observed around the cisterna magna and upper cervical canal. Repeated MR images obtained over an 11-month period indicated the for mation and acute enlargement of the syrinx. Ten months after the accident, the patient presented with sensory disturbance in both upper extremities and spasticity due to syringomyelia. He underwent craniocervical decompressive surgery and doraplasty, which reduced the size of syringomyelia. The authors postulate that the patent central canal may play a role in determining the location of a syrinx remote from a focus of cerebrospinal fluid obstruction.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
6/36. Cerebellar haemorrhage after supratentorial aneurysm surgery with lumbar drainage.Haemorrhage within the posterior fossa (PF) after supratentorial surgery is a very rare and exceedingly dangerous complication. Only 28 cases were found in the literature. Up to now, no pathogenetic factor has decisively proven to be the cause of this phenomenon. We present clinical details of a patient operated on for aneurysm of the anterior communicating artery. Lumbar drainage was used during surgery, with the loss of a large amount of cerebrospinal fluid (200 ml). Other causes in our case which may have led to cerebellar shift or a critical increase in transmural venous pressure with subsequent vascular disruption and haemorrhage were extreme head rotation during lengthy surgery and blood pressure peaks in the early postoperative period. Repeated computed tomography (CT) allowed immediate diagnosis of this complication and control of its conservative management. After postponed ventriculoperitoneal shunt, the patient recovered completely.- - - - - - - - - - ranking = 21.645181545947keywords = haemorrhage (Clic here for more details about this article) |
7/36. Ruptured dissecting anterior inferior cerebellar artery aneurysm--case report.A 39-year-old woman presented with a rare dissecting aneurysm of the proximal anterior inferior cerebellar artery (AICA). She presented with sudden onset of headache and vomiting, and subsequently became comatose with acute respiratory distress syndrome. Computed tomography showed subarachnoid hemorrhage and ventricular dilation. Left vertebral angiography identified a fusiform aneurysm at the proximal portion of the left AICA. The patient underwent endovascular treatment using Guglielmi detachable coils. The aneurysm was completely embolized. Computed tomography detected no infarcted areas in the regions supplied by the AICA. She was discharged without neurological deficits.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
8/36. Huge arachnoid cyst of the posterior fossa with cerebellar tentorium dysplasia associated with juvenile polyposis.We report an infant with a huge arachnoid cyst of the posterior fossa with dysplasia of the cerebellar tentorium and meningeal sinus and associated juvenile polyposis. neuroimaging studies disclosed a huge median cystic lesion extending posterosuperiorly over the cerebellum. The cerebellar tentorium was raised to the parietal area; the vermis was normoplastic. Cystography showed no direct communication with the 4th ventricle or subarachnoid space. We discuss the differential diagnosis of median cysts of the posterior fossa and the association of juvenile polyposis.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
9/36. Chronic cerebral paragonimiasis combined with aneurysmal subarachnoid hemorrhage.A 67-year-old Korean woman attended our hospital complaining of a severe headache. A brain computed tomography scan showed conglomerated, high-density, calcified nodules in the left temporo-occipito-parietal area and high-density subarachnoid hemorrhage in the basal cisterns. magnetic resonance imaging of the brain shows multiple conglomerated iso- or low-signal intensity round nodules with peripheral rim enhancement. She underwent craniotomies to clip the aneurysm and remove the calcified masses. paragonimus westermani eggs were identified in the calcified necrotic lesions. Results of parasitic examinations on the sputum and an enzyme-linked immunosorbent assay for P. westermani were all negative. The patient presented with headache and dizziness that had occurred for more than 30 years. She had not eaten freshwater crayfish or crabs. However, she had sometimes prepared raw crabs for several decades. overall, this case was diagnosed as chronic cerebral paragonimiasis, in which she may have been infected through the contamination of utensils during the preparation of the second intermediate hosts, combined with a cerebral hemorrhage.- - - - - - - - - - ranking = 5keywords = subarachnoid (Clic here for more details about this article) |
10/36. Postangiographic 3D CT findings of a thrombosed dissecting aneurysm of the posterior inferior cerebellar artery.We report a case of a thrombosed dissecting aneurysm of the posterior inferior cerebellar artery with subarachnoid hemorrhage. Although the aneurysmal sac was not shown on an angiogram on the day of the onset, 3D CT performed immediately after angiography revealed the aneurysm. The patient was successfully treated by endovascular occlusion.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
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