1/31. Multiple major cerebral artery thromboses with profound thrombocytopenia in acute leukaemia.A child with acute lymphoblastic leukaemia complicated by prolonged gastrointestinal and skin haemorrhages due to profound thrombocytopenia finally died of thrombotic occlusions of major cerebral arteries due to mucormycosis. biopsy of any suspect lesion is needed urgently before prolonged therapy with amphotericin b is started. So far there have been no cures in childhood.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/31. Ruptured intracranial mycotic aneurysm presenting as cerebral haemorrhage in an infant: case report and review of the literature.A 2-month-old male infant presented with intracranial haemorrhage caused by ruptured intracranial mycotic aneurysm. Computed tomography and cerebral selective angiography revealed a large haematoma in the left sylvian fissure and a mycotic aneurysm of a peripheral branch of the middle cerebral artery. Despite the successful surgical removal, the child did not recover from the initial brain injury and died 2 months later. There have been fewer than 10 reported cases of infantile mycotic aneurysms and its occurrence in the absence of infectious endocarditis is exceptionally rare.- - - - - - - - - - ranking = 5keywords = haemorrhage (Clic here for more details about this article) |
3/31. Characteristics of aneurysms arising from the horizontal portion of the anterior cerebral artery.BACKGROUND: Aneurysms arising from the proximal portion of the anterior cerebral artery (A1: horizontal portion) are quite rare and are considered to be unique, because they are usually connected with other vascular anomalies and are sometimes part of a multiple aneurysm occurrence. A1 aneurysm cases experienced over the past seven and a half years are summarized in this paper. methods: A total of 413 patients were surgically treated including 142 patients with subarachnoid hemorrhage (SAH); the remaining 271 patients had unruptured aneurysms. Among them, nine cases were categorized as constituent A1 aneurysms, three with SAH and six with unruptured aneurysms. RESULTS: The shape of the aneurysm was saccular in all nine cases. Three of the nine cases had associated vascular malformations. The average aneurysm diameter in the three cases with SAH was 4.0 mm, which is smaller than other common aneurysms presenting with SAH. Eight aneurysms developed at the takeoff point of perforating arteries-the medial lenticulostriate artery in five cases and the recurrent artery of Heubner in three cases. In the remaining case, the aneurysm originated from the proximal end of the associated A1 fenestration. All nine patients had an excellent outcome after surgery. CONCLUSION: A1 aneurysms require surgical elimination even if they are small. We emphasize the importance of preserving the blood flow of these perforating arteries by avoiding compression with either the clip blade or the clip body itself.- - - - - - - - - - ranking = 9.3457162051375keywords = subarachnoid (Clic here for more details about this article) |
4/31. Dissecting aneurysms of the middle cerebral artery: neuroradiological and clinical features.There are few reported cases of nontraumatic dissecting aneurysms of the middle cerebral artery (MCA), and their neuroradiological and clinical features have not been analysed. We looked at these aspects in a collaborative study. We reviewed 13 patients diagnosed as having a dissecting aneurysm of the MCA based on clinical signs and neuroradiological findings in 46 stroke centres between 1995 and 1999. There were four patients who presented with cerebral ischaemia, and nine who presented with bleeding. Of the former group, three were aged less than 15 years. cerebral angiography showed extensive stenosis and a double lumen of the M1 portion in all four patients. High signal on T1-weighted images around the arterial flow void, due to intramural haematoma, was often seen in the second week. MR angiography showed findings corresponding those of intra-arterial angiography in all four cases. We saw an infarct on CT or MRI in territory of the perforating branches of the M1 segment in all four patients. In the patients presenting with bleeding, pure subarachnoid haemorrhage or a sylvian fissure haematoma was seen on initial CT, and the predominant angiographic finding was dilatation with stenosis, but the site of the lesions was not uniform. A double lumen or intimal flap was seen in about half the cases. Rebleeding occurred within 14 days of the onset in five of the nine patients, with a poor prognosis.- - - - - - - - - - ranking = 44.958423215606keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |
5/31. Abnormal intracranial vascular networks ("moyamoya" disease), possibly due to occlusion of bilateral internal carotid arteries--a case report with histometrical analysis.An autopsy case of abnormal intracranial vascular networks at the base of the brain corresponding to so-called rete mirabile, associated with occlusion of bilateral internal carotid arteries was reported. This patient was a 62 year-old female who died about two months after sudden onset of subarachnoid hemorrhage. At autopsy, abnormal vascular networks termed as rete mirabile were observed to be collateral blood supplies among the cerebral regions with flow of the anterior, middle, and posterior cerebral arteries, caused by long-standing obstruction of bilateral internal carotid arteries at the syphon level. Morphometrical analysis was done by measuring the length of internal elastic membrane of the internal carotid arteries in cross section, and comparing it with those of controlled persons of the same sex and age without any intracranial disorders and hypertensive histories. The result that no significant difference was observed between the former and the latter values suggested that the unusual cerebro-vascular disorder of this case developed not on the base of congenital anomaly including hypoplasia of internal carotid arteries or arteriovenous malformation but as an acquired lesion established for a long time.- - - - - - - - - - ranking = 9.3457162051375keywords = subarachnoid (Clic here for more details about this article) |
6/31. Thrombosed aneurysm of the middle cerebral artery with occlusion of the distal parent artery--case report.A 54-year-old female presented with subarachnoid hemorrhage due to rupture of a small middle cerebral artery aneurysm, found to be thrombosed at surgery and not visualized on the preoperative angiograms. One major branch of the middle cerebral artery was found to be occluded near the trifurcation. The lumen of the branch proximal to the occlusion had appeared as the aneurysmal opacification on the preoperative angiograms.- - - - - - - - - - ranking = 9.3457162051375keywords = subarachnoid (Clic here for more details about this article) |
7/31. 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 = 9.3457162051375keywords = subarachnoid (Clic here for more details about this article) |
8/31. Aneurysms located at the proximal anterior cerebral artery and anterior communicating artery associated with middle cerebral artery aplasia: case report.BACKGROUND: Aneurysms arising from the proximal anterior cerebral artery (ACA) are quite rare. Here, we report upon such a case of aneurysms located at the proximal ACA and anterior communicating artery associated with middle cerebral artery (MCA) aplasia. CASE DESCRIPTION: A 64-year-old woman complained of severe headache. brain computed tomography scans demonstrated acute subarachnoid hemorrhage. Angiograms showed 2 aneurysms located at the anterior communicating artery and proximal ACA, but did not show an MCA shadow on the lesion side. Instead, multiple collateral vessels ran toward the sylvian fissure and supplied the MCA territory, together with hypertrophied perforating branches. The operative findings confirmed that the cordlike rudimentary MCA had no internal blood flow. The 2 aneurysms were secured by neck clipping. CONCLUSION: The combined effects of these anomalies on the hemodynamic equilibrium of the arteries and the genesis of the aneurysms are noteworthy.- - - - - - - - - - ranking = 9.3457162051375keywords = subarachnoid (Clic here for more details about this article) |
9/31. Isolated central nervous system arteriopathy with multiple aneurysms in an adolescent. A case report.A 17-year-old male suffered recurrent subarachnoid hemorrhages due to multiple aneurysms in the distal branches of the cerebral arteries. autopsy revealed arteriopathy as well as the aneurysms. The arteriopathy was widespread, affecting the distal branches of small and medium-sized muscular cerebral arteries, as well as the anterior and posterior spinal arteries, and vasocorona. The arteriopathy was characterized by prominent intimal thickening, discontinuity or absence of the internal elastic lamina, and thinning and/or disappearance of smooth muscle in the tunica media with fibroplasia. Slight intimal thickening was also observed in the arteries of the circle of willis and its major branches, as well as in the basilar artery. However, the arterioles, venules and veins showed no remarkable features. The arterial lesions were found only in the central nervous system. The multiple aneurysms in the distal branches of the cerebral arteries, which had produced the main symptoms and clinical signs, were due to the arteriopathy.- - - - - - - - - - ranking = 9.3457162051375keywords = subarachnoid (Clic here for more details about this article) |
10/31. The expanded endonasal approach for an endoscopic transnasal clipping and aneurysmorrhaphy of a large vertebral artery aneurysm: technical case report.OBJECTIVE: Aneurysms of the vertebral artery are rare, comprising less than 5% of all aneurysms. They can present with subarachnoid hemorrhage, medullary compression, and cranial neuropathies. In consideration of their surrounding regional anatomy, they present a formidable surgical challenge to the neurosurgeon using traditional techniques. Recent advances in endoscopic transnasal surgery have provided an additional approach for the treatment of these difficult lesions. CLINICAL PRESENTATION: We present a case of a large vertebral artery aneurysm causing mass effect on the medulla. Initial treatment consisted of endovascular trapping of the aneurysm; however, because of concerns that the remaining aneurysm and intraluminal thrombus was causing mass effect and continued brainstem compression, a decompressive procedure was required. INTERVENTION: After the endovascular trapping, the patient underwent a completely endoscopic transnasal surgical clipping and aneurysmorrhaphy. After exposure of the aneurysm, distal and proximal clips were applied transnasal, and the aneurysmorrhaphy completed using suction and ultrasonic aspiration. CONCLUSION: In consideration of their surrounding regional anatomy, aneurysms of the vertebral artery present a formidable surgical challenge to the neurosurgeon. Although endovascular techniques have proven to be extremely valuable for the treatment of these lesions, they are limited when patients have significant mass effect with brainstem compression or cranial neuropathy. Advances in endoscopic transnasal surgery have provided an additional approach for the treatment of these difficult lesions. This case report represents, to our knowledge, the first literature report of a transnasal endoscopic aneurysm clipping and thrombectomy.- - - - - - - - - - ranking = 9.3457162051375keywords = subarachnoid (Clic here for more details about this article) |
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