1/9. Surgical treatment of internal carotid artery anterior wall aneurysm with extravasation during angiography--case report.A 54-year-old female presented subarachnoid hemorrhage from an aneurysm arising from the anterior (dorsal) wall of the internal carotid artery (ICA). During four-vessel angiography, an extravasated saccular pooling of contrast medium emerged in the suprasellar area unrelated to any arterial branch. The saccular pooling was visualized in the arterial phase and cleared in the venophase during every contrast medium injection. We suspected that the extravasated pooling was surrounded by hard clot but communicated with the artery. Direct surgery was performed but major premature bleeding occurred during the microsurgical procedure. After temporary clipping, an opening of the anterior (dorsal) wall of the ICA was found without apparent aneurysm wall. The vessel wall was sutured with nylon thread. The total occlusion time of the ICA was about 50 minutes. Follow-up angiography demonstrated good patency of the ICA. About 2 years after the operation, the patient was able to walk with a stick and to communicate freely through speech, although left hemiparesis and left homonymous hemianopsia persisted. The outcome suggests our treatment strategy was not optimal, but suture of the ICA wall is one of the therapeutic choices when premature rupture occurs in the operation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/9. central nervous system involvement in a child with polyarteritis nodosa and severe atopic dermatitis.polyarteritis nodosa is a diffuse vasculitis of small- and medium-sized muscular arteries that can involve the vessels of one or several organ systems. We report an 11-year-old boy with severe atopic dermatitis further complicated with erythroderma and cerebellar symptoms. Laboratory studies showed negative antinuclear antibodies and antineutrophil cytoplasmic antibodies; increased serum complement, IgG cryoglobulins 96.8 mg/dL (0-80) and serum IgG 2,160 mg/dL (613-1,295), and positive alpha-cardiolipin test. The IgE value was high. skin prick tests and RAST were positive for dust mites and casein. The viral profile was negative. Imaging studies disclosed tortuousity in the vessels and ischemic infarction in the cerebellum and thalamus. A diagnosis of polyarteritis nodosa with central nervous system involvement was made. The patient improved with immunosuppressive therapy and thalidomide. Currently, the patient is controlled and in a rehabilitation program. Other cases of polyarteritis nodosa associated with atopic dermatitis have not been reported.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/9. The spectrum of presentations of venous infarction caused by deep cerebral vein thrombosis.The classic features of thrombosis of the deep cerebral venous system are severe dysfunction of the diencephalon, reflected by coma and disturbances of eye movements and pupillary reflexes, resulting in poor outcome. However, partial syndromes without a decrease in the level of consciousness or brainstem signs exist, which may lead to initial misdiagnoses. The spectrum of clinical symptoms reflects the degree of venous congestion, which depends not only on the extent of thrombosis in the deep veins but also on the territory of the involved vessels and the establishment of venous collaterals. For example, thrombosis of the internal cerebral veins with (partially) patent basal veins and sufficient collaterals may result in relatively mild symptoms. Deep cerebral venous system thrombosis is an underdiagnosed condition when symptoms are mild, even in the presence of a venous hemorrhagic congestion. Identification of venous obstruction has important therapeutic implications. The diagnosis should be strongly suspected if the patient is a young woman, if the lesion is within the basal ganglia or thalamus, and especially if it is bilateral.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/9. Cortical laminar necrosis related to prolonged focal status epilepticus.Cortical laminar necrosis (CLN) is radiologically defined as high intensity cortical lesions on T1 weighted MRI images following a gyral distribution. Histopathologically, CLN is characterised by pannecrosis of the cortex involving neurones, glial cells, and blood vessels. It has been reported to be associated with hypoxia, metabolic disturbances, drugs, and infections. We present two patients who developed CLN and permanent neurological deficits after prolonged and repeated focal status epilepticus. The possible mechanisms leading to CLN in these patients are discussed, together with the implications of prompt and aggressive treatment in similar cases.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/9. Anterior choroidal artery-territory infarction. Report of cases and review.Occlusion of the anterior choroidal artery (AChA) can cause infarction in the posterior limb of the internal capsule. infarction is less frequent in the thalamus, midbrain, temporal lobe, and lateral geniculate body territories of the AChA. The most common clinical sign is hemiparesis. Hemisensory loss is usually transient but may be severe at onset. Homonymous upper-quadrant anopia, hemianopia, or upper- and lower-quadrant sector anopsia can be present. A homonymous defect in the upper and lower visual fields sparing the horizontal meridian is probably diagnostic of a lesion in the lateral geniculate body in the territory of the AChA. The most common stroke mechanism is small-vessel occlusive disease, predominantly found in hypertensive and diabetic patients, but cardiac-origin embolism also can affect the AChA territory. Two of our patients had infarction after temporal lobe resection for epilepsy. Occasionally patients have associated disabilities of higher cortical function that are usually transient. The lesion should be recognizable by computed tomography.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/9. Transient vertical monocular hemianopsia with anomalous retinal artery branching.A 62-year-old man reported 6 stereotyped attacks of transient loss of vision in the lateral visual field of the right eye and was subsequently found to have right internal carotid artery occlusion. Fundoscopy revealed an anomalous central retinal artery branching whereby a single stem vessel supplied the superior and inferior nasal quadrants of the retina. Circulatory insufficiency in this anomalous stem could explain the occurrence of vertical monocular hemianopsia as an unusual manifestation of ipsilateral carotid artery atherosclerosis.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
7/9. Traumatic hypopituitarism associated with bitemporal hemianopia in a prepuberal child.The case of a boy affected by post-traumatic hypopituitarism associated with bitemporal hemianopia is described. While traumatic bitemporal hemianopia is not an extraordinary occurence, traumatic injuries have been rarely reported among the causes of hypopituitarism. This may be because the cranial trauma in most of the cases is too severe to permit survival. After having considered the diagnostic problems the authors briefly review the peculiar vascular supply to the chiasma and anterior diencephalon and try to consider the pathogenetic mechanism of the syndrome. Direct contusion necrosis and direct intraparenchymal hemorrage in the chiasma and in the hypophysis or hypothalamus are considered the most probable causal factors; however, the concomitant occurence of chiasmal and hypopituitary injury might be explained by a single transient compressive mechanism either on the tubero-hypophysial arteries or on the smaller vessels of the infundibular network. The difficulty of ascertaining both the pathogenetic mechanism and the seat of the endocrine lesions on the basis of the clinical signs is stressed.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/9. Significance of scintillating scotoma of late onset.Scintillating hemianopic scotomas are usually caused either by migraine or, more rarely, vertebral-basilar insufficiency. We report two patients in whom this symptom was probably caused by platelet microthrombi in pial vessels of the visual cortex. These patients were similar in that they had scintillating scotomas which began after the age of fifty and abnormal platelet aggregability. Since increased platelet aggregability is associated with cerebral vascular accidents and is treatable, older patients who develop teichopsias should have appropriate hematological tests.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/9. SLE and sjogren's syndrome associated with unilateral moyamoya vessels in cerebral arteries.moyamoya disease is a rare clinical entity, diagnosed by cerebral angiography and characterized by occlusion of the internal carotid artery system and the development of collateral arteries. A 30-year-old woman with systemic lupus erythematosus and sjogren's syndrome recurrently presented transient right homonymous hemianopsia. cerebral angiography showed occlusion of the left posterior cerebral artery associated with the development of collateral circulation ("moyamoya vessels"). In a young adult, as in this case, the unilaterality of the lesion and the presentation of transient ischemic attacks rather than subarachnoid hemorrhage are rare features for moyamoya disease. antiphospholipid syndrome was absent.- - - - - - - - - - ranking = 2.5keywords = vessel (Clic here for more details about this article) |