1/16. Internal carotid artery aneurysm repair requiring skull base resection: a case study.A 51-year-old man with a history of hypertension and smoking with an internal carotid artery (ICA) aneurysm was a referral from an outside hospital. He had a history remarkable for headaches for 6 months refractory to conventional therapy, but no stroke, transient ischemic attack, seizure activity, or neck pain. Arteriogram revealed a right ICA aneurysm at the level of the skull base with no accessible cervical ICA distal to the aneurysm. The petrous and intracranial ICA were normal. A team approach to repair was undertaken with a skull base resection and ICA exposure by head and neck surgeons and vascular reconstruction with vein graft from common carotid to petrous portion of ICA by vascular surgeons. A small right parietal infarction was noted in the postoperative period and became a focus of seizure activity. Anti-seizure medication was successful and transient upper-extremity weakness cleared. Transient dysfunction of cranial nerves VII and IX developed. The complex nature of the operation required expertise from different surgical specialties, and the postoperative complication mandated medical specialty and extensive inpatient and outpatient physical, occupational, and speech therapies ICA aneurysms of the skull base are uncommon. Historic treatment involved either ligation with a high risk of stroke or bypass to intracranial artery because direct repair was difficult. With a skilled team approach, direct repair as described is effective. This article focuses on the complexity of the surgical procedure, perioperative care, outcome of surgical intervention, and a multidisciplinary approach to the care of the patient undergoing ICA aneurysm repair requiring skull base resection.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/16. Subarachnoid haemorrhage: a clinical overview.Subarachnoid haemorrhage affects up to 9,000 people a year in the UK (Lindsay and Bone 1997) and is a devastating condition. Although many patients make a good physical recovery, some are left with cognitive and perceptual deficits. Early rehabilitation and support is essential, and caring for these patients and their families is a major challenge for nurses.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/16. Haemorrhagic brain injury: a care study.Mark was only 20 years old when an unfortunate sequence of events dramatically altered his life. In July 1989 he sustained two subarachnoid haemorrhages within a fortnight, first from a left anterior communicating artery aneurysm and then from a right middle cerebral artery aneurysm. Both aneurysm were successfully clipped but Mark remained hemiplegic with severe physical and behavioural problems, including incontinence, sexual disinhibition, aggression and uninhibited spitting. In November 1989, he was transferred to a neuro-rehabilitation unit and his management there will be described, showing how his complex problems were managed within enforced environmental limitations.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/16. Homicidal cerebral artery aneurysm rupture.When a normally natural mechanism of death is induced by physical injury or intense emotional stress, it is appropriate to rule the manner of death as something other than natural. When the case-specific circumstances are such that the death occurs as a result of the criminal activity of another person, it is acceptable to rule such deaths as homicides. Presented herein is a case of homicidal cerebral artery aneurysm rupture occuring in an intoxicated, 46-year-old man who was punched in the face by another individual. The details of the case are presented, followed by a discussion of the controversies that exist when dealing with such cases. Guidelines for investigating similar deaths are presented, with emphasis on the timing of the trauma in relation to onset of symptoms due to aneurysm rupture.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/16. Contrast settling in cerebral aneurysm angiography.During angiography, blood flow is visualized with a radiopaque contrast agent, which is denser than blood. In complex vasculature, such as cerebral saccular aneurysms, the density difference may produce an appreciable gravity effect, where the contrast material separates from blood and settles along the gravity direction. Although contrast settling has been occasionally reported before, the fluid mechanics behind it have not been explored. Furthermore, the severity of contrast settling in cerebral aneurysms varies significantly from case to case. Therefore, a better understanding of the physical principles behind this phenomenon is needed to evaluate contrast settling in clinical angiography. In this study, flow in two identical groups of sidewall aneurysm models with varying parent-vessel curvature was examined by angiography. Intravascular stents were deployed into one group of the models. To detect contrast settling, we used lateral view angiography. time-intensity curves were analysed from the angiographic data, and a computational fluid dynamic analysis was conducted. Results showed that contrast settling was strongly related to the local flow dynamics. We used the Froude number, a ratio of flow inertia to gravity force, to characterize the significance of gravity force. An aneurysm with a larger vessel curvature experienced higher flow, which resulted in a larger Froude number and, thus, less gravitational settling. Addition of a stent reduced the aneurysmal flow, thereby increasing the contrast settling. We found that contrast settling resulted in an elevated washout tail in the time-intensity curve. However, this signature is not unique to contrast settling. To determine whether contrast settling is present, a lateral view should be obtained in addition to the anteroposterior (AP) view routinely used clinically so as to rule out contrast settling and hence to enable a valid time-intensity curve analysis of blood flow in the aneurysm.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/16. Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by physical exertion.The clinical characteristics of perimesencephalic nonaneurysmal subarachnoid hemorrhage (SAH) caused by physical exertion were analyzed to investigate the causes and mechanisms of perimesencephalic nonaneurysmal SAH. Nine of 209 patients with spontaneous SAH were identified as having perimesencephalic nonaneurysmal SAH. Perimesencephalic nonaneurysmal SAH in four males and three females was precipitated by exertion. Age, sex predominance, type of exertion, symptoms, loss of consciousness during bleeding, clinical grade, angiographic spasm, hydrocephalus, delayed ischemic deficit, rebleeding, hypertension, and outcome were evaluated in these seven patients. Outcomes were assessed using the glasgow outcome scale. patients showed male predominance (57.1%), relatively young age (mean 50 years), low frequency of hypertension (28.6%), good clinical grade (World Federation of Neurological Surgeons grade I or II), and excellent outcomes including no rebleeding, no symptomatic hydrocephalus, and no delayed ischemic deficits. The type of exertion was swimming in two patients, golfing in two patients, heavy lifting in two patients, and bending forward during gymnastics in one patient. physical exertion including components of the valsalva maneuver is an important predisposing factor for perimesencephalic nonaneurysmal SAH. Such physical exertion produces increased intrathoracic pressure, which blocks the internal jugular venous return, resulting in elevated intracranial venous pressure or mechanical swelling of the intracranial veins, and leads to venous or capillary breakdown.- - - - - - - - - - ranking = 6keywords = physical (Clic here for more details about this article) |
7/16. Type III collagen mutations cause fragile cerebral arteries.Premature vascular aneurysms and fragility of cerebral arteries are commonly associated with type III collagen mutations and physical signs suggesting a generalized abnormality of connective tissue. Sometimes these traits are clearly genetically transmitted. Here we present seven examples of early cerebrovascular aneurysms or fragility including five examples of carotid cavernous sinus aneurysms. With one exception in which we suspect the mutation is too small to be detected, all of them had easily visible abnormalities of their type III collagen proteins. Further work in progress will eventually allow the characterization of their mutations at gene sequence level and will be followed by the ability to prevent transmission of the mutant genes in these families.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/16. Unawareness of impaired face recognition.We report investigations of the face processing abilities of SP, a right-handed woman who had suffered a subarachnoid haemorrhage from a right middle cerebral artery aneurysm. Although she could correctly assign visual stimuli to the 'face' category without difficulty, SP performed poorly on all other face processing, tasks, including 'closure' (Mooney faces), perception of facial expression, unfamiliar face matching, and identification of familiar faces. Identification of familiar people from nonfacial cues (names) remained relatively well-preserved, but severe impairments were evident on all face recognition tasks. Her errors mostly involved either failures to find a face familiar at all, or misidentification as another familiar person. In face-name learning tasks, there was evidence of 'covert' recognition of faces she failed to recognize overtly. SP's face processing impairment remained stable across a 20-month period of investigation, yet throughout this period she did not think that she had any problems in face recognition, and continued to show lack of insight into this impairment even when directly confronted with its consequences on formal testing. In contrast, SP showed adequate insight into other physical and cognitive impairments produced by her illness, including poor memory, hemiplegia, and hemianopia. We propose that her lack of insight into her face recognition problems involves a deficit-specific anosognosia, resulting from impairment of domain-specific monitoring abilities.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/16. Dissecting aneurysm of intracranial vertebral artery: case report and review of literature.A spontaneous dissecting aneurysm of the intracranial portion of the dominant right vertebral artery presented as massive subarachnoid hemorrhage, excruciating headache, and respiratory arrest in a 57-year-old white man with a history of systemic hypertension. He died on the 3rd day. Postmortem examination revealed a dissecting hemorrhage extending for 2.1 cm along the artery; rupture of the intima, media, and adventitia could be demonstrated. The intramural accumulation of blood in the proximal segments appeared to be related to retrograde dissection within a media weakened by cystic degeneration. Accumulation of pools of mucoid ground substance was also demonstrated in other intracranial and extracranial arteries. Hemodynamic stresses due to arterial hypertension and physical exertion may have played a contributory role in the etiopathogenesis of this uncommon form of cerebrovascular accident. A comprehensive literature review permits a comparison of supratentorial and infratentorial dissecting aneurysms; vertebral and basilar artery dissections are presented in tabular form.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/16. Intracranial aneurysms in early childhood.A case of an aneurysm of the middle cerebral artery in a 17-month-old child has been presented and the literature on the problem reviewed. A total of 27 aneurysms in young children (under two years of age) has been found. The characteristics that define this group of patients are: a greater proportion of aneurysms of the middle cerebral artery and its branches and of the vertebrobasilar system; greater size of the aneurysms; and frequent pseudotumor syndromes. The surgical prognosis in this group of patients is excellent. The physical and pathophysiological characteristics of these aneurysms appearing in early childhood are described.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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