1/15. Acquired pial arteriovenous fistula following cerebral vein thrombosis.BACKGROUND: We report a unique case of an acquired pial arteriovenous fistula occurring after an asymptomatic thrombosis of a superficial cerebral vein. CASE DESCRIPTION: A cerebral angiogram performed in a 51-year-old man with subarachnoid hemorrhage revealed a 10-mm ruptured anterior communicating artery aneurysm and a thrombosed left superficial middle cerebral vein. Coil embolization of the anterior communicating aneurysm was performed. Follow-up angiography 18 months later revealed a new, asymptomatic, pial arteriovenous fistula between the previously thrombosed left superficial middle cerebral vein and a small sylvian branch of the left middle cerebral artery. CONCLUSIONS: This case provides evidence that pial arteriovenous fistulas may develop as acquired lesions and furthermore may rarely follow cerebral vein thrombosis. Several cases of dural arteriovenous fistulas, as well as a single case of a mixed pial-dural arteriovenous fistula, occurring after dural sinus thrombosis have been reported previously. However, to our knowledge, this is the first report of an acquired pial arteriovenous fistula following a cerebral vein thrombosis.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
2/15. A phase Ib/II trial of granulocyte-macrophage-colony stimulating factor and interleukin-2 for renal cell carcinoma patients with pulmonary metastases: a case of fatal central nervous system thrombosis.BACKGROUND: interleukin-2 (IL-2) and granulocyte-macrophage-colony stimulating factor (GM-CSF) are cytokines with nonoverlapping pleiotropic effects. In a prior Phase Ib study, this combination of agents exhibited antitumor effects in the lungs of four of eight patients with renal cell carcinoma and pulmonary metastases. We conducted this Phase Ib/II trial to determine the response rate of renal cell carcinoma patients with pulmonary metastases treated with continuous infusion IL-2 plus GM-CSF. methods: patients with renal cell carcinoma and pulmonary metastases were treated with 1.5, 2.25, or 4.5 x 10(6) IU/m(2)/day 96-hour continuous infusion IL-2 on Days 1-4, 8-11, and 15-18, and 1.25, 2.25, or 2.5 microg/kg/day GM-CSF on Days 8-19. RESULTS: Sixteen patients were treated per protocol, 14 of whom could be evaluated for disease progression. None of these 14 patients had >50% shrinkage of either total tumor burden or pulmonary metastasis. One patient developed Grade 5 neurotoxicity. autopsy revealed acute multifocal cerebral venous thrombosis as well as acute subdural and subarachnoid hemorrhage. CONCLUSIONS: The combination of IL-2 and GM-CSF may be associated with marked morbidity and, as in one case in this study, mortality. No significant antitumor activity was appreciated. Thus, the combination of IL-2 and GM-CSF, when administered at this dose and according to this schedule, does not appear to be active in renal cell carcinoma and is associated with significant toxicities. Further studies using this combination of agents should only be undertaken with extreme caution and particular attention to neurotoxicity.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
3/15. Cortical vein thrombosis misinterpreted as intracranial haemorrhage in severe ovarian hyperstimulation syndrome: case report.A case of cortical vein thrombosis presenting as intracranial haemorrhage is described in a patient with ovarian hyperstimulation syndrome (OHSS) after IVF and embryo transfer. Veno-occlusive disease of the brain could appear as a haemorrhagic lesion on magnetic resonance imaging (MRI) and this made the initial diagnosis of cortical vein thrombosis difficult. The patient developed deep vein thrombosis 2 weeks after the intracranial event and the diagnosis of cortical vein thrombosis was made at that time on MRI study after the resolution of the haemorrhage. This patient actually developed generalized thrombosis as a complication to OHSS. Although the initial MRI picture may be misleading, the diagnosis of thrombosis should always be kept in mind, as it is the commonest cause of intracranial lesions after OHSS.- - - - - - - - - - ranking = 2.4832015807257keywords = haemorrhage (Clic here for more details about this article) |
4/15. Brain involvement in haemolytic-uraemic syndrome: MRI features of coagulative necrosis.We describe radiological demonstration of brain involvement in haemolytic-uraemic syndrome (HUS) in two siblings with a very different clinical course. While the brother presented with a mild, reversible encephalopathy, his sister developed high-signal lesions in the cortex, putamen and caudate nucleus on T1-weighted images, seen as dense areas on CT. biopsy revealed coagulative necrosis due to microthrombosis without haemorrhage, calcification or infection. These findings suggest a possible prognostic role for MRI in cases of encephalopathy due to HUS.- - - - - - - - - - ranking = 0.41386693012095keywords = haemorrhage (Clic here for more details about this article) |
5/15. An angiographic lesion mimicking pseudo-aneurysm in cerebral arteriovenous malformation.In cerebral arteriovenous malformations (AVMs), a pseudo-aneurysm represents rupture site, and its presence is known as a factor for rebleeding. We report a case of cerebral AVM presenting with intracerebral haemorrhage in which cerebral angiography showed a lesion mimicking pseudo-aneurysm. Although the patient needed urgent surgical decompression, it was delayed because early haematoma evacuation would induce rebleeding from the rupture site. The authors attempted to occlude the pseudoaneurysm interventionally before surgery. After surgical excision, the lesion that was believed to be a pseudo-aneurysm was revealed as a partially thrombosed venous sac having a thick fibrous wall. In this report, the authors discuss the pitfalls in the interpretation of pseudo-aneurysms in angiographic AVM architecture.- - - - - - - - - - ranking = 0.41386693012095keywords = haemorrhage (Clic here for more details about this article) |
6/15. Cerebral venous thrombosis, intraventricular haemorrhage and white matter lesions in a preterm newborn with factor v (Leiden) mutation.We report a preterm newborn who presented extensive cerebral vein thrombosis on MRI but no abnormal neurological signs. The baby underwent MRI as germinal-matrix intraventricular haemorrhage was revealed by a routine ultrasound brain scan performed on day 16; earlier ultrasound scans (day 2, 7, 12) were all normal. Cerebral vein thrombosis was diagnosed at the first MRI scan together with abnormal restriction in diffusion weighted imaging in the frontal white matter parenchyma. Bilateral microcavitations with a linear pattern of distribution reflecting the distribution of medullary veins developed a week later in the same white matter areas where abnormal diffusion weighted imaging was formerly noted. The baby was later found to be heterozygous for factor v Leiden.- - - - - - - - - - ranking = 2.0693346506047keywords = haemorrhage (Clic here for more details about this article) |
7/15. Complete asymptomatic thrombosis and resorption of a congenital giant intracranial aneurysm.Intracranial aneurysms in infants are rare, but are associated with a high risk of rupture and subarachnoid hemorrhage. The authors report a case of an incidentally diagnosed, probably congenital, asymptomatic giant aneurysm of the posterior communicating artery in a 9-month-old girl, which completely thrombosed following a diagnostic superselective angiography without any neuropathological incident. Follow-up magnetic resonance imaging revealed that the aneurysm decreased further in size and was largely resorbed within 3 years after the initial finding. In single cases the natural history of congenital giant aneurysms may be better than previously assumed.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
8/15. Small aneurysms as a cause of thromboembolic stroke.OBJECTIVE AND IMPORTANCE: A small percentage of patients with intracranial aneurysms present with embolic stroke distal to the site of the aneurysm. thromboembolism typically occurs in large or giant aneurysms where reduction of flow within the aneurysm is thought to increase the possibility of clot formation. Only a few examples are available in the literature of patients with smaller aneurysms who develop embolic infarction distal to the lesion. We have experience with two such patients with an apparent common pathophysiology. CLINICAL PRESENTATION: Patient 1 with a distal left middle cerebral artery infarct was found to have an 18 mm carotid artery bifurcation aneurysm (patient age 49 years). Patient 2 had a 7 mm right middle cerebral artery aneurysm with a small distal embolus (patient age 65 years). At surgery both patients were found to have atherosclerotic disease involving the aneurysm base and parent vessel. In each instance, the aneurysm was opened during temporary vessel occlusion and microendarterectomy was performed. Occlusion of one of the major arterial branches exiting the aneurysm was also present with anterior cerebral artery occlusion in the case of ICA bifurcation lesion and MCA branch occlusion in the case of the MCA aneurysm. Both patients made a good recovery following surgery. CONCLUSION: In small aneurysms with atherosclerotic disease distal thromboembolism may occur. Surgical treatment with microendarterectomy is appropriate to prevent further emboli and potential for subarachnoid hemorrhage. (Fig. 5, Ref. 16.)- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
9/15. Neuropsychological manifestations in a case of bilateral thalamic infarction.Neuropsychological manifestation has been reported with lesions of the anterior and non-specific thalamic nuclei and mammilothalamic tract (MMT). These have been reported in the setting of arterial infarction and/or haemorrhage. Cerebral venous sinus thrombosis (CVT) is a rare cause of brain infarction. It occurs in the setting of oral contraceptive administration or pregnancy. Inherited thrombophilias are documented risk factors. The most frequent being heterozygous factor v Leiden mutation. We report a single case of bilateral thalamic infarction due to cerebral vein and sinus thrombosis. Clinically the case manifested with memory impairment and dysexecutive symptoms. Predisposing factor for venous thrombosis was a homozygous factor v Leiden mutation. The patient was treated with anticoagulation and made a good recovery.- - - - - - - - - - ranking = 0.41386693012095keywords = haemorrhage (Clic here for more details about this article) |
10/15. Intracranial pseudoaneurysm due to rupture of a saccular aneurysm mimicking a large partially thrombosed aneurysm ("ghost aneurysm"): radiological findings and therapeutic implications in two cases.Intracranial pseudoaneurysm formation due to ruptured non-traumatic saccular aneurysm is extremely rare. We experienced two cases of large pseudoaneurysm formation due to rupture of a saccular aneurysm. The neuroradiological ghost-like appearance of the aneurysms led to misdiagnoses as large partially thrombosed aneurysm. Two cases of large intracranial pseudoaneurysm formation due to rupture of a saccular aneurysm occurred in a 77-year-old comatose woman with an aneurysm on the anterior wall of the internal carotid artery and a 73-year-old comatose woman with an anterior cerebral artery (azygos) aneurysm. Both patients suffered subarachnoid hemorrhage associated with intracerebral and intraventricular hematomas. angiography showed peculiar "ghost-like" appearance of the aneurysm including delayed filling, changing shape, retention of the contrast material after the venous phase, and unclear location of neck. neck clipping surgeries were performed, but were difficult because of the preoperative misdiagnosis as large partially thrombosed aneurysm. The entity of "ghost aneurysm" caused by rupture of a saccular aneurysm should be considered in the clinical diagnosis.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
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