1/32. Primary repair with in-situ interposition graft for infrarenal mycotic aortic pseudoaneurysm.This is a case report of a pseudoaneurysm due to salmonella aortitis in a 52 year old man. The condition is rare and represents one of the few cases reported in malaysia. The diagnosis was made preoperatively by ultrasonography and computed tomography. This was confirmed at surgery where there was a 3 cm defect at the posterior wall of the aorta at L2/3 level. The aneurysmal sac extended to the retrocrural space at the 12th vertebra level cranially on the right side to the lower border of the 3rd lumbar vertebra caudally. It had a smooth fibrous wall and contained a mixture of organised haematoma and pus. At operation the aneurysm was excised, the affected region was carefully debrided and the aorta grafted with an in-situ in-lay graft. Antibiotic therapy was instituted until clinical response was evident, leukocytosis was reduced and blood culture was negative. However 4 months after surgery, the patient returned in irreversible shock and succumbed to disseminated intravascular coagulation secondary to massive upper gastrointestinal haemorrhage from an aortoduodenal fistula.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/32. Intraventricular haemorrhage due to ruptured posterior inferior cerebellar artery aneurysm in tuberculous meningitis.A 9-year-old Asian boy with known miliary tuberculosis, tuberculous meningitis and hydrocephalus was successfully treated with chemotherapy and ventriculoperitoneal shunting, but re-presented 7 months later with an intraventricular haemorrhage secondary to a ruptured left posterior inferior cerebellar artery mycotic aneurysm. The aneurysm was successfully treated by craniotomy and clipping. Tuberculous mycotic intracranial aneurysms are rare, but they should be considered in patients with tuberculous meningitis, particularly when there is a rapid neurological deterioration which may represent rupture.- - - - - - - - - - ranking = 5keywords = haemorrhage (Clic here for more details about this article) |
3/32. External carotid artery aneurysm in an infant presenting with oropharyngeal haemorrhage.We report an unusual case of a mycotic external carotid artery aneurysm presenting in a nine-month-old infant. She presented with coryzal-like symptoms and oropharyngeal haemorrhage. This was thought initially to be due to acute tonsillitis. There was significant haemorrhage and reversible hypovolaemic arrest. A contrast computerised tomography scan (CT) confirmed the diagnosis of a mycotic external carotid artery aneurysm. This was subsequently successfully treated by percutaneous embolization with microcoil insertion.- - - - - - - - - - ranking = 6keywords = haemorrhage (Clic here for more details about this article) |
4/32. Intracranial infective aneurysms: angiographic evaluation with treatment.Infective intracranial aneurysms are relatively uncommon. They develop due to septic embolisation of the vasa vasorum or lumen of the artery, with resultant focal arteritis and necrosis, leading to aneurysm formation. They are an important cause for intracranial haemorrhage. Six cases of infective aneurysms are described. A focus of infection could be detected in all the patients. Surgery was done in three cases, out of which two patients made significant recovery, while one patient died in the immediate postoperative period. Out of the three cases, treated conservatively with antibiotic therapy, there was total resolution on follow up angiogram in two, while one patient was lost to follow up.- - - - - - - - - - ranking = 2.316411511994keywords = intracranial haemorrhage, haemorrhage (Clic here for more details about this article) |
5/32. Carotid artery aneurysm of granulomatous origin.A native of the Western Caroline islands presented with a granulomatous aneurysm of the right common carotid artery measuring 7 to 8 cm, which was resected and replaced with a reversed segment of saphenous vein. Adequacy of the collateral circulation to the brain was established by occlusion of the common carotid artery with local anesthesia. This was followed by definitive operation with general endotracheal anesthesia and induced hypertension. Although tuberculosis was the most likely etiologic agent, sarcoid could not be ruled out. Granulomatous aneurysms of the common carotid are extremely rare, and if this case was sarcoid in origin, it is the first such case reported. Only one other similar aneurysm could be found in the literature. Of the various methods of reconstruction of the common carotid artery reported, autogenous reversed saphenous vein is recommended strongly.- - - - - - - - - - ranking = 0.00086542563214148keywords = brain (Clic here for more details about this article) |
6/32. Case report. Mycotic arteritis due to aspergillus fumigatus in a diabetic with retrobulbar aspergillosis and mycotic meningitis.A 74-year-old man with diabetes mellitus type II, retinopathy and polyneuropathy suffered from exophthalmus, ptosis and diplopia. magnetic resonance imaging and computer tomography showed a space-occupying process in the right orbital apex. An extranasal ethmoidectomy accompanied by an orbitotomia revealed the presence of septated hyphae. aspergillus fumigatus was grown from the tissue. After surgical removal of the fungal masses, therapy with amphotericin b (1 mg kg(-1) body weight) plus itraconazole (Sempera, 200 mg per day) over 6 weeks was initiated. Five months later the patient's condition deteriorated again, with vomiting, nausea and pain behind the right eye plus increasing exophthalmus. Antifungal therapy was started again with amphotericin b and 5-fluorocytosine. neutropenia did not occur. The patient became somnolent and deteriorated, a meningitis was suggested. Aspergillus antigen (titre 1:2, Pastorex) was detected in liquor. Anti-Aspergillus antibodies were not detectable. Both the right eye and retrobulbar fungal masses were eradicated by means of an exenteratio bulbi et orbitae. However, renal insufficiency and an apallic syndrome developed and the patient died. At autopsy, a mycotic aneurysm of the arteria carotis interna dextra was detected. The mycotic vasculitis of this aneurysm had caused a rupture of the blood vessel followed by a massive subarachnoidal haemorrhage. In addition, severe mycotic sphenoidal sinusitis and aspergillosis of the right orbit were seen, which had led to a bifrontal meningitis.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
7/32. Awake craniotomy for microsurgical obliteration of mycotic aneurysms: technical report of three cases.OBJECTIVE AND IMPORTANCE: Infectious (mycotic) aneurysms that do not resolve with medical treatment require surgical obliteration, usually requiring sacrifice of the parent artery. In addition, patients with mycotic aneurysms frequently need subsequent cardiac valve repair, which often necessitates anticoagulation. Three cases of awake craniotomy for microsurgical clipping of mycotic aneurysms are presented. Awake minimally invasive craniotomy using frameless stereotactic guidance on the basis of computed tomographic angiography enables temporary occlusion of the parent artery with neurological assessment before obliteration of the aneurysm. CLINICAL PRESENTATION: A 56-year-old woman presented with progressively worsening mitral valve disease and a history of subacute bacterial endocarditis and subarachnoid hemorrhage 30 years previously. A cerebral angiogram revealed a 4-mm left middle cerebral artery (MCA) angular branch aneurysm, which required obliteration before mitral valve replacement. The second patient, a 64-year-old woman with a history of rheumatic fever, had an 8-mm right distal MCA aneurysm diagnosed in the setting of pulmonary abscess and worsening cardiac function as a result of mitral valve disease. The third patient, a 57-year-old man with a history of fevers, night sweats, and progressive mitral valve disease, had an enlarging left MCA angular branch aneurysm despite the administration of antibiotics. Because of their location on distal MCA branches, none of the aneurysms were amenable to preoperative test balloon occlusion. INTERVENTION: After undergoing stereotactic computed tomographic angiography with fiducial markers, the patients underwent a minimally invasive awake craniotomy with frameless stereotactic navigation. In all cases, the results of the neurological examination were unchanged during temporary parent artery occlusion and the aneurysms were successfully obliterated. CONCLUSION: Awake minimally invasive craniotomy for an infectious aneurysm located in eloquent brain enables awake testing before permanent clipping or vessel sacrifice. Combining frameless stereotactic navigation with computed tomographic angiography allowed us to perform the operation quickly through a small craniotomy with minimal exploration.- - - - - - - - - - ranking = 0.00086542563214148keywords = brain (Clic here for more details about this article) |
8/32. aspergillosis of the central nervous system causing subarachnoid hemorrhage from mycotic aneurysm of the basilar artery--case report.The authors present an extremely rare case of aspergillosis of the central nervous system (CNS) causing subarachnoid hemorrhage (SAH). A 78-year-old female developed facial pain, progressive deterioration in left visual acuity, and left total ophthalmoplegia. Computed tomography demonstrated a heterogeneously enhanced mass extending from the sphenoid sinus to the left cavernous sinus and left orbit, and angiography showed luminal narrowing and irregularity of the left internal carotid artery at its siphon. biopsy of the left orbital and sphenoid sinus mass resulted in the diagnosis of Aspergillus granuloma. Despite combined administration of amphotericin-B and 5-FC, she became comatose from brainstem infarction and finally, suddenly died. Postmortem examination revealed massive SAH due to a ruptured mycotic aneurysm of the basilar artery. aspergillosis of the CNS is a growing problem with the wider use of immunosuppressants and antibiotics. To the authors' knowledge, however, only 13 cases of CNS aspergillosis causing SAH have been reported. The prognosis is absolutely bad, with all patients dying from rupture of major intracranial arteries such as the internal carotid artery and basilar artery. early diagnosis and vigorous chemotherapy are important.- - - - - - - - - - ranking = 0.00086542563214148keywords = brain (Clic here for more details about this article) |
9/32. Alternative surgical strategy for the treatment of a mycotic aortic arch aneurysm.We report the case of a 69-year-old man who presented with a symptomatic mycotic aneurysm of the aortic arch. Diagnosis was confirmed by positron emission tomography and by blood cultures positive for salmonella species. A complete resection of the aortic arch process was performed via left thoracotomy using a cryopreserved aortic homograft and normothermic left heart bypass. The left-sided cerebral vessels were clamped, and adequacy of collateral left brain flow and oxygenation was confirmed by neurophysiologic monitoring. Using this less-invasive operative strategy, we avoided the risks inherent to deep hypothermic circulatory arrest and the use of prosthetic materials.- - - - - - - - - - ranking = 0.00086542563214148keywords = brain (Clic here for more details about this article) |
10/32. A dangerous dilemma: management of infectious intracranial aneurysms complicating endocarditis.A 41-year-old right-handed man with bicuspid aortic valve and a 3-month history of chronic fever and weight loss presented with sudden onset of severe headache. Computerised tomography of the head revealed a right basal ganglia haemorrhage. Further investigation documented streptococcus mitis bacteraemia, a fusiform right middle cerebral artery aneurysm, and an abscess at the base of the anterior leaflet of the mitral valve. The patient subsequently died when repeat aneurysmal haemorrhage resulted in cerebral herniation and brain death while on antibiotic therapy. Infectious intracranial aneurysms (IIAs) are uncommon but severe complications of bacterial endocarditis. Several case series have been published evaluating the management of IIAs, but no randomised controlled trials exist to guide treatment decisions. Improved diagnostic techniques, microvascular neurosurgical approaches, and endovascular therapies hold the promise of improved outcomes in the future. This difficult case is used to show an approach towards the management of IIAs complicating bacterial endocarditis based on a review of the published work.- - - - - - - - - - ranking = 2.0008654256321keywords = haemorrhage, brain (Clic here for more details about this article) |
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