1/27. A provocative internal carotid artery balloon occlusion test with 99mTc-HM-PAO CBF mapping--report of three cases.The balloon occlusion test (BOT) of the internal carotid artery (ICA), combined with induced hypotension and cerebral blood flow (CBF) mapping, was carried out in three patients with a large or giant aneurysm of the ICA. Occlusion of the ICA for 10 minutes in the normotensive state was followed by 5 minutes of induced hypotension. During the last 2 minutes of hypotensive occlusion, technetium-99m-hexamethyl-propyleneamine oxime was administered to study the CBF. All patients tolerated the procedure well. One patient with moderate CBF reduction developed ischemic complications 24 hours after permanent ICA occlusion. Another showed no significant change in CBF and tolerated permanent ICA occlusion well, while the third refused permanent occlusion. The provocative BOT combined with CBF mapping is a promising predictor of complications of ICA occlusion secondary to perfusion abnormalities.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/27. cerebral infarction due to giant cell arteritis-three case reports.The objective of this report was to explore the clinical features of patients with cerebral infarction due to giant cell (temporal) arteritis (GCA) and its characteristic changes in pathology, and on computed tomography (CT) and magnetic resonance imaging (MRI). Three cases of cerebral infarction due to GCA, treated during the past 2 years, were analyzed. Their clinical manifestations were observed carefully, their temporal artery biopsies were performed, their immunohistochemistries were done, and CT as well as MRI were used. The results showed that all the patients had new-onset headache and temporal artery abnormality when the disease began, and there was tremor on the right limbs of 1 patient; temporal artery biopsies revealed evidence of inflammatory cell infiltration in the arterial wall, mainly including t-lymphocytes and macrophages; small cerebral infarction foci were found on CT and MRI; and the responses to corticosteroid therapies were good. The results suggest that it is important to recognize the clinical features of cerebral infarction due to GCA, including the changes of pathology and on CT and MRI. In some cases, special attention is paid to differentiating between atherosclerotic infarction and infections to avoid misdiagnosis.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
3/27. The ELANA technique: constructing a high flow bypass using a non-occlusive anastomosis on the ICA and a conventional anastomosis on the SCA in the treatment of a fusiform giant basilar trunk aneurysm.A patient with a partially thrombosed fusiform giant basilar trunk aneurysm presented with devastating headache and symptoms of progressive brain stem compression. Having an aneurysm inaccessible for endovascular treatment, and after failing a vertebral artery balloon occlusion test, he was offered bypass surgery in order to exclude the aneurysm from the cerebral circulation and relieve his symptoms. A connection between the intracranial internal carotid artery and the superior cerebellar artery was created whereupon the basilar artery was ligated just distally to the aneurysm. The proximal anastomosis on the internal carotid artery was made using the excimer laser-assisted non-occlusive anastomosis (ELANA) technique, while a conventional end-to-side anastomosis was used for the distal anastomosis on the superior cerebellar artery. Intra-operative flowmetry showed a flow through the bypass of 40 ml/min after ligation of the basilar artery. An angiogram 24 hours later showed normal filling of the bypass and the vessels supplied by it, but also disclosed a subtotal occlusion of the proximal ipsilateral middle cerebral artery with delayed filling distally. The patient, who had a known thrombogenic coagulopathy, died the following day. autopsy showed no signs of ischemia in the territories supplied by the bypass, but a thrombus in the proximal middle cerebral artery and massive acute hemorrhagic infarction with swelling in its territory and uncal herniation. Multiple fresh thrombi were found in the lungs. The ELANA anastomosis showed re-endothelialisation without thrombus formation on the inside.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
4/27. Cysticercal chronic basal arachnoiditis with infarcts, mimicking tuberculous pathology in endemic areas.neurocysticercosis (NCC) is the most common of the parasitic diseases affecting the CNS, with protean clinical manifestations. stroke as a complication of NCC occurs in a very small percentage of cases, mostly involving small perforating vessels while major intracranial vessel involvement is extremely rare. The present report involves two autopsied cases of chronic cysticercal basal arachnoiditis causing large arterial territory infarcts and, in the second case, a hypothalamic mass. They were diagnosed and managed, clinically and by neuroimaging, as stroke and neurotuberculosis, respectively. The diagnosis was established only at autopsy, which revealed NCC causing basal arachnoiditis, major vessel vasculitis and infarcts. Histologically, case 1 showed degenerating racemose cysticercal cyst within the thick basal exudate. In the second case, remnants of the degenerated cysticercal cyst in the form of hooklets and calcareous corpuscles were identified within the giant cell inciting a granulomatous response to form a hypothalamic mass lesion mimicking tuberculoma. The present case report highlights the importance of considering the non-tuberculous etiologies of chronic basal arachnoiditis like NCC before initiating therapy especially in countries endemic to both NCC and tuberculosis, like india.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
5/27. Giant middle cerebral artery aneurysm with parent artery occlusion--case report.A 54-year-old female was admitted with consciousness disturbance and right hemiparesis. Computed tomographic (CT) scans and angiograms revealed diffuse subarachnoid hemorrhage, a partially thrombosed, giant middle cerebral artery aneurysm (5 x 5 x 4 cm), and occlusion of the parent artery at the aneurysm site. Despite conservative treatment, a generalized convulsion occurred. Emergency CT scans revealed irregular enlargement of the left temporal high-density mass and severe mass effect due to cerebral infarction. Barbiturate coma therapy was administered, but she did not recover and died 9 days after admission. Only two cases of ruptured aneurysm with simultaneous occlusion of the major cerebral vessels have been reported, both with poor outcome. In this case, the mechanism of parent artery occlusion is unclear, but thrombus protrusion from the giant aneurysm into the parent artery may have been involved.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
6/27. Subdural hemorrhage in the posterior fossa caused by a ruptured cavernous carotid artery aneurysm after a balloon occlusion test. Case report.Given the relatively benign natural history of cavernous carotid artery aneurysms and based on anecdotal reports in the literature of subarachnoid hemorrhage (SAH) or subdural hemorrhage (SDH) from these aneurysms, observation is warranted and typically recommended. In this case report, the authors describe a woman who harbored a partially thrombosed, giant cavernous aneurysm that ruptured after she underwent a balloon occlusion test (BOT) and predominately led to an SDH. The authors believe that this occurrence is the first such report in the English literature. They discuss possible mechanisms for this event and the literature related to SAH or SDH from cavernous aneurysms, including why cavernous aneurysms cause such hemorrhages. The authors also recommend that attention be paid to such lesions regarding the possibility of aneurysmal rupture following a BOT.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
7/27. Mononeuritis multiplex and occipital infarction complicating giant cell arteritis.A 67-year-old lady with giant cell arteritis presented with a normal erythrocyte sedimentation rate (ESR) and developed occipital infarction and mononeuritis multiplex shortly after being started on high dose steroids.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
8/27. Contralateral hemiplegia in herpes zoster ophthalmicus. role of temporal artery biopsy.We describe clinical, radiological and pathological findings in a case of herpes zoster ophthalmicus who developed contralateral hemiplegia. The CT scan showed discrete infarction of the right internal capsule and the right carotid angiogram showed concentric narrowing of the supraclinoid portion of right internal carotid artery. Superficial temporal artery biopsy showed infiltration by lymphocytes and plasma cells without any granuloma formation or giant cells. The importance of trigemino-vascular connections in the pathogenesis of this complication of herpes zoster ophthalmicus and the role of temporal artery biopsy in the diagnosis of arteritis following herpes zoster are discussed.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
9/27. brain stem infarction as a complication of giant-cell arteritis.Two cases of brain stem infarction as an early and fatal complication of giant-cell arteritis are reported. These complications occurred despite adequate treatment with corticosteroids. The findings at autopsy are compared with those of the literature. The possible pathogenetic mechanisms of vertebro basilar occlusion and the therapeutical implications are discussed.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
10/27. Bilateral obstruction of internal carotid artery from giant-cell arteritis and massive infarction limited to the vertebrobasilar area.We have studied a patient with tight narrowing of both internal carotid arteries (ICAs) due to giant-cell arteritis. Although the brain supply through the internal and external carotid arteries pathways was totally inefficient, the patient suffered a progressive extensive infarction limited to the vertebrobasilar/posterior cerebral arteries area, except small lesions in the internal capsules. Both vertebral arteries were patent, although a fresh clot partially filled one of them. Without evidence for distal embolization, intracranial involvement by the arteritis, or generalized hypotension, we suggest that our patient suffered an intracranial steal phenomenon from the vertebrobasilar system towards the carotid circulation.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
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