1/33. Unusual cranial nerve palsy caused by cavernous sinus aneurysms. Clinical and anatomical considerations reviewed.BACKGROUND: Two cases of intracavernous internal carotid artery aneurysm with unusual clinical findings are reported. The pathomechanism and clinical significance are discussed. CASE DESCRIPTION: The first patient was a 49-year-old woman who presented with 6th nerve palsy and Horner's syndrome caused by a posteriorly located intracavernous aneurysm. The symptoms improved gradually in proportion to the size of the aneurysm. The second patient was a 69-year-old woman with isolated oculomotor superior division palsy caused by an anteriorly located large aneurysm. CONCLUSION: In the first case, a local aneurysmal compression at both the 6th nerve and the sympathetic fibers sent from the plexus on the intracavernous internal carotid artery is the most probable explanation. In the second case, the aneurysm might have selectively compressed the superior division of the oculomotor nerve at the anterior cavernous sinus. Clinical recognition of these syndromes results in a better diagnostic orientation. The authors discuss the pertinent anatomy and pathophysiology of the lesions because these findings are rarely seen clinically or in the literature.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/33. vertigo and cranial nerve palsy caused by different forms of spontaneous dissections of internal and vertebral arteries.In this report we compare a subintimal hemorrhage of a dissected vertebral artery to a subadventitial hemorrhage of a dissected extracranial internal carotid artery. A subintimal hemorrhage compresses the lumen of the artery. Therefore, magnetic resonance imaging (MRI), angiography and ultrasound are screening methods. For the subadventitial hemorrhage, which does not really compress the lumen but forms an aneurysmal dilatation, MRI is the only method of choice. We describe a case in which vertigo, nausea and vomiting are the only symptoms of a subintimal vertebral artery dissection. In this case an infarction of the cerebellar region supplied by the superior cerebellar artery could be demonstrated. Our second case demonstrates a palsy of the 10th, 11th and 12th cranial nerves, which is a less frequent symptom of internal artery dissections. The palsy of these cranial nerves seems to be caused by compression of the nerves or their nutritional arteries close to the aneurysmal dilatation of the subadventitial dissected internal carotid artery. In both cases clinical symptoms were resolved after anticoagulation.- - - - - - - - - - ranking = 0.2keywords = aneurysm (Clic here for more details about this article) |
3/33. Neurological deterioration after coil embolization of a giant basilar apex aneurysm with resolution following parent artery clip ligation. Case report and review of the literature.The authors present the case of a patient who suffered from progressive cranial nerve dysfunction, radiographically documented brainstem compression, and peduncular hallucinosis after undergoing endosaccular coil placement in a giant basilar apex aneurysm. Symptom resolution was achieved following clip ligation of the basilar artery. The pathogenesis of aneurysm mass effect due to coil placement is discussed and the pertinent literature is reviewed.- - - - - - - - - - ranking = 0.6keywords = aneurysm (Clic here for more details about this article) |
4/33. Cranial nerve pareses following wrapping of a ruptured dissecting vertebral artery aneurysm: a possible complication of cyanoacrylate glue--case report.A 51-year-old female with a ruptured dissecting vertebral artery aneurysm underwent an uneventful wrapping technique using Biobond-soaked gauze through a unilateral suboccipital transcondyle approach. On the 3rd postoperative day, she developed pareses of the ipsilateral VII through XII cranial nerves. Daily intravenous administration of 300 mg of hydrocortisone was started. This treatment was continued and dosage was tapered until the 10th postoperative day. The cranial nerve pareses deteriorated until the 8th postoperative day, but slowly resolved by 3 weeks after surgery. The patient was discharged with slight hoarseness and dysphasia 5 weeks after surgery. She had only slight hoarseness at 6 months. This complication was probably due to a neural toxic response to the Biobond.- - - - - - - - - - ranking = 0.5keywords = aneurysm (Clic here for more details about this article) |
5/33. Percutaneous intracranial stent placement for aneurysms.OBJECT: Intracranial stent placement combined with coil embolization is an emerging procedure for the treatment of intracranial aneurysms. The authors report their results using intracranial stents for the treatment of intracranial aneurysms. methods: A prospectively maintained database was reviewed to identify all patients with intracranial aneurysms that were treated with intracranial stents. Ten lesions, including eight broad-based aneurysms and two dissecting aneurysms, were treated in 10 patients. Four lesions were located in the cavernous segment of the internal carotid artery, two at the vertebrobasilar junction, two at the basilar trunk, one at the basilar apex, and one in the intracranial vertebral artery. Attempts were made to place stents in 13 patients, but in three the stents could not be delivered. Altogether, intracranial stents were placed in 10 patients for 10 lesions. Results that were determined to be satisfactory angiographically were achieved in all 10 lesions. Two patients suffered permanent neurological deterioration related to stent placement. In two patients, the aneurysm recurred after stent-assisted coil embolization. In one case of recurrence a second attempt at coil embolization was successful, whereas in the second case of recurrence parent vessel occlusion was required and well tolerated. CONCLUSIONS: Intracranial stents can be a useful addition to coil embolization by providing mechanical, hemodynamic, and visual benefits in the treatment of complex, broad-based aneurysms.- - - - - - - - - - ranking = 1.1keywords = aneurysm (Clic here for more details about this article) |
6/33. Isolated bilateral abducens nerve palsies caused by the rupture of a vertebral artery aneurysm.We report two cases with isolated bilateral abducens nerve palsies due to the rupture of a vertebral aneurysm. Surgery revealed that the aneurysm did not directly compress the abducens nerve. Within a year after the subarachnoid hemorrhage, the patients gained full recovery from the bilateral abducens nerve palsies. In view of the clinical and operative findings, it may be regarded as a compression and/or stretching of the bilateral abducens nerves by a thick clot in the prepontine cistern, and not as a manifestation of the raised intracranial pressure. The mechanisms of the isolated abducens nerve palsy are discussed.- - - - - - - - - - ranking = 0.6keywords = aneurysm (Clic here for more details about this article) |
7/33. oculomotor nerve palsies in children.Fifty-four patients with oculomotor nerve palsy who presented over a 21-year period at our institution were reviewed retrospectively. There were 38 isolated third nerve lesions, and 16 with additional cranial nerve involvement. Eleven cases were congenital in origin, and 43 were acquired. Of the acquired group, 31 were traumatic, 7 infection-related, 3 attributed to migraine or other vascular causes, and 2 neoplastic. Average follow up was 36 months. The congenital lesions were predominantly right-sided; amblyopia, although common, responded well to treatment. Trauma and bacterial meningitis accounted for more cases of isolated oculomotor nerve palsy than seen in the previous literature. In distinct contrast to the adult population, no cases of diabetes, posterior communicating artery aneurysms, metastatic tumors, or pituitary lesions were found.- - - - - - - - - - ranking = 0.1keywords = aneurysm (Clic here for more details about this article) |
8/33. Intracanalicular aneurysm of the anterior inferior cerebellar artery revealed by multi-detector CT angiography.A 62-year-old woman had sudden-onset headache and posterior neck pain, and a subarachnoid hemorrhage was revealed by unenhanced CT. Both multi-detector CT angiography and digital subtraction angiography were performed and revealed a small intracanalicular aneurysm of the left anterior inferior cerebellar artery. The patient underwent successful retrosigmoid craniectomy and trapping of the aneurysm. This case shows the ability of multi-detector CT angiography to indicate bony landmarks that can alter the surgical approach.- - - - - - - - - - ranking = 0.6keywords = aneurysm (Clic here for more details about this article) |
9/33. Pseudoaneurysm of the cervical carotid artery with hypoglossal and glossopharyngeal nerve paralysis.We report a case of a pseudoaneurysm of the internal carotid artery with associated hypoglossal and glossopharyngeal nerve paralysis. Correlative findings with magnetic resonance imagery and arteriography are described.- - - - - - - - - - ranking = 0.5264645227288keywords = aneurysm, pseudoaneurysm (Clic here for more details about this article) |
10/33. Oculomotor neuropathy syndrome. A diagnostic challenge in nasopharyngeal carcinoma.Of 22 patients with different kinds of oculomotor neuropathy syndrome (ONS), 18 were initially suspected of suffering from nasopharyngeal carcinoma (NPC). However, in a series of evaluations, their diagnoses eventually proved to be other diseases such as cranial neuritis, aneurysm of intracranial internal carotid artery, chordoma, etc. The remaining four patients initially diagnosed as having aneurysm of skull base or pituitary lesion were actually NPC sufferers. Therefore, one should be very careful in differentiating NPC from many other diseases contributing to the similar manifestation of ONS.- - - - - - - - - - ranking = 0.2keywords = aneurysm (Clic here for more details about this article) |
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