1/35. Aneurysm of the posterior inferior cerebellar artery caused by a traumatic perforating artery tear-out mechanism in a child.Traumatic posterior circulation aneurysms in the absence of fractures and penetrating wounds are extremely uncommon, especially in children. To our knowledge this is the first traumatic posterior inferior cerebellar artery(pica) aneurysm reported that cannot be related to a skull fracture or a trauma caused by the edge of a rigid meningeal structure. In the present case, the initial subarachnoid hemorrhage (SAH) was caused by a perforating artery, originating from the pica, which was torn out as the result of a deceleration trauma. Such a mechanism explains both the initial SAH and the development of the false aneurysm responsible for the second SAH.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/35. Acute traumatic posteroinferior cerebellar artery aneurysms: report of three cases.OBJECTIVE AND IMPORTANCE: Posterior fossa subarachnoid hemorrhage secondary to blunt head trauma is rarely associated with traumatic aneurysms of the posterior circulation. CLINICAL PRESENTATION: We present three cases of posterior fossa subarachnoid hemorrhage from ruptured posteroinferior cerebellar artery (pica) aneurysms after blunt head trauma. In each case, there was no associated penetrating injury or cranial fracture. All three patients presented with acute hydrocephalus requiring ventriculostomy. Two of the three patients had a proximal pica aneurysm visible on emergent angiography. The remaining patient's aneurysm, although not visible on his initial angiogram, was detected on a subsequent angiogram 72 hours later. INTERVENTION: All patients underwent successful surgical clipping of their aneurysms. Two cases required sacrificing of the parent vessels because of the friable nature of the false aneurysms. In each case, severe symptomatic vasospasm occurred, requiring angioplasty. All three patients also required a ventriculoperitoneal shunt for persistent hydrocephalus. CONCLUSION: Features of these three cases and similar cases reported in the literature support the theory that vascular ruptures and traumatic aneurysms of the proximal pica may be related to anatomic variability of the pica as it transverses the brainstem. This variability predisposes individuals to vascular lesions, which occur in a continuum based on the severity of the injury. Posterior fossa subarachnoid hemorrhage after head injury requires a high index of suspicion and warrants aggressive diagnostic and therapeutic interventions.- - - - - - - - - - ranking = 3.6666666666667keywords = aneurysm (Clic here for more details about this article) |
3/35. rupture of a large ophthalmic segment saccular aneurysm associated with closed head injury: case report.OBJECTIVE AND IMPORTANCE: Although each year approximately 30,000 to 50,000 cases of subarachnoid hemorrhage in the united states are caused by the rupture of intracranial saccular aneurysms, there is little information in the literature documenting the association of aneurysmal rupture with closed head injury. CLINICAL PRESENTATION: A 61-year-old woman presented after a motor vehicle accident with multiple injuries, including a severe closed head injury. Computed tomography revealed a diffuse basal subarachnoid hemorrhage. Angiography revealed the source as a large aneurysm arising from the ophthalmic segment of the left carotid artery. INTERVENTION: After the patient was stabilized for her multiple injuries, she underwent craniotomy and clipping of the aneurysm. She recovered without developing new neurological deficits. CONCLUSION: Although the association of head trauma and aneurysmal subarachnoid hemorrhage is rare, the presence of significant basal subarachnoid blood on a computed tomographic scan should alert the physician to the possibility of a ruptured aneurysm.- - - - - - - - - - ranking = 3.3333333333333keywords = aneurysm (Clic here for more details about this article) |
4/35. Bilateral traumatic caroticocavernous fistulae: total resolution following unilateral occlusion.balloon occlusion is the accepted treatment for direct posttraumatic caroticocavernous fistula. We present a case of bilateral traumatic fistulae associated with a pseudoaneurysm. Resolution of both fistulae occurred following treatment of one of them by balloon occlusion of the internal carotid artery. This case highlights the importance of considering a more conservative approach to bilateral fistulae or those associated with a pseudoaneurysm. We review other treatment options.- - - - - - - - - - ranking = 2.0001934649913keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
5/35. Proximal M2 false aneurysm after head trauma--Case report.A 72-year-old male presented with a post-traumatic false aneurysm of the right proximal M2 artery with massive subarachnoid hemorrhage after closed head injury. Serial computed tomography (CT) and angiography showed the development of the aneurysm which was verified at autopsy. He was admitted in a drowsy state just after a motorcycle accident. Initial brain CT showed subarachnoid hemorrhage without skull fracture. Follow-up brain CT showed a huge hematoma in the right temporal lobe. He died 47 hours after the accident. Histological examination of the aneurysm showed a false aneurysm. delayed diagnosis of traumatic aneurysms leads to high mortality, so early surgical treatment is essential to save such patients.- - - - - - - - - - ranking = 3keywords = aneurysm (Clic here for more details about this article) |
6/35. Traumatic intracranial aneurysm after blunt trauma.Traumatic intracranial aneurysms are rare and represent less than 1% of all cerebral aneurysms. This type of aneurysm develops after blunt or penetrating head trauma. Surgical clipping and/or endovascular occlusion are the definitive treatments. This report describes the very unusual case of a patient who has survived for 2 years with conservative management alone.- - - - - - - - - - ranking = 2.3333333333333keywords = aneurysm (Clic here for more details about this article) |
7/35. Increases in GABA concentrations during cerebral ischaemia: a microdialysis study of extracellular amino acids.OBJECTIVES: Increases in the extracellular concentration of the excitatory amino acids glutamate and aspartate during cerebral ischaemia in patients are well recognised. Less emphasis has been placed on the concentrations of the inhibitory amino acid neurotransmitters, notably gamma-amino-butyric acid (GABA), despite evidence from animal studies that GABA may act as a neuroprotectant in models of ischaemia. The objective of this study was to investigate the concentrations of various excitatory, inhibitory and non-transmitter amino acids under basal conditions and during periods of cerebral ischaemia in patients with head injury or a subarachnoid haemorrhage. methods: Cerebral microdialysis was established in 12 patients with head injury (n=7) or subarachnoid haemorrhage (n=5). Analysis was performed using high performance liquid chromatography for a total of 19 (excitatory, inhibitory and non-transmitter) amino acids. patients were monitored in neurointensive care or during aneurysm clipping. RESULTS: During stable periods of monitoring the concentrations of amino acids were relatively constant enabling basal values to be established. In six patients, cerebral ischaemia was associated with increases (up to 1350 fold) in the concentration of GABA, in addition to the glutamate and aspartate. Parallel increases in the concentration of glutamate and GABA were found (r=0.71, p<0.005). CONCLUSIONS: The results suggest that, in the human brain, acute cerebral ischaemia is not accompanied by an imbalance between excitatory and inhibitory amino acids, but by an increase in all neurotransmitter amino acids. These findings concur with the animal models of ischaemia and raise the possibility of an endogenous GABA mediated neuroprotective mechanism in humans.- - - - - - - - - - ranking = 0.33333333333333keywords = aneurysm (Clic here for more details about this article) |
8/35. Unexpected delayed rupture of the vertebral-posterior inferior cerebellar artery aneurysms following closed head injury.Subarachnoid haemorrhage secondary to closed head injury is rarely associated with traumatic aneurysms of the posterior circulation. We report two cases of ruptured vertebral-posterior inferior cerebellar artery (VA-pica) pseudoaneurysms following closed head injuries. In each case, there was no associated penetrating injury or skull fracture. The first patient was kicked followed by disturbed consciousness. The computerized tomography (CT) scan on admission and cerebral angiography on the 11th day after the trauma revealed a massive subarachnoid haemorrhage (SAH) with pan-ventricular haemorrhage and an aneurysm of the right pica near its origin. Further ruptures occurred on the 12th, 15th, and 66th day, and he died on the 69th day. The second patient complained of persistent headache and nausea following a fight on the previous day. A CT scan and angiography on the 1st day after the trauma showed posterior fossa SAH with fourth ventricular blood and a tiny protrusion of the left VA-pica. On the 14th day, repeated angiography revealed a remarkable growth of the aneurysm, followed by the second rupture. The repair of the VA-pica junction was urgently performed with successful exclusion of the aneurysm. To our knowledge, only eight cases of traumatic aneurysms located at the VA or the pica near its origin have been reported. When intraventricular blood is found with massive subarachnoid blood or with posterior fossa SAH, this ominous complication should be considered. Traumatic VA-pica pseudoaneurysms are curable by refined microsurgical techniques, if diagnosed in time.- - - - - - - - - - ranking = 5.0001934649913keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
9/35. Giant intracavernous internal carotid artery aneurysm with fatal epistaxis.The case history and autopsy findings of a 32-year-old male, who suffered a mild closed-head injury and then had repeated epistaxis beginning 5 months later, is presented. The condition culminated in an episode of fatal epistaxis 1 year after the injury. At one time during the course of his work-up, the etiology of his repeated epistaxis was thought to be a vascular nasopharyngeal neoplasm. The diagnosis of an intracavernous internal carotid artery aneurysm was made only at autopsy. The principles of management of traumatic intracavernous internal carotid artery aneurysm presenting with epistaxis are discussed.- - - - - - - - - - ranking = 2keywords = aneurysm (Clic here for more details about this article) |
10/35. Traumatic superficial temporal artery aneurysm.Traumatic aneurysm of the superficial temporal artery is an uncommon lesion. Two cases of post-traumatic superficial temporal artery aneurysm are presented.- - - - - - - - - - ranking = 2keywords = aneurysm (Clic here for more details about this article) |
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