1/31. Ruptured distal anterior choroidal artery aneurysm presenting with casting intraventricular haemorrhage.This report describes a rare case of a distal anterior choroidal artery aneurysm which developed intraventricular haemorrhage without subarachnoid haemorrhage as shown on computerized tomographic (CT) scan. A 69-year-old hypertensive man suddenly became unconscious. An emergency CT scan showed a severe intraventricular haemorrhage and a small round low-dense lesion within the haematoma at the right trigone. The haematoma with obstructive hydrocephalus made the lateral ventricles larger on the right than on the left. CT scan could not detect any subarachnoid haemorrhage. Right interal carotid angiography revealed a saccular aneurysm at the plexal point of the right anterior choroidal artery. We approached the aneurysm and the small round lesion through the trigone via a right temporo-occipital corticotomy. We could clip the aneurysmal neck and remove the intraventricular haematoma and the papillary cystic mass (corresponding to the small round lesion on CT scan) totally in one sitting. Histological examination revealed the aneurysm to be a true one and the papillary cystic mass to be a choroid plexus cyst.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
2/31. Distal calcarine fusiform aneurysm: a case report and review of literature.A 50 year old female who was operated for atrial septal defect 8 years back, presented with clinical features suggestive of subarachnoid haemorrhage (grade I, Hunt and Hess). CT scan of brain revealed haemorrhage in all the supratentorial basal cisterns, sylvian cistern and small haematoma in the left occipital lobe. Conventional CT and MR angiography revealed aneurysm in relation to distal part of the calcarine branch of the left posterior cerebral artery (PCA). Left occipital craniotomy in prone position followed by deep dissection in the occipital lobe showed fusiform aneurysm of the distal part of the calcarine branch. PCA aneurysms constitute only 0.2 to 1% of all intracranial aneurysms and among them distal PCA aneurysms are most rare, constituting only 1.3%. They too are mostly seen at the bifurcation of the PCA. The present case however, is unique in the sense that it has developed as a fusiform aneurysm in the distal part of the calcarine branch. To the best of our knowledge this is rare among the rarest.- - - - - - - - - - ranking = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
3/31. Ruptured intracranial mycotic aneurysm presenting as cerebral haemorrhage in an infant: case report and review of the literature.A 2-month-old male infant presented with intracranial haemorrhage caused by ruptured intracranial mycotic aneurysm. Computed tomography and cerebral selective angiography revealed a large haematoma in the left sylvian fissure and a mycotic aneurysm of a peripheral branch of the middle cerebral artery. Despite the successful surgical removal, the child did not recover from the initial brain injury and died 2 months later. There have been fewer than 10 reported cases of infantile mycotic aneurysms and its occurrence in the absence of infectious endocarditis is exceptionally rare.- - - - - - - - - - ranking = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
4/31. Cerebral aneurysms in the perforating artery manifesting intracerebral and subarachnoid haemorrhage--report of two cases.BACKGROUND: An arteriosclerotic aneurysm in the perforating artery has been focused on as a causative factor for hypertensive intracerebral haemorrhage. However, its pathogenesis remains unknown, and its existence is still a controversy. CASE DESCRIPTION: A 62-year-old female and a 70-year-old male with a history of hypertension suffered from intracerebral haemorrhage accompanied by subarachnoid haemorrhage. Cerebral angiograms demonstrated an aneurysm arising from the perforating artery at the central location of the haematoma in both cases. The aneurysms were confirmed as the cause of bleeding during microsurgery, and were resected. Histological examination of the surgical specimens revealed that the walls of the aneurysms lacked internal elastic lamina and consisted only of the adventitia. CONCLUSION: These findings demonstrate that the aneurysm in the perforating artery can be a causative factor for hypertensive intracerebral haemorrhage, and indicate that the loss of internal elastic lamina induced by hypertension may contribute to the formation of the aneurysm of the perforating artery.- - - - - - - - - - ranking = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
5/31. 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 = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
6/31. Regrowth of residual ruptured aneurysms treated by Guglielmi's Detachable Coils which demanded further treatment by surgical clipping: report of 7 cases and review of the literature.OBJECT: The management of intracranial aneurysms has truly evolved after the introduction of endovascular treatment by Guglielmi Detachable Coils (GDC). In our department, for every case (ruptured or unruptured aneurysm) we discuss in the first place endovascular treatment. When coiling is feasible, it is done as a first choice. If not (intracranial compressive haematoma, coiling unfeasible or dangerous), the patient is operated upon. Failure of the endovascular technique, like incomplete treatment and regrowth of the residual sac, becomes a subject of discussion. Some cases need complementary treatment for large or unstable residual aneurysm. methods: Thus, between 1997 and 2000, 59 ruptured aneurysms were treated using an endovascular method by means of GDC. In 15 of this cases complementary treatment was needed, due to the size or instability of the residual aneurysm. In 8 cases a new embolization was possible and in 7 cases a complementary surgical procedure was needed, due to the impossibility of further endovascular treatment. RESULTS: Out of these 7 cases who were operated upon after coiling, clipping of the residual neck was possible in 4 cases; in 3 cases clipping was impossible due to the partial filling of the aneurysm neck by the coils. In these 3 cases, a ligation of the residual neck, associated with coagulation of the sac was performed. DISCUSSION: The difficulty of the treatment of an residual aneurysm after coiling is discussed as well as those surgical techniques alternative to clipping (wrapping or coagulation of the residual sac).- - - - - - - - - - ranking = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
7/31. 'Mirror image' distal anterior cerebral artery aneurysms. A case report of two patients with review of literature.We report two cases of patients with bilateral 'mirror image' or 'kissing' aneurysms at the distal anterior cerebral arteries who presented with subarachnoid haemorrhage and frontal intracerebral haematoma.- - - - - - - - - - ranking = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
8/31. Dissecting aneurysms of the middle cerebral artery: neuroradiological and clinical features.There are few reported cases of nontraumatic dissecting aneurysms of the middle cerebral artery (MCA), and their neuroradiological and clinical features have not been analysed. We looked at these aspects in a collaborative study. We reviewed 13 patients diagnosed as having a dissecting aneurysm of the MCA based on clinical signs and neuroradiological findings in 46 stroke centres between 1995 and 1999. There were four patients who presented with cerebral ischaemia, and nine who presented with bleeding. Of the former group, three were aged less than 15 years. cerebral angiography showed extensive stenosis and a double lumen of the M1 portion in all four patients. High signal on T1-weighted images around the arterial flow void, due to intramural haematoma, was often seen in the second week. MR angiography showed findings corresponding those of intra-arterial angiography in all four cases. We saw an infarct on CT or MRI in territory of the perforating branches of the M1 segment in all four patients. In the patients presenting with bleeding, pure subarachnoid haemorrhage or a sylvian fissure haematoma was seen on initial CT, and the predominant angiographic finding was dilatation with stenosis, but the site of the lesions was not uniform. A double lumen or intimal flap was seen in about half the cases. Rebleeding occurred within 14 days of the onset in five of the nine patients, with a poor prognosis.- - - - - - - - - - ranking = 0.66666666666667keywords = haematoma (Clic here for more details about this article) |
9/31. Remote hypertensive intracerebral haematoma following clipping of an intracranial aneurysm.We report a case of a 58-year-old woman who presented with an aneurysmal subarachnoid haemorrhage. Immediately following clipping of this aneurysm, she had a spontaneous hypertensive bleed in the contralateral hemisphere. Although very unusual, hypertensive episodes following aneurysmal subarachnoid haemorrhage must carry a risk of such an intracranial event.- - - - - - - - - - ranking = 1.3333333333333keywords = haematoma (Clic here for more details about this article) |
10/31. frontal lobe cerebral aneurysm rupture presenting as psychosis.A 23 year old male with acute onset of blunted affect, looseness of associations and auditory hallucinations presented to a tertiary care hospital 10 days after development of symptoms. Before transfer, the patient received a diagnosis of schizophreniform disorder and treatment with haloperidol was started which resulted in moderate improvement. Examination led to detection of a ruptured cerebral aneurysm in the left frontal lobe. Evacuation of the haematoma and repair of the aneurysm resulted in nearly complete resolution of symptoms. The rare incidence of acute aneurysm rupture, presenting in the case described, demonstrates the importance of a complete neurological examination in the evaluation of acute mental status changes.- - - - - - - - - - ranking = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
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