1/27. Ischemic events associated with unruptured intracranial aneurysms: multicenter clinical study and review of the literature.OBJECTIVE: To determine the prevalence, clinical characteristics, and long-term outcomes in cases involving transient ischemic attacks (TIAs) or ischemic strokes secondary to embolization from unruptured intracranial aneurysms. methods: We identified all available patients with intracranial aneurysms and ischemic strokes in three university-affiliated hospitals, using either international classification of diseases-9th Revision codes or local registries. patients with clinically or radiologically detected cerebral infarctions distal to intracranial aneurysms, in the absence of other causes for the infarctions, were included. An aneurysmal embolic source was considered highly probable by the primary neurosurgeon/neurologist in all cases. Follow-up data for the patients were acquired through reviews of clinical visits or telephone interviews. A review of the literature was performed to identify characteristics of previously reported patients. RESULTS: Ischemic strokes or TIAs attributable to embolization from the aneurysmal sac were observed for 9 of 269 patients (3.3%) with unruptured aneurysms. Of these nine patients, five were women and four were men (mean age, 62 yr; age range, 45-72 yr). Symptomatic aneurysms were located in the middle cerebral artery (n = 4), internal carotid artery (n = 3), posterior cerebral artery (n = 1), or vertebral artery (n = 1). The mean maximal diameter was 12.5 mm (range, 5-45 mm). Six patients underwent surgical treatment, of whom two experienced postoperative cerebral infarctions referable to the distribution of the artery harboring the aneurysm. Two patients were treated with aspirin, and one patient received no treatment. The mean follow-up period was 38 months (range, 1-60 mo). None of the patients experienced additional ischemic events during the follow-up period. Among the 41 previously reported patients, conservative treatment was used for 20 patients (mean follow-up period, 50.7 /- 44.5 mo). Four of the 20 patients experienced recurrent TIAs, 1 patient experienced worsening of symptoms, and 1 patient died during the follow-up period. A total of 21 patients underwent surgical treatment (mean follow-up period, 33.6 /- 32.3 mo). Of these patients, only one experienced recurrent TIAs. Two patients experienced postoperative seizures, and one patient died during the follow-up period. All recurrent symptoms with either surgical or conservative treatment were transient, and no patient experienced a major or disabling stroke during the follow-up period. CONCLUSION: Ischemic events can occur distal to both small and large unruptured intracranial aneurysms (predominantly in the anterior circulation). The long-term risk of recurrent ischemic events, particularly major or disabling strokes, seems to be low with either surgical or conservative treatment.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/27. heparin-induced thrombocytopenia and thrombosis following subarachnoid hemorrhage. Case report.The authors present a case of heparin-induced thrombocytopenia and thrombosis (HITT) that occurred after aneurysmal subarachnoid hemorrhage (SAH), and they review the relevant literature. An immune-mediated syndrome, HITT is characterized by moderate thrombocytopenia and paradoxical vascular thromboses. Although it has been estimated in prospective studies that HITT occurs in between 1 and 3% of patients receiving heparin, it is underrecognized in the neurosurgical literature. In the present case, a 49-year-old woman underwent clipping of a right posterior communicating artery aneurysm after suffering a Hunt and Hess Grade III SAH. She had an uncomplicated postoperative course with good clip positioning and no vasospasm observed on a cerebral angiogram obtained on Day 7. On Day 23, the patient developed a right hemiparesis and experienced a grand mal seizure. A head computerized tomography scan revealed a hemorrhagic infarct in the left middle cerebral artery distribution. Repeated cerebral angiograms did not show vasospasm. She was thrombocytopenic (platelet count as low as 46 x 10(9)/L on Day 28 compared with 213 x 10(9)/L on Day 1) and had been receiving heparin flushes to maintain intravenous catheter patency. An assay for HITT-associated antibodies was positive. The heparin flushes were discontinued and the platelet count recovered (121 x 10(9)/L). She improved neurologically, but was left with a significant right hemiparesis at discharge. This patient had assay-proven heparin-induced thrombocytopenia despite minimal exposure to heparin. Because there was no evidence of vasospasm or other factors to account for her delayed hemorrhagic infarction, an HITT-related disorder seemed most likely. Despite a large body of literature describing HITT in nonneurosurgical patients, only three previous neurosurgical cases have been published. This case report may serve to heighten awareness of this disorder.- - - - - - - - - - ranking = 0.15384615384615keywords = aneurysm (Clic here for more details about this article) |
3/27. Retrocardiac arteriovenous malformation causing recurrent cerebral ischemia.A 28-year-old woman had been suffering from recurrent cerebral embolizations for almost 9 years. A retrocardiac arteriovenous malformation was identified as the source of emboli. It was supplied by chest wall veins and the right upper pulmonary vein, connected to the back wall of the left atrium and a possibly aberrant hepatic vein originating from the abdomen. The aneurysm was resected and all supplying veins ligated. The vein from below the diaphragm was implanted into the right atrium. Her postoperative course was uncomplicated. Long-term follow-up free from cerebrovascular events.- - - - - - - - - - ranking = 0.076923076923077keywords = aneurysm (Clic here for more details about this article) |
4/27. Sudden respiratory arrest resulting from brainstem embolism in a patient undergoing endovascular abdominal aortic aneurysm repair.Surgery on the aorta is a great challenge for the anesthesiologist, even with newly developed and less invasive stent-graft procedures. The case of a fatal cerebral embolism during endovascular repair of an abdominal aortic aneurysm is reported, and the potential mechanisms underlying this unexpected complication are discussed.- - - - - - - - - - ranking = 0.38461538461538keywords = aneurysm (Clic here for more details about this article) |
5/27. Coil embolization of an incidental posterior cerebral artery aneurysm after initial OA-PCA bypass surgery.Aneurysms of the posterior cerebral artery (PCA) are rare and imply a variety of treatment modalities. We present a case of an incidental, nonruptured posterior cerebral artery aneurysm, which was successfully occluded by coil embolization after a bypass between the occipital artery and the distal posterior cerebral artery was created. MR imaging in a neurologically normal 26-year-old man, performed in the course of a work-up for nonrelated symptoms, incidentally revealed a partially thrombosed and calcified aneurysm of the left posterior cerebral artery (P2 segment). This was confirmed by angiography. Due to aneurysm configuration and localization in the asymptomatic patient, primary clipping or endovascular occlusion was considered to be too hazardous. Four weeks after successful microvascular connection of the left occipital artery to the distal posterior cerebral artery, the PCA was occluded at the level of the aneurysm with a detachable coil. The patient remained asymptomatic, without visual field defects. The above presented combined microvascular (bypass) and endovascular (coil embolization) treatment with excellent result should be considered as alternative in patients with nonruptured, asymptomatic P2 aneurysms, which are high risk for primary clipping or endovascular occlusion.- - - - - - - - - - ranking = 0.69230769230769keywords = aneurysm (Clic here for more details about this article) |
6/27. Serial neuroimaging of a growing thrombosed giant aneurysm of the distal anterior cerebral artery--case report.An 81-year-old female presented with a giant aneurysm of the distal anterior cerebral artery (A3) which grew from a small saccular aneurysm to a huge aneurysm within 36 months before manifesting as a mass lesion. The thrombosed portion of the aneurysm showed growth, whereas the aneurysmal cavity did not change in size. Computed tomography and magnetic resonance imaging showed new bleeding in the thrombosed portion. Hemorrhage into the thrombus and/or aneurysmal wall might have caused the aneurysmal growth. She refused surgery and was discharged with no deficits. Distal anterior cerebral artery aneurysm which shows neuroimaging signs of growth requires regular follow up as such lesions may become giant before manifesting clinical symptoms.- - - - - - - - - - ranking = 0.92307692307692keywords = aneurysm (Clic here for more details about this article) |
7/27. Use of glycoprotein IIb-IIIa inhibitor for a thromboembolic complication during Guglielmi detachable coil treatment of an acutely ruptured aneurysm.Thrombotic occlusion of the anterior communicating and right anterior cerebral arteries occurred during embolization of an acutely ruptured aneurysm of the anterior communicating artery. Traditional management, including superselective infusion of a fibrinolytic agent, was unsuccessful in reestablishing normal vessel patency. Therefore, an intravenous dose of abciximab was administered. Serial angiography showed that normal vessel patency was reestablished within 10 min. There were no adverse events related to abciximab administration, and the patient recovered from the procedure without neurologic deficit.- - - - - - - - - - ranking = 0.38461538461538keywords = aneurysm (Clic here for more details about this article) |
8/27. Spontaneous total thrombosis of distal superior cerebellar artery aneurysm.We report the case of an aneurysm of the distal segment of the superior cerebellar artery (SCA) which showed complete spontaneous thrombosis. Initial angiography performed in another institution showed 3 non-ruptured aneurysms located on the right distal SCA, C3 segment of the right internal carotid artery (ICA) and left basilar artery (BA)-SCA bifurcation. The patient had two episodes of transient cerebellar ataxia of the right hand before admission to our hospital, but no neurological signs were noted on admission. Computed tomography (CT) and magnetic resonance image (MRI) showed a thrombosed mass on the right cerebellar peduncle, and angiography showed no filling of the right SCA from its origin. A follow up angiogram 9 month after endovascular surgery for other aneurysms showed no recanalization of SCA or the aneurysms. There are no previous reports of total spontaneously thrombosed non-giant aneurysms of the distal segment of the SCA.- - - - - - - - - - ranking = 0.69230769230769keywords = aneurysm (Clic here for more details about this article) |
9/27. Aneurysm of the inferior vena cava in a 5-year-old boy.The authors present a case of an aneurysm of the inferior vena cava in a 5-year-old boy. The boy suffered from acute pulmonary and paradoxical cerebral embolism after a minor abdominal trauma. magnetic resonance angiography was the key for correct diagnosis of the retroperitoneal process and helped develop a strategy for surgery. The boy underwent resection of the aneurysm and a prosthetic replacement of the distal inferior vena cava. Aneurysms of the inferior vena cava are very rare conditions. The diagnosis is difficult because they may mimic a retroperitoneal tumor. thrombosis and embolism are common complications of aneurysms of the vena cava.- - - - - - - - - - ranking = 0.23076923076923keywords = aneurysm (Clic here for more details about this article) |
10/27. Surgical treatment of the thrombosed vein of galen aneurysm.OBJECTIVE AND IMPORTANCE: Vein of Galen aneurysm is a rare congenital anomaly of cerebral circulation and occurs mainly in newborns and children. The spontaneously thrombosed vein of Galen aneurysm is especially rare and an uncommonly reported event. CLINICAL PRESENTATION: Two patients with a spontaneously thrombosed vein of Galen aneurysm were operated on at our institute. CT and MRI demonstrated space-occupying lesions of the pineal region and two other masses in the posterior fossa in the second case. The first described case should be referred to as the true type of aneurysm. The vascular malformation, revealed in the second case should be referred to as the false type. In this case the vein of Galen was enlarged to a gigantic size due to the blood drainage from the arteriovenous malformation supplying it from the inferior posterior cerebellar artery. TECHNIQUE: Thrombosed aneurysmal sacs were resected totally by subtentorial supracerebellar and median suboccipital approaches. CONCLUSION: The authors report two cases of successful surgical resection of a thrombosed vein of Galen aneurysm in children. Diagnostic features are considered and the informative value of magnetic resonance imaging is stressed. The principles of choosing the right approach and dissection techniques of thrombosed aneurysms of the vein of Galen are described.- - - - - - - - - - ranking = 0.84615384615385keywords = aneurysm (Clic here for more details about this article) |
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