1/26. Acquired pial arteriovenous fistula following cerebral vein thrombosis.BACKGROUND: We report a unique case of an acquired pial arteriovenous fistula occurring after an asymptomatic thrombosis of a superficial cerebral vein. CASE DESCRIPTION: A cerebral angiogram performed in a 51-year-old man with subarachnoid hemorrhage revealed a 10-mm ruptured anterior communicating artery aneurysm and a thrombosed left superficial middle cerebral vein. Coil embolization of the anterior communicating aneurysm was performed. Follow-up angiography 18 months later revealed a new, asymptomatic, pial arteriovenous fistula between the previously thrombosed left superficial middle cerebral vein and a small sylvian branch of the left middle cerebral artery. CONCLUSIONS: This case provides evidence that pial arteriovenous fistulas may develop as acquired lesions and furthermore may rarely follow cerebral vein thrombosis. Several cases of dural arteriovenous fistulas, as well as a single case of a mixed pial-dural arteriovenous fistula, occurring after dural sinus thrombosis have been reported previously. However, to our knowledge, this is the first report of an acquired pial arteriovenous fistula following a cerebral vein thrombosis.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/26. Guglielmi detachable coil treatment of a partially thrombosed giant basilar artery aneurysm in a child.We report a partially thrombosed giant of the aneurysm basilar artery with prominent mass effect, diagnosed in an 11 year-old child who presented with neurological deficits due to brain stem compression. After the patent portion of the aneurysm was embolised with Guglielmi detachable coils, remarkable clinical improvement occurred. Angiography demonstrated complete occlusion of the aneurysm and MRI revealed dramatic shrinkage of the aneurysm at 6-month and 1-year follow-up.- - - - - - - - - - ranking = 4keywords = aneurysm (Clic here for more details about this article) |
3/26. Combined neuroendovascular stenting and coil embolization for cervical carotid artery dissection causing symptomatic mass effect.BACKGROUND: Carotid artery dissection manifesting with symptomatic mass effect has been treated surgically according to the previous literature. Recently, some cases of carotid artery dissection manifesting with ischemic symptoms were treated successfully with endovascular insertion of coils after stenting. methods: A 42-year-old man with spontaneous dissection of the left cervical internal carotid artery (ICA) presented with the major complaint of left neck swelling and pain that was considered to be the mass effect of a pseudoaneurysm caused by dissection of the ICA. Endovascular therapy using a stent and coils was performed. The self-expanding stent was deployed to cover the neck of the pseudoaneurysm. A microcatheter was then guided through the stent mesh into the aneurysm, and coils were placed to pack it.RESULTS: Four months later, angiography revealed complete embolization of the aneurysm with preserved flow in the ICA. The mass effect attributable to the pseudoaneurysm was relieved symptomatically as well as radiologically. CONCLUSION: Cervical artery dissection with symptomatic mass effect can be treated successfully by the combination of stent and coils. This may be considered as an alternative to conventional proximal ligation, extracranial-intracranial bypass, or direct surgical repair.- - - - - - - - - - ranking = 2.5870478474222keywords = aneurysm, pseudoaneurysm (Clic here for more details about this article) |
4/26. case reports: sudden worsening of cluster headache: A signal of aneurysmal thrombosis and enlargement.We report a 55-year-old man presenting with symptoms of cluster headache, including throbbing pain behind the left eye, tearing, and rhinorrhea. magnetic resonance imaging and magnetic resonance angiography revealed no abnormalities. Two days of intravenous dihydroergotamine resolved his pain. His headaches were somewhat relieved with a treatment regimen of 100 mg of imipramine each night, 40 mg of propranolol twice a day, 250 mg of divalproex three times a day, and dihydroergotamine nasal spray for breakthrough headaches. Two months later, the severity of his pain increased dramatically. Repeat imaging revealed a large thrombosed left posterior communicating artery aneurysm. Following obliterative surgery, his headaches are infrequent and mild and resemble tension headaches. Dramatic changes in headache characteristics can be an indicator of aneurysmal enlargement and thrombosis. This case illustrates the importance of repeat imaging when a patient's headache significantly worsens.- - - - - - - - - - ranking = 3keywords = aneurysm (Clic here for more details about this article) |
5/26. Giant aneurysm of the azygos anterior cerebral artery--case report.A 77-year-old female presented with a giant aneurysm of the azygos anterior cerebral artery (ACA) manifesting as acute onset of akinetic mutism caused by enlargement of the aneurysm resulting from rapid thrombus formation within the aneurysmal sac. Thrombus removal to obtain decompression of the aneurysmal bulk and tension was performed before parent artery occlusion to prevent thromboembolic events. The aneurysmal neck was completely clipped with preservation of the parent artery and all branches. This strategy for direct neck clipping of a giant thrombosed distal ACA aneurysm can reduce the possibility of ischemic sequelae.- - - - - - - - - - ranking = 5keywords = aneurysm (Clic here for more details about this article) |
6/26. Giant intracranial aneurysm of the anterior communicating artery treated by direct surgical approach. Case report.We report the singular case of an exceptionally large giant communicating artery aneurysm successfully treated with a direct surgical approach. The clinical presentation was a relatively short history of frontal headache. In the pre- and postcontrast CT scans the lesion mimicked an intracranial tumor. At surgery the intraluminal thrombus was partially removed with an ultrasonic surgical aspirator; the decompression allowed the isolation and subsequent temporary dipping of the tracts A1 and A2 of both the anterior cerebral arteries. It was then possible to complete the thrombectomy and to dip the neck of the aneurysm. The report emphasizes the indispensable role of MRI for the accurate diagnosis of giant intracranial aneurysms and the recent improvement of the surgical results concerning this category of aneurysms (mainly related to the present wider availability of technical surgical instrumentation).- - - - - - - - - - ranking = 4keywords = aneurysm (Clic here for more details about this article) |
7/26. 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 = 4.5keywords = aneurysm (Clic here for more details about this article) |
8/26. 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 = 2.5keywords = aneurysm (Clic here for more details about this article) |
9/26. 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 = 4.5290159491407keywords = aneurysm, pseudoaneurysm (Clic here for more details about this article) |
10/26. Evolution of incidentally-discovered fusiform aneurysms of the vertebrobasilar arterial system: neuroimaging features suggesting progressive aneurysm growth.This study investigated the natural history and biological behavior of incidental fusiform aneurysms in four patients with incidental fusiform aneurysms of the vertebrobasilar arterial system who had been followed up for more than 3 years (mean 3.5 years). Two lesions remained the same size, and two lesions gradually grew. Angiography showed the non-growing fusiform aneurysms as a circumferentially or unilaterally fusiform dilatation of a short segment of the vertebral artery with smooth walls and a steep slope of the dilatation, and the growing fusiform aneurysms as unilaterally fusiform involving a long segment of the vertebral artery or basilar artery with irregular walls and a gentle slope of dilatation. Magnetic resonance (MR) imaging demonstrated the non-growing fusiform aneurysms as a signal-void area, and the growing fusiform aneurysms as high and intermediate signals in addition to the normal flow void. The heterogeneous MR intensities probably correspond to turbulent flow, laminar flow, thrombosis, or intramural hematoma. Differentiation of growing and non-growing fusiform aneurysms is very difficult at the initial diagnosis. However, enlargement of the fusiform aneurysms is consistent with hemorrhage into the aneurysmal wall, which is confirmed by MR imaging. Fusiform aneurysms with the characteristics of the growing aneurysms cannot be overlooked because of the potential to develop into giant fusiform aneurysms which are very difficult to manage therapeutically.- - - - - - - - - - ranking = 10keywords = aneurysm (Clic here for more details about this article) |
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