1/16. Systemic lupus erythematosus, berry aneurysm and subarachnoid haemorrhage.A 57-year-old woman with SLE and subarachnoid haemorrhage is described. The aetiology of the haemorrhage was a saccular aneurysm. The literature is reviewed.- - - - - - - - - - ranking = 1keywords = berry (Clic here for more details about this article) |
2/16. subarachnoid hemorrhage from intracranial dissecting aneurysms of the anterior circulation. Two case reports.Two rare cases of intracranial dissecting aneurysms of the anterior circulation associated with subarachnoid hemorrhage (SAH) are described. A 56-year-old female presented with a dissecting aneurysm in the proximal segment of the left middle cerebral artery. Proximal occlusion of the affected artery and a superficial temporal artery-middle cerebral artery anastomosis were performed, but the outcome was poor. A 61-year-old male presented with a dissecting aneurysm in the proximal segment of the left anterior cerebral artery. Clipping was enhanced by a piece of fascia lata, allowing patency of the affected artery with a satisfactory outcome. Dissecting aneurysm of the carotid system should be considered in a patient with SAH but no evidence of berry aneurysm.- - - - - - - - - - ranking = 0.25keywords = berry (Clic here for more details about this article) |
3/16. Is the rupture of cerebral berry aneurysms influenced by the perianeurysmal environment?PURPOSE: To evaluate contact between cerebral berry aneurysms and the perianeurysmal environment and to study the influence this contact has on aneurysm rupture. MATERIALS AND methods: In a series of 76 consecutive patients, pre- and post-contrast CT images of 87 aneurysms were evaluated. Aneurysm locations were identified and aneurysms were divided into two different groups depending on whether they had ruptured or not. Contact between aneurysms and the perianeurysmal environment was studied when present, and considered to be balanced or unbalanced according to symmetry of contact and type of contact interface, i.e. with bone, dura, etc. RESULTS: rupture occurred in 47 aneurysms at an average maximum dome size of 7.4 mm. There was contact with elements of the perianeurysmal environment in 38 (81%) of ruptured cases and no evidence of contact in 7 (15%). The nature of contact was unclear in 2 (4%) ruptured aneurysms. In the aneurysms with contact, the nature of contact was unbalanced in 34 (72%) and balanced in 4 (9%). Unbalanced aneurysms ruptured at significantly smaller sizes (average: 7.7 mm) than balanced aneurysms (average: 11.4 mm). Seven aneurysms of small size (3.3-6.9 mm, average: 4.8 mm) were found to have ruptured, despite the fact that they were too small to exhibit contact with the perianeurysmal environment. In 40 unruptured aneurysms (average size: 6.3 mm), contact with the perianeurysmal environment was found in 15 aneurysms, for which balanced contact was found in 11 (27.5%) and unbalanced contact in 4 (10%), and no contact in 25 (62.5%). The average size of the aneurysms without contact (3.7 mm) was significantly smaller than that with balanced contact (10.3 mm) or with unbalanced contact (11.3 mm). CONCLUSION: Aneurysms exhibit contact with their perianeurysmal environment as soon as they reach a size that exceeds their allowance given by the local subarachnoid space. The contact with the environment was found to be an additional determinant parameter in the evolution of cerebral berry aneurysms and their risk to rupture.- - - - - - - - - - ranking = 1.5keywords = berry (Clic here for more details about this article) |
4/16. subarachnoid hemorrhage after exercise stress testing.exercise stress testing is generally a safe, common procedure used to evaluate patients with suspected or known cardiopulmonary disease. Noncardiac complications are rare. A single case of hypertensive intracranial hemorrhage as a result of exercise stress testing is reported in the literature. This report presents a case of subarachnoid hemorrhage from a ruptured berry aneurysm after stress testing in a patient with autosomal polycystic kidney disease and renal failure.- - - - - - - - - - ranking = 0.25keywords = berry (Clic here for more details about this article) |
5/16. Why are aneurysms of the posterior inferior cerebellar artery so unique? Clinical experience and review of the literature.BACKGROUND: Aneurysms of the posterior inferior cerebellar artery (pica) are rare lesions. The anatomical behaviour of the artery itself is complex and characterised by a multitude of variations. The same holds true for the aneurysms discovered there. Dissecting aneurysms can be found from the pica origin to the distal artery berry. They have a wider range of clinical and radiographical presentations and their surgical treatment requires more than one standard approach. methods: We encountered 14 patients with pica aneurysms within two surgical series of a total of 1345 cerebral aneurysm patients (1 %). In this patient group of the last 27 years only 3 of the 14 were distal aneurysms ("true" pica aneurysms) RESULTS: The 14 patients harboured 15 aneurysms (9 right-sided and 6 left-sided). The female/male ratio of the patients was 9/5, the mean age 52.7 years. 13 of them had sustained an SAH. 7/14 patients were hypertensive, in 10 patients at least one of putative cerebrovascular risk factors was found. From the 15 aneurysms treated, 11 were typical berry aneurysms, 4 dissecting aneurysms. The aneurysms ranged in size from 5 to 20 mm (mean 9.1). 11 aneurysms were located within the anterior medullary segment, 1 in the tonsillomedullary and 2 in the telovelomedullary segments. All patients were surgically treated, 10 in a semi-sitting position via a suboccipital craniotomy, 4 in the prone position. 13 aneurysms were clipped, two were treated differently. Two patients died due to their bad preoperative clinical status. CONCLUSIONS: The clinical, radiographical and surgical approaches to pica aneurysms still represent a challenge.- - - - - - - - - - ranking = 0.5keywords = berry (Clic here for more details about this article) |
6/16. Extracranial vertebral and carotid dissection occurring in the course of subarachnoid hemorrhage.The pathogenesis of both intracranial aneurysms and spontaneous cervical artery dissection may be related to an underlying vasculopathy. Seven cases of spontaneous cervical artery dissection in the course of ruptured berry aneurysms are reported here.- - - - - - - - - - ranking = 0.25keywords = berry (Clic here for more details about this article) |
7/16. Pure motor hemiparesis with stable somatosensory evoked potential monitoring during aneurysm surgery: case report.We report a patient who sought treatment for an acute subarachnoid hemorrhage as a result of an intracranial aneurysm. Management included early surgical repair and intraoperative monitoring of evoked potentials. Pan-angiography revealed berry aneurysms of the communicating anterior artery and right middle cerebral artery. Surgery was uneventful, and the somatosensory evoked potential monitoring did not show any abnormalities. Nevertheless, the patient showed a neurological deficit due to a clip-related infarct in the right middle cerebral artery territory characterized by a right hemiparesis with no sensory deficit. This case report supports the possibility of false-negative results in single-mode intraoperative monitoring during aneurysm surgery.- - - - - - - - - - ranking = 0.25keywords = berry (Clic here for more details about this article) |
8/16. Intradural-extramedullary cavernous hemangioma of the left motor root C7--case report and update of the literature.OBJECTIVE: Intradural-extramedullary cavernomas of the spine are rare lesions with only 21 published cases to date. Due to their rareness and special characteristics diagnosis often is difficult. We report on an additional case of an intradural-extramedullary cavernoma of the spine. PATIENT: A 56-year-old male presented with left shoulder pain and acute onset of pain affecting the whole spinal column two weeks prior to admission. There were no motor deficits, but a hypesthesia corresponding to the right distal C8-dermatome. MRI revealed an intradural-extramedullary, expansive lesion at the level of C6 with a hyperintense appearance in both T (1)- and T (2)-weighted images. Neither a hemosiderin rim nor contrast enhancement was visible. RESULTS: During surgery a hematoma and a reddish, berry-like tumor adherent to the left motor root C7 were removed. There were no new neurological deficits, and shoulder and back pain resolved within a few weeks after surgery. Histopathologically a cavernous hemangioma was diagnosed. CONCLUSIONS: The patient's symptoms were caused both by direct nerve compression and by spinal hemorrhage, most likely spinal SAH. As there was no characteristic hemosiderin rim and due to the hyperintense appearance in T (1)- and T (2)-weighted MR scans, a radiological diagnosis of hemorrhage and classification of the lesion was difficult. Despite their rareness, in patients with signs of spontaneous, spinal SAH and/or nerve compression syndromes cavernous hemangiomas have to be considered as a potential cause.- - - - - - - - - - ranking = 0.25keywords = berry (Clic here for more details about this article) |
9/16. Ruptured middle cerebral artery aneurysm with intracerebral hemorrhage in younger patients appearing moribund: emergency operation?Four women, aged 39 to 46 years, were urgently admitted to our neurosurgical unit after strokes. On admission, all appeared moribund, presenting with deep coma, pupils bilaterally dilated and fixed, decerebrate posture, and markedly abnormal respiratory patterns. Computed tomography revealed subarachnoid hemorrhage with an associated large intracerebral hematoma and pronounced shift of midline structures in all four cases. Because of the clinical appearance, the patients were given urea and were operated without preceding angiography. The origin of the hemorrhage was identified as a middle cerebral artery (MCA) bifurcation berry aneurysm in one patient and giant MCA aneurysms in the other three. The hematomas were evacuated, and the aneurysms were occluded. All four patients received intravenous nimodipine, none showed any sign of delayed ischemic deterioration, and all regained full consciousness within a few days. One patient died 3 weeks later from a pulmonary embolus. Three patients are presently at home with moderate focal neurological deficits and moderate to marked cognitive impairment. The psychosocial readjustment was very good in a patient with a left giant aneurysm, satisfactory in a patient with a right giant aneurysm, and unsatisfactory in a patient with a right berry aneurysm. The indications, ethical considerations, and technical aspects of operating on seemingly moribund patients who probably harbor a ruptured MCA aneurysm are discussed.- - - - - - - - - - ranking = 0.5keywords = berry (Clic here for more details about this article) |
10/16. Aneurysmal subarachnoid hemorrhage presenting as cardiorespiratory arrest.Three cases of subarachnoid hemorrhage (SAH) due to ruptured developmental (berry) aneurysm are reported. Two patients presented with cardiac arrest and were successfully resuscitated, but the diagnosis of SAH was delayed and this most likely influenced poor final outcome. The third patient presented with irreversible respiratory arrest. The possible mechanisms responsible for SAH-triggered cardiac arrhythmia and/or respiratory arrest are discussed. Absence of previous cardiac history, persistent headache, focal neurologic findings (especially papilledema or subhyaloid hemorrhages) should warn the clinician of the possibility of SAH and warrant further neurologic investigation.- - - - - - - - - - ranking = 0.25keywords = berry (Clic here for more details about this article) |
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