1/14. A case of subarahnoid hemorrhage with persistent shock and transient ST elevation simulating acute myocardial infarction.Electrocardiographic changes in neurovascular disease are not rare. patients with subarachnoid hemorrhage have electrocardiographic (ECG) abnormalities that may mimic ischemic heart disease and acute myocardial infarction. Outflow of catecholamines in the early stage of subarachnoid hemorrhage contributes to elevated blood pressure in most patients. hypotension is a rare presentation in subarachnoid hemorrhage. We report a case of subarachnoid hemorrhage with transient ST elevation and intractable shock simulating acute myocardial infarction, and review the mechanism of ECG changes in subarachnoid hemorrhage.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/14. pregnancy and subarachnoid hemorrhage: a case report.Cerebrovascular diseases are rare in pregnancy and mostly caused by rupture of an arterial aneurysm. We present the case of a pregnant woman at 36 weeks of gestation who had a subarachnoid hemorrhage resulting from rupture of an unknown aneurysm, and who underwent a cesarean section and an endovascular treatment to embolize the aneurysm.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/14. Double microcatheter technique for endovascular coiling of wide-neck aneurysms using a new guiding device for the transcarotid approach: technical note.In the endovascular treatment of cerebrovascular diseases, positioning the guiding catheter is of great importance. In cases where vessel tortuosity prohibits positioning the guiding catheter in the carotid artery via the femoral approach, we use a direct carotid approach via common carotid artery puncture. For direct puncture of the common carotid artery we devised a 6-Fr sheath with double insertion points. This new device facilitates the use of double microcatheters and provides safe and effective vascular access.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/14. Transient global amnesia after cerebral angiography with iohexol.We describe a patient without a previous history of migraine or epilepsy and with no known vascular risk factors, who suffered subarachnoid haemorrhage. During vertebral angiography using nonionic contrast medium (iohexol), spasm of the basilar artery was seen. The patient suffered transient global amnesia. Angiography 3 months later with the same contrast medium was normal and produced no further deficit. This case lends support to the supposed ischaemic aetiology of transient global amnesia; in patients without other evidence of cerebrovascular disease, arterial spasm may be responsible.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/14. Stroke in the young: relationship of active cocaine use with stroke mechanism and outcome.BACKGROUND: cocaine and other vasoactive substances are known causes of cerebrovascular disease. Ictus during drug intake adversely affects outcome. MATERIALS AND methods: A retrospective review revealed 42 patients with cocaine abuse and stroke. Aneurysmal bleed occurred in 15 patients; the rest had stroke. The outcome of stroke because of cocaine intoxication was analyzed. RESULTS: Mean age for stroke was 38 ( /- 8.5 SD) years; males out-numbered females (20 : 7) similar to the pattern seen in subarachnoid hemorrhage (SAH) following aneurysm rupture. Nine had intracerebral hematomas, 6 had SAH with intracerebral hemorrhage (ICH)/ infarct, I had transverse myelopathy. Transient ischemic attack was identified in 4. Carotid occlusion was found in 2, and slow-flow in the vertebrobasilar system in 1. Fifteen were known hypertensives. cocaine was the principal substance in all patients; 7 used other substances including marijuana and heroin. Three patients had hiv, 3 had hepatitis, 2 had syphilis, and 1 had tuberculosis. urinalysis was positive for cocaine metabolites in 15; 2 had late analysis. Nine had ICH or SAH with poor neurological status at admission and died. cocaine intoxication correlated with fatal cerebrovascular accident (CVA) (p < 0.001) and poor Glasgow Outcome Score (GOS) (p < 0.001). CONCLUSION: Stroke and cocaine use correlated with fatal CVA and poor outcome. Prompt diagnostic intervention may reveal the incidence of CNS injury with cocaine abuse.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/14. aorta coarctation presenting with intracranial aneurysm rupture.Most vascular diseases have a tendency to affect both heart and the brain. Intracranial aneurysms are more often found in patients with aorta coarctation than in general population, and aneurysm rupture occurs much earlier in these patients. Here, we report a case of aorta coarctation which was diagnosed with its cerebrovascular complications. Before presenting with cerebrovascular complications, the disease can easily be diagnosed with physical examination and non-invasive radiological investigations like echocardiography or cardiac magnetic resonance imaging.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/14. Transcranial Doppler in cerebrovascular disease.Doppler analysis of flow in intracranial arteries is now possible using a 2 MHz probe allowing sufficient penetration of bone to obtain signals noninvasively. Thirty-two normal subjects, and 11 patients with cerebrovascular diseases including vasospasm following subarachnoid hemorrhage, middle cerebral artery stenosis, and extracranial internal carotid artery stenosis were studied by transcranial Doppler. Increased peak velocity and spectral broadening of the reflected signal corresponded to clinical and angiographic evidence of middle cerebral artery vasospasm or stenosis. Decreased peak velocity and blunted waveforms occurred in the middle cerebral artery ipsilateral to severe extracranial internal carotid stenosis with poor crossfilling from the contralateral carotid artery. Abnormalities resolved following carotid endarterectomy. Transcranial Doppler identifies vasospasm or stenosis of the middle cerebral artery and may allow noninvasive evaluation of collateral flow across the anterior circle of willis in patients with extracranial carotid artery stenosis.- - - - - - - - - - ranking = 5keywords = vascular disease (Clic here for more details about this article) |
8/14. Use of extracranial-intracranial bypass in the management of symptomatic vasospasm.Delayed ischemic deficits from vasospasm after subarachnoid hemorrhage remain a major source of death and disability to patients surviving subarachnoid hemorrhage. Ideal treatment for this condition would prevent or reverse spasm in major subarachnoid vessels. This goal remains elusive. Considerable success has been obtained with augmentation of flow in ischemic regions by induced hypertension and hypervolemia. Some patients are not good candidates for this therapy because of underlying cardiovascular disease or the presence of unsecured aneurysms. A total of 11 patients have recently undergone extracranial-intracranial bypass for the treatment of symptomatic vasospasm. Bypass was performed in 4 patients due to failure of medical management and in 7 patients due to our reluctance to induce hypertension in the setting of unsecured aneurysms. Eight of the 11 patients responded neurologically to the bypass procedure within 24 hours. In 6 cases, neurological deficits either improved or resolved. After operation, all 8 patients maintained their preoperative neurological status with lower mean arterial blood pressures than before bypass. Noncomatose patients with focal middle cerebral ischemic deficits and secured aneurysms in whom medical management has failed or in whom these measures are contraindicated may indeed benefit from extracranial-intracranial bypass. patients with unsecured aneurysms remote from an ischemic middle cerebral territory should probably be revascularized if cautious hypertension fails to improve their conditions.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
9/14. Dissecting aneurysms of the basilar artery in 2 patients.An uncommon consequence of intracranial vascular disease is the intramural dissection of blood or "dissecting aneurysm". A 69-year-old man with chronic subarachnoid hemorrhage from a posterior fossa mass lesion and a 30-year-old man with migraine and a brain stem stroke illustrate the diverse etiologic, clinical, radiographic, and pathologic characteristics of this unusual lesion.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
10/14. Monitoring cardiac function and intravascular volume in neurosurgical patients.Evaluation of cardiac function and intravascular volume has proved essential in two broad groups of neurosurgical patients: those with cerebrovascular disease and those with intracranial hypertension. For accurate assessment of cardiac function and intravascular volume, determinations were made by a dye dilution technique. This approach was used in 68 patients, in whom 215 dye dilution measurements were made. Useful parameters of left ventricle function included cardiac output, cardiac index, stroke volume, and mixing time. Important measures for the assessment of intravascular volume were mixing volume, dispersion volume, total peripheral resistance, central venous pressure, and mean pulmonary artery wedge pressure. Cardiopulmonary monitoring by this dye dilution technique has proved useful, relatively noninvasive, rapid, and easily repeatable in a wide variety of clinical situations in which cardiac function and state of hydration require accurate assessment. By adding this dye dilution technique to the more commonly used methods for evaluating intravascular volume and cardiac function, more accurate monitoring of critically ill neurosurgical patients can be carried out.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
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