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Sample records for aneurysmal subarachnoid haemorrhage

  1. Trends in monitoring patients with aneurysmal subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Springborg, J B; Frederiksen, H-J; Eskesen, V; Olsen, Niels Vidiendal

    2005-01-01

    After aneurysmal subarachnoid haemorrhage (SAH), the clinical outcome depends upon the primary haemorrhage and a number of secondary insults in the acute post-haemorrhagic period. Some secondary insults are potentially preventable but prevention requires prompt recognition of cerebral or systemic...

  2. Computertomography in subarachnoid haemorrhage and aneurysm

    International Nuclear Information System (INIS)

    59 patients with SAH and an aneurysm were investigated by CT and angiography. In the 59 patients 67 aneurysms were found. The mean interval between SAH and CT was 8 days, between SAH and angiography 11 days. Blood in the CSF space was visualized up to the 9th day in the patients and 67% of those investigated showed blood in the CSF-space in the CT. In 31% of the patients an aneurysm, in 29% an intracerebral haemorrhage and in 19% a recent infarct was found. A hydrocephalus was seen in 13% of the patients. Of 12 patients with recent infarcts 8 showed vasospasm which correlated in time and location with the infarct. (Author)

  3. Post eclamptic aneurysmal rupture subarachnoid haemorrhage diagnosed in the puerperium

    International Nuclear Information System (INIS)

    The incidence of subarachnoid and/or intracerebral haemorrhage in women during pregnancy is rare. The risk depends on the stage of pregnancy, but seems to be highest during the late third trimester, during delivery and in the puerperium. Headache can be a symptom of both preeclampsia, subarachnoid haemorrhage and other pathologies or conditions. It is essential for pregnant women with a suspected ruptured aneurysm to be investigated and treated without delay, irrespective of fear of harm to the foetus, to avoid complications from aneurysm rupture. This case study presents a 39-year-old woman who was 35 weeks and 3 days pregnant with known preeclampsia. She endured a headache for the three days leading up to the delivery with associated diplopia on the third day, but these symptoms were thought to be related to her preeclampsia. Over the three hours following childbirth, her headache became more severe and she suffered from vomiting, loss of vision, torticollis and seizures. Computed tomography (CT) of her head revealed a subarachnoid haemorrhage while CT angiography of the Circle of Willis failed to reveal an aneurysm and 4-vessel angiography only demonstrated an area slightly suspicious for the presence of an aneurysm. 3D rotational angiography clearly demonstrated a 1-2 mm aneurysm superior to the left terminal internal carotid artery. In this case, 3D rotational angiography proved to be a valuable additional technique. This patient underwent surgery for her ruptured aneurysm and has made an excellent recovery

  4. Can CT angiography rule out aneurysmal subarachnoid haemorrhage in CT scan-negative subarachnoid haemorrhage patients?

    Science.gov (United States)

    Lim, Lee Kai; Dowling, Richard J; Yan, Bernard; Mitchell, Peter J

    2014-01-01

    Current management guidelines for CT scan-negative subarachnoid haemorrhage (SAH) patients recommend cerebral digital subtraction angiography (DSA). We aimed to investigate the utility of CT angiography (CTA) as a substitute for DSA in these patients. We included patients who presented with SAH confirmed by spectrophotometric xanthochromia analysis of cerebrospinal fluid (CSF) whereby the CT scan was negative. Electronic records were reviewed to collect data on non-contrast CT scan, CTA and DSA results. Patients without DSA or with other explanations for CSF xanthochromia were excluded. Sixty-three patients with CT scan-negative SAH were included. The diagnosis of SAH was confirmed by CSF analysis. All 63 patients underwent both DSA and CTA. Using DSA as the benchmark, CTA demonstrated a negative predictive value, positive predictive value, sensitivity and specificity of 98%, 82%, 90% and 96%, respectively, for the detection of intracranial aneurysms. CTA correctly identified patients in whom there were no underlying aneurysms responsible for SAH, with one patient with suspected dissection referred for further evaluation using MRI and DSA. PMID:23954458

  5. Spinal arachnoiditis as a consequence of aneurysm-related subarachnoid haemorrhage

    International Nuclear Information System (INIS)

    Only a few case reports currently exist regarding symptomatic spinal arachnoiditis following aneurysm-related subarachnoid haemorrhage. We present three patients who developed symptomatic spinal arachnoiditis following spontaneous aneurysm rupture. Following initial aneurysm and subarachnoid haemorrhage management (including ventriculo-peritoneal shunt placement), all three patients developed gradually worsening neurological abnormalities, and subsequent imaging demonstrated spinal arachnoiditis. Despite spinal decompression, all three patients experienced progressively worsening neurological decline.

  6. Leisure and social participation in patients 4–10 years after aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Buunk, Anne M.; Groen, Rob J. M.; Veenstra, Wencke S.; Spikman, Jacoba M.

    2015-01-01

    Objective: To investigate the long-term resumption of leisure and social activities in patients with aneurysmal subarachnoid haemorrhage (aSAH) and to determine the role of executive dysfunction and aneurysms in anterior brain regions in particular. Method: Leisure and social functioning of 200 pati

  7. Superior cerebellar aneurysm causing subarachnoid haemorrhage in a 17-year-old with alagille syndrome.

    LENUS (Irish Health Repository)

    O'Connell, David

    2012-04-01

    Alagille syndrome is a rare autosomal dominant condition characterised by mutation in Jagged1 gene. Intracranial aneurysms may be seen in this condition and may present as subarachnoid hemorrhage. We describe the first case of superior cerebellar aneurysm rupture causing WFNS grade 1 subarachnoid haemorrhage in a 17-year-old girl. The clinical condition and management of this rare occurrence is discussed with a review of literature.

  8. Subarachnoid haemorrhage in identical twins.

    OpenAIRE

    Schon, F; Marshall, J

    1984-01-01

    A pair of identical twins both of whom died of subarachnoid haemorrhage from ruptured anterior communicating artery aneurysms are reported. These twins are compared to the three other reported twins with ruptured cerebral aneurysms.

  9. Dose evaluation for long-term magnesium treatment in aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    van Norden, A G W; van den Bergh, W M; Rinkel, G J E

    2005-01-01

    BACKGROUND: Magnesium is a neuroprotective agent that might prevent or reverse delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage (SAH). We are presently running a randomized, placebo-controlled, double blind trial with magnesium sulphate (64 mmol/day intravenously). We studied whe

  10. Magnesium therapy after aneurysmal subarachnoid haemorrhage a dose-finding study for long term treatment

    NARCIS (Netherlands)

    van den Bergh, W M; Albrecht, K W; Berkelbach van der Sprenkel, J W; Rinkel, G J E

    2003-01-01

    BACKGROUND: Magnesium is a neuroprotective agent which might prevent or reverse delayed cerebral ischemia (DCI) after aneurysmal subarachnoid haemorrhage (SAH). Although the dosage for short-term magnesium therapy is well established, there is lack of knowledge on the dosage for extended use of magn

  11. Therapeutic decision and management of aneurysmal subarachnoid haemorrhage based on computed tomographic angiography.

    Science.gov (United States)

    Dehdashti, A R; Rufenacht, D A; Delavelle, J; Reverdin, A; de Tribolet, N

    2003-02-01

    The purpose of this study was to evaluate the potential of high quality computed tomographic angiography (CTA) to replace digital subtraction angiography (DSA) in cases of ruptured saccular aneurysms and perform early surgical clipping or coiling on the basis of CTA alone. In a prospective study, 100 patients with aneurysmal subarachnoid haemorrhage (SAH) diagnosed by computed tomography underwent CTA. CTA revealed a total of 118 aneurysms including all ruptured aneurysms. A decision of direct surgical clipping, endovascular coiling or therapeutic abstention was made in 89 cases (89%) on the basis of CTA alone. Sixty-one direct surgical procedures were performed after CTA. Twenty-six cases underwent DSA for immediate endovascular treatment of the ruptured aneurysm. In 11 cases (11%), a DSA was performed prior to the therapeutic decision because of unclear aneurysm. Four cases were not treated because of initial poor clinical grade. The surgical findings were compared with CTA data and were considered accurate in all but one case. All patients underwent postoperative DSA within 10 days after SAH. The sensitivity and the specificity of CTA for the detection of all aneurysms, as compared with postoperative DSA, were 95.1 and 100%, respectively. A total of six unruptured aneurysms were missed initially, but were visible retrospectively on CTA in all but one case and were found in patients with multiple aneurysms in whom the ruptured aneurysm was detected by CTA. Current quality CTA allows reliable pretreatment planning for the majority of cases of aneurysmal subarachnoid haemorrhage and diminishes the pretreatment evaluation time critically. Complementary pretreatment DSA is required in situations where CTA characteristics of the ruptured aneurysm is unsatisfactory. PMID:12779201

  12. Prediction of two month modified Rankin Scale with an ordinal prediction model in patients with aneurysmal subarachnoid haemorrhage

    OpenAIRE

    Sneade Mary; Yarnold Julia; Kerr Richard SC; Molyneux Andrew J; Lingsma Hester F; Risselada Roelof; Steyerberg Ewout W; Sturkenboom Miriam CJM

    2010-01-01

    Abstract Background Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH. Methods We studied patients enrolled in the International Subarachnoid Aneurysm Trial (ISAT), a randomized multicentre trial to compare coiling and clipping in aSAH patients. Several models were explored to estimate a patient's outcome according to the mod...

  13. Prediction of two month modified Rankin Scale with an ordinal prediction model in patients with aneurysmal subarachnoid haemorrhage

    OpenAIRE

    Risselada, Roelof; Roozenbeek, Bob; Molyneux, Andrew; Kerr, R. S. C.; Yarnold, Julia; Sneade, Mary; Steyerberg, Ewout; Sturkenboom, Miriam

    2010-01-01

    textabstractBackground. Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH. Methods. We studied patients enrolled in the International Subarachnoid Aneurysm Trial (ISAT), a randomized multicentre trial to compare coiling and clipping in aSAH patients. Several models were explored to estimate a patient's outcome according to th...

  14. Classification of non-aneurysmal subarachnoid haemorrhage: CT correlation to the clinical outcome

    International Nuclear Information System (INIS)

    Aim: To propose a new computed tomography (CT)-based classification system for non-aneurysmal subarachnoid haemorrhage (SAH), which predicts patients' discharge clinical outcome and helps to prioritize appropriate patient management. Methods and materials: A 5-year, retrospective, two-centre study was carried out involving 1486 patients presenting with SAH. One hundred and ninety patients with non-aneurysmal SAH were included in the study. Initial cranial CT findings at admission were correlated with the patients' discharge outcomes measured using the Modified Rankin Scale (MRS). A CT-based classification system (type 1-4) was devised based on the topography of the initial haemorrhage pattern. Results: Seventy-five percent of the patients had type 1 haemorrhage and all these patients had a good clinical outcome with a discharge MRS of ≤1. Eight percent of the patients presented with type 2 haemorrhage, 62% of which were discharged with MRS of ≤1 and 12% of patients had MRS 3 or 4. Type 3 haemorrhage was found in 10%, of which 16% had good clinical outcome, but 53% had moderate to severe disability (MRS 3 and 4) and 5% were discharged with severe disability (MRS 5). Six percent of patients presented with type 4 haemorrhage of which 42% of the patients had moderate to severe disability (MRS 3 and 4), 42% had severe disability and one-sixth of the patients died. Highly significant differences were found between type 1(1a and 1b) and type 2 (p = 0.003); type 2 and type 3 (p = 0.002); type 3 and type 4 (p = 0.001). Conclusion: Haemorrhages of the type 1 category are usually benign and do not warrant an extensive battery of clinical and radiological investigations. Type 2 haemorrhages have a varying prognosis and need to be investigated and managed along similar lines as that of an aneurysmal haemorrhage with emphasis towards radiological investigation. Type 3 and type 4 haemorrhages need to be extensively investigated to find an underlying cause.

  15. Classification of non-aneurysmal subarachnoid haemorrhage: CT correlation to the clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Nayak, S., E-mail: sanjeevnayak@hotmail.co [Department of Neuroradiology, University Hospital of North Staffordshire, North Staffordshire Royal Infirmary, Princes Road, Stoke-on-Trent, Staffordshire, ST4 7LN (United Kingdom); Kunz, A.B.; Kieslinger, K. [University Clinic of Neurology, Paracelsus Medical University Salzburg (Austria); Ladurner, G.; Killer, M. [University Clinic of Neurology, Paracelsus Medical University Salzburg (Austria); Neuroscience Institute, Christian Doppler Clinic, Paracelsus Medical University Salzburg (Austria)

    2010-08-15

    Aim: To propose a new computed tomography (CT)-based classification system for non-aneurysmal subarachnoid haemorrhage (SAH), which predicts patients' discharge clinical outcome and helps to prioritize appropriate patient management. Methods and materials: A 5-year, retrospective, two-centre study was carried out involving 1486 patients presenting with SAH. One hundred and ninety patients with non-aneurysmal SAH were included in the study. Initial cranial CT findings at admission were correlated with the patients' discharge outcomes measured using the Modified Rankin Scale (MRS). A CT-based classification system (type 1-4) was devised based on the topography of the initial haemorrhage pattern. Results: Seventy-five percent of the patients had type 1 haemorrhage and all these patients had a good clinical outcome with a discharge MRS of {<=}1. Eight percent of the patients presented with type 2 haemorrhage, 62% of which were discharged with MRS of {<=}1 and 12% of patients had MRS 3 or 4. Type 3 haemorrhage was found in 10%, of which 16% had good clinical outcome, but 53% had moderate to severe disability (MRS 3 and 4) and 5% were discharged with severe disability (MRS 5). Six percent of patients presented with type 4 haemorrhage of which 42% of the patients had moderate to severe disability (MRS 3 and 4), 42% had severe disability and one-sixth of the patients died. Highly significant differences were found between type 1(1a and 1b) and type 2 (p = 0.003); type 2 and type 3 (p = 0.002); type 3 and type 4 (p = 0.001). Conclusion: Haemorrhages of the type 1 category are usually benign and do not warrant an extensive battery of clinical and radiological investigations. Type 2 haemorrhages have a varying prognosis and need to be investigated and managed along similar lines as that of an aneurysmal haemorrhage with emphasis towards radiological investigation. Type 3 and type 4 haemorrhages need to be extensively investigated to find an underlying cause.

  16. High mean fasting glucose levels independently predict poor outcome and delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Kruyt, N. D.; Roos, Y. W. B. M.; Mees, S. M. Dorhout; van den Bergh, W. M.; Algra, A.; Rinkel, G. J. E.; Biessels, G. J.

    2008-01-01

    Background: Hyperglycaemia has been related to poor outcome and delayed cerebral ischaemia (DCI) after aneurysmal subarachnoid haemorrhage (aSAH). Objective: This study aimed to assess whether in patients with aSAH, levels of mean fasting glucose within the first week predict poor outcome and DCI be

  17. Prediction of two month modified Rankin Scale with an ordinal prediction model in patients with aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    R. Risselada (Roelof); B. Roozenbeek (Bob); A.J. Molyneux (Andrew); R.S.C. Kerr; J. Yarnold (Julia); M. Sneade (Mary); E.W. Steyerberg (Ewout); M.C.J.M. Sturkenboom (Miriam)

    2010-01-01

    textabstractBackground. Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH. Methods. We studied patients enrolled in the Internatio

  18. Erythropoietin in the cerebrospinal fluid of patients with aneurysmal subarachnoid haemorrhage originates from the brain

    DEFF Research Database (Denmark)

    Springborg, Jacob Bertram; Sonne, Bjarne; Frederiksen, Hans Jørgen;

    2003-01-01

    Recent years' research has revealed a specific, neuroprotective erythropoietin (EPO) system in the central nervous system (CNS) that is upregulated by hypoxia. The presence and dynamics of EPO in the cerebrospinal fluid (CSF) of patients with subarachnoid haemorrhage (SAH) has not been investigated....... We collected a total of 83 corresponding serum and CSF samples from 18 patients with aneurysmal SAH and compared the concentrations of EPO with those of blood-derived markers of blood-brain barrier function (albumin, transferrin, alpha(2)-macroglobulin) and with those of proteins with well-known CNS...... synthesis (prealbumin, apolipoprotein E). The EPO concentration in CSF was 0.93 (0.82) mU/ml (median and inter-quartile range). Nine patients presented CSF-EPO values above 1 mU/ml. CSF levels did not correlate with serum concentrations and were independent of blood-brain barrier integrity suggesting a...

  19. Serum concentration of adhesion molecules in patients with delayed ischaemic neurological deficit after aneurysmal subarachnoid haemorrhage: the immunoglobulin and selectin superfamilies

    OpenAIRE

    Nissen, J.; Mantle, D; Gregson, B.; Mendelow, A

    2001-01-01

    OBJECTIVES—Adhesion molecules are involved in the pathogenesis of cerebral ischaemia and may play a part in the pathophysiology of delayed ischaemic neurological deficit (DIND) after aneurysmal subarachnoid haemorrhage. It was hypothesised that after aneurysmal subarachnoid haemorrhage, adhesion molecules may play a part in the pathophysiology of DIND as reflected by significantly altered serum concentrations in patients with and without DIND.
METHODS—In a prospective ...

  20. Aneurysmal subarachnoid haemorrhage: outcome of aneurysm clipping in elderly patients and predictors of unfavourable outcome

    International Nuclear Information System (INIS)

    To determine the outcome of treatment of microsurgical clipping in elderly (60 - 70 years) patients with aneurysmal subarachnoid hemorrhage and determine the predictors of poor outcome. Study Design: Longitudinal analytical study. Place and Duration of Study: Nishtar Hospital, Multan, Mayo Hospital, Lahore, Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2000 to January 2010. Methodology: Elderly patients (60 - 70 years) with ruptured cerebral aneurysm were enrolled and graded on the basis of World Federation of Neurosurgeons Scale (WFNS). Aneurysm sac obliteration was done in all the patients with microsurgical clipping. Postoperatively, the patients were assessed upto 3 months for outcome parameters i.e., neurological deterioration (based on WFNS grade and modified Rankin scale as favourable (mRS score 2). The factors associated with unfavourable outcome were also noted which included age > 65 years, poor initial WFNS grade, and the occurrence of ischaemia. Results: The mean age of the 48 patients was 65 + 5.45 years. There were 31 (64.6%) male and 17 (35.4%) female patients. Postprocedural neurological deterioration occurred in 23 patients (47.9%) related to ischaemia in 14 (29.16%), rebleeding in 1 (2%), and hydrocephalus in 8 (16.66%). At 03 months, the outcome was favourable in 25 patients (52.08%) and unfavourable in 23 (47.91%). Conclusion: In old patients, careful pre-operative assessment, interdisciplinary approach and meticulous tissue handling during aneurysm clipping may decrease the unfavourable outcome. (author)

  1. Cerebral haemodynamics in patients with hydrocephalus after subarachnoid haemorrhage due to ruptured aneurysm

    International Nuclear Information System (INIS)

    Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) may be reduced in patients with normal pressure hydrocephalus (NPH) after subarachnoid haemorrhage (SAH). However, little is known about brain circulation in asymptomatic patients with ventriculomegaly after SAH. This study investigated CBF and CVR in symptomatic and asymptomatic patients with ventriculomegaly to clarify the mechanism of NPH. CBF and CVR were investigated in 48 patients with ventriculomegaly after SAH due to ruptured aneurysm. Mean CBF of the whole brain was measured by first-pass radionuclide angiography using technetium-99m hexamethylpropylene amine oxime. CVR was measured as the percentage change from the baseline mean CBF value after administration of 500 mg acetazolamide. Thirty patients with NPH who responded to shunting had significantly (P<0.01) reduced mean CBF and CVR compared with normal controls. Fourteen asymptomatic patients with ventriculomegaly showed significant (P<0.01) reduction in CVR but no difference in mean CBF. Four symptomatic patients who did not respond to shunting showed significantly (P<0.01) reduced mean CBF but had preserved CVR. Postoperative mean CBF and CVR increased significantly (P<0.01) in 21 patients who responded to shunting, but showed no significant change in four symptomatic patients who did not respond to shunting. Reduction of CBF superimposed on pre-existing impairment of CVR may be an essential step in the mechanism responsible for the manifestation of symptoms of NPH. (orig.)

  2. Predictor’s of Mortality in Patients with Aneurysmal Subarachnoid Haemorrhage and Reebleding

    Directory of Open Access Journals (Sweden)

    Dannys Rivero Rodríguez

    2015-01-01

    Full Text Available Methods. “Ameijeiras Brother’s” and “Cmdt. Manuel Fajardo” Hospitals enrolled 64 patients (multicentre retrospective cohort with aneurysmal subarachnoid haemorrhage and rebleeding. The patients were admitted to the Stroke Unit (SU between January 1, 2006, and December 1, 2013. Demographic, clinical, and radiological variables were examined in logistic regression to evaluate independent factors for increasing the risk of death. Results. Patients with systolic blood pressure >160 mmHg (P=0.02, serum glucose >7 mmol/L (P=0.02, aneurysm location in artery communicant anterior (P=0.03, and black/mixed race (P=0.008 were significant related to death in univariate analysis. Risk factors (HTA, smoke, alcohol consumption, and DM, complication, multiplex rebleeding and stage of WFNS, and Fisher’s scale were not related to mortality. Patients with three or more complications had a higher mortality rate (P=0.002. The results of the multivariate logistic regression analysis indicated that race (black/mixed, P=0.00, OR 4.62, and 95% IC 1.40–16.26, systolic blood pressure (>160 mmHg, P=0.05, OR 2.54, and 95% IC 1.01–3.13, and serum glucose (>7.0 mmol/L, P=0.05, OR 1.82, and 95% IC 1.27–2.67 were independent risk factors for death. Conclusions. The black/mixed race, SBP, and serum glucose were independent predictors of mortality. Three or more complications were associated with increasing the probability to death. Further investigation is necessary to validate these findings.

  3. Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Gray Alastair

    2010-04-01

    Full Text Available Abstract Background To estimate life years and quality-adjusted life years (QALYs lost and the economic burden of aneurysmal subarachnoid haemorrhage (aSAH in the United Kingdom including healthcare and non-healthcare costs from a societal perspective. Methods All UK residents in 2005 with aSAH (International Classification of Diseases 10th revision (ICD-10 code I60. Sex and age-specific abridged life tables were generated for a general population and aSAH cohorts. QALYs in each cohort were calculated adjusting the life tables with health-related quality of life (HRQL data. Healthcare costs included hospital expenditure, cerebrovascular rehabilitation, primary care and community health and social services. Non-healthcare costs included informal care and productivity losses arising from morbidity and premature death. Results A total of 80,356 life years and 74,807 quality-adjusted life years were estimated to be lost due to aSAH in the UK in 2005. aSAH costs the National Health Service (NHS £168.2 million annually with hospital inpatient admissions accounting for 59%, community health and social services for 18%, aSAH-related operations for 15% and cerebrovascular rehabilitation for 6% of the total NHS estimated costs. The average per patient cost for the NHS was estimated to be £23,294. The total economic burden (including informal care and using the human capital method to estimate production losses of a SAH in the United Kingdom was estimated to be £510 million annually. Conclusion The economic and disease burden of aSAH in the United Kingdom is reported in this study. Decision-makers can use these results to complement other information when informing prevention policies in this field and to relate health care expenditures to disease categories.

  4. Advances in the understanding of delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage [version 1; referees: 4 approved

    Directory of Open Access Journals (Sweden)

    Liam Flynn

    2015-11-01

    Full Text Available Delayed cerebral ischaemia has been described as the single most important cause of morbidity and mortality in patients who survive the initial aneurysmal subarachnoid haemorrhage. Our understanding of the pathophysiology of delayed cerebral ischaemia is meagre at best and the calcium channel blocker nimodipine remains the only intervention to consistently improve functional outcome after aneurysmal subarachnoid haemorrhage. There is substantial evidence to support cerebral vessel narrowing as a causative factor in delayed cerebral ischaemia, but contemporary research demonstrating improvements in vessel narrowing has failed to show improved functional outcomes. This has encouraged researchers to investigate other potential causes of delayed cerebral ischaemia, such as early brain injury, microthrombosis, and cortical spreading depolarisation. Adherence to a common definition of delayed cerebral ischaemia is needed in order to allow easier assessment of studies using multiple different terms. Furthermore, improved recognition of delayed cerebral ischaemia would not only allow for faster treatment but also better assessment of interventions. Finally, understanding nimodipine’s mechanism of action may allow us to develop similar agents with improved efficacy.

  5. Neurosurgical versus endovascular treatment of subarachnoid haemorrhage caused by ruptured cerebral aneurysm: comparison of patient outcomes.

    Science.gov (United States)

    Kamensky, J

    2015-03-01

    The aim of this critical review is to determine whether endovascular treatment (EVT) of a subarachnoid haemorrhage (SAH) has better patient outcomes than neurosurgical treatment (NST). A review of six cohort studies (listed in Table 1) was carried out and the main findings were summarised in the conclusion. In addition the list of author's recommendations is included at the end of the paper. Theatre practitioners involved in neurosurgery might find this review useful in enhancing their understanding of how SAH is currently treated. It could also bring some insights about the reasons why a particular modality of the treatment was chosen for their patient. PMID:26016283

  6. Erythropoietin in patients with aneurysmal subarachnoid haemorrhage: a double blind randomised clinical trial

    DEFF Research Database (Denmark)

    Springborg, J B; Møller, C; Gideon, P;

    2007-01-01

    BACKGROUND: Erythropoietin (EPO) is neuroprotective in experimental models of stroke and subarachnoid haemorrhage (SAH) and possibly in patients with thromboembolic stroke. We studied the efficacy and safety of EPO in patients with SAH. METHODS: A larger scale clinical trial was planned but...... preliminarily terminated because of a lower than expected inclusion rate. However, 73 patients were randomised to treatment with EPO (500 IU/kg/day for three days) or placebo. The primary endpoint was Glasgow Outcome Score at six months. We further studied surrogate measures of secondary ischaemia, i...... statistically significant group differences in the primary or secondary outcome measures. EPO was well tolerated. CONCLUSIONS: Beneficial effects of EPO in patients with SAH cannot be excluded or concluded on the basis of this study and larger scale trials are warranted....

  7. Polymorphisms of apolipoprotein E and aneurysmal subarachnoid haemorrhage: A meta-analysis.

    Science.gov (United States)

    Arati, S; Sibin, M K; Bhat, Dhananjaya I; Narasingarao, K V L; Chetan, G K

    2016-09-01

    Subarachnoid haemorrhage (SAH) is characterised by bleeding in the subarachnoid space in the brain. There are various polymorphisms in genes which are associated with this disease. We performed a systematic meta- analysis to investigate the relationship of APOE polymorphism on aSAH. A comprehensive literature search was done in the Pubmed database, Science Direct, Cochrane library and Google Scholar. The OR and 95% CI were evaluated for the gene and aSAH association using fixed and random effect models. Publication bias was assessed using Begg's funnel plot and Egger's regression test. All statistical evaluations were done using the software Review Manager 5.0 and Comprehensive Meta Analysis v2.2.023. A total of 9 studies were assessed on APOE polymorphism (1100 Cases, 2732 Control). Meta analysis results showed significant association in ε2/ ε2 versus ε3/ε3, ε2 versus ε3 genetic models and ε2 allele frequency. In subgroup analysis statistically significant association was observed in Asians in the genetic models ε2/ ε2 versus ε3/ε3, ε2/ε3 versus ε3/ε3, ε2 versus ε3 and also in ε2 allele frequency. However, in Caucasian population only ε2/ε2 versus ε3/ε3 genetic model showed significant association between APOE and risk of aSAH. In this meta-analysis study, the ε2/ε2 genotype is associated with increased risk of aSAH. PMID:27408823

  8. Prediction of two month modified Rankin Scale with an ordinal prediction model in patients with aneurysmal subarachnoid haemorrhage

    Directory of Open Access Journals (Sweden)

    Sneade Mary

    2010-09-01

    Full Text Available Abstract Background Aneurysmal subarachnoid haemorrhage (aSAH is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH. Methods We studied patients enrolled in the International Subarachnoid Aneurysm Trial (ISAT, a randomized multicentre trial to compare coiling and clipping in aSAH patients. Several models were explored to estimate a patient's outcome according to the modified Rankin Scale (mRS at two months after aSAH. Our final model was validated internally with bootstrapping techniques. Results The study population comprised of 2,128 patients of whom 159 patients died within 2 months (8%. Multivariable proportional odds analysis identified World Federation of Neurosurgical Societies (WFNS grade as the most important predictor, followed by age, sex, lumen size of the aneurysm, Fisher grade, vasospasm on angiography, and treatment modality. The model discriminated moderately between those with poor and good mRS scores (c statistic = 0.65, with minor optimism according to bootstrap re-sampling (optimism corrected c statistic = 0.64. Conclusion We presented a calibrated and internally validated ordinal prognostic model to predict two month mRS in aSAH patients who survived the early stage up till a treatment decision. Although generalizability of the model is limited due to the selected population in which it was developed, this model could eventually be used to support clinical decision making after external validation. Trial Registration International Standard Randomised Controlled Trial, Number ISRCTN49866681

  9. Role of 123I-IMP SPET in the early diagnosis of borderline chronic hydrocephalus after aneurysmal subarachnoid haemorrhage

    International Nuclear Information System (INIS)

    Chronic hydrocephalus after aneurysmal subarachnoid haemorrhage (SAH) is easily diagnosed in most cases. However, the diagnosis is sometimes difficult in borderline cases, in which (a) pathognomonic clinical deterioration due to hydrocephalus is masked by the neurological deficits caused in the acute stage of SAH and (b) ventricular enlargement is not so marked on CT scan. The purpose of this study was to investigate whether or not iodine-123 labelled N-isopropyl-p-iodoamphetamine (123I-IMP) single-photon emission tomography (SPET) is of value for the early diagnosis of borderline chronic hydrocephalus after SAH. Fifteen patients who met the criteria of borderline chronic hydrocephalus were selected for the study, and underwent a shunt operation. The patients were divided into a shunt-effective group and a shunt-ineffective group according to neurological improvement after the shunt operation. 123I-IMP SPET was performed in the acute stage of SAH, within 1 week before the shunt operation, and 2 weeks after the shunt operation. Regional cerebral blood flow was estimated by the 123I-IMP autoradiographic method. Pre-shunting periventricular low-perfusion areas showed statistically significant differences between the two groups (P123I-IMP SPET can be used for both the early diagnosis of borderline chronic hydrocephalus after SAH and the prediction of shunt effectiveness. (orig.)

  10. Role of {sup 123}I-IMP SPET in the early diagnosis of borderline chronic hydrocephalus after aneurysmal subarachnoid haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Ohkuma, Hiroki; Tanaka, Masahiko; Suzuki, Shigeharu [Dept. of Neurosurgery, Hirosaki University School of Medicine, Hirosaki (Japan); Kondoh, Izumi [Dept. of Rehabilitation Medicine, Institute of Brain Science, Hirosaki University School of Medicine, Hirosaki (Japan)

    2000-05-01

    Chronic hydrocephalus after aneurysmal subarachnoid haemorrhage (SAH) is easily diagnosed in most cases. However, the diagnosis is sometimes difficult in borderline cases, in which (a) pathognomonic clinical deterioration due to hydrocephalus is masked by the neurological deficits caused in the acute stage of SAH and (b) ventricular enlargement is not so marked on CT scan. The purpose of this study was to investigate whether or not iodine-123 labelled N-isopropyl-p-iodoamphetamine ({sup 123}I-IMP) single-photon emission tomography (SPET) is of value for the early diagnosis of borderline chronic hydrocephalus after SAH. Fifteen patients who met the criteria of borderline chronic hydrocephalus were selected for the study, and underwent a shunt operation. The patients were divided into a shunt-effective group and a shunt-ineffective group according to neurological improvement after the shunt operation. {sup 123}I-IMP SPET was performed in the acute stage of SAH, within 1 week before the shunt operation, and 2 weeks after the shunt operation. Regional cerebral blood flow was estimated by the {sup 123}I-IMP autoradiographic method. Pre-shunting periventricular low-perfusion areas showed statistically significant differences between the two groups (P<0.05). In the shunt-effective group, periventricular low-perfusion areas on pre-shunting SPET were significantly enlarged compared with those in the acute stage of SAH (P<0.05), and they were significantly reduced after the shunt operation (P<0.05). In the shunt-ineffective group, periventricular low-perfusion areas showed no significant changes during the course. These results suggest that periventricular low-perfusion areas enlarge in the early stage of chronic hydrocephalus after SAH, and that {sup 123}I-IMP SPET can be used for both the early diagnosis of borderline chronic hydrocephalus after SAH and the prediction of shunt effectiveness. (orig.)

  11. Serum concentration of adhesion molecules in patients with delayed ischaemic neurological deficit after aneurysmal subarachnoid haemorrhage: the immunoglobulin and selectin superfamilies

    Science.gov (United States)

    Nissen, J; Mantle, D; Gregson, B; Mendelow, A

    2001-01-01

    OBJECTIVES—Adhesion molecules are involved in the pathogenesis of cerebral ischaemia and may play a part in the pathophysiology of delayed ischaemic neurological deficit (DIND) after aneurysmal subarachnoid haemorrhage. It was hypothesised that after aneurysmal subarachnoid haemorrhage, adhesion molecules may play a part in the pathophysiology of DIND as reflected by significantly altered serum concentrations in patients with and without DIND.
METHODS—In a prospective study, mean serum concentrations of ICAM-1, VCAM-1, PECAM, and E, P, and L-selectin were compared between patients without (n=23) and with (n=13) DIND in patients with World Federation of Neurological Surgeons (WFNS) grades 1 or 2subarachnoid haemorrhage. Serum was sampled from patients within 2 days of haemorrhage and on alternate days until discharge. Concentrations of adhesion molecules were measured by standard procedures using commercially available enzyme linked immunoabsorbent assays.
RESULTS—There were non-significant differences in serum concentrations of ICAM-1 (290.8 ng/ml v 238.4 ng/ml, p=0.0525), VCAM-1 (553.2ng/ml v 425.8 ng/ml, p=0.053), and PECAM (22.0 ng/ml v 21.0 ng/ml, p=0.56) between patients without and with DIND respectively. The E-selectin concentration between the two patient groups (44.0ng/ml v 37.4 ng/ml, p=0.33) was similar. The P-selectin concentration, however, was significantly higher in patients with DIND compared with those patients without DIND (149.5 ng/ml v 112.9 ng/ml, p=0.039). By contrast, serum L-selectin concentrations were significantly lower in patients with DIND (633.8 ng/ml v 897.9 ng/ml, p=0.013).
CONCLUSIONS—Of all the adhesion molecules examined in this study, P and L-selectin are involved in the pathophysiology of DIND after aneurysmal subarachnoid haemorrhage.

 PMID:11511705

  12. [Subarachnoid hemorrhage without aneurysm].

    Science.gov (United States)

    Müller-Forell, W; Welschehold, S; Köhler, J; Schicketanz, K H

    2002-11-01

    The rupture and bleeding of intracranial aneurysms is the most common cause of a spontaneous, non-traumatic subarachnoid hemorrhage (SAH). In up to 20% of these patients, no aneurysm is found, but the prognosis of these patients is known to be better than in those with aneurysms. The retrospective evaluation of the initial CT- and angiographic findings of 773 patients with spontaneous SAH, who underwent (up to three) 4-vessel DSA, brought a percentage of 12.4% with negative angiography. We found the favourable prognosis of these patients with negative angiography not only to be dependent from the distribution of the hemorrhage, with preference to perimesencephalic pattern, but the initial clinical state. 85% of our patients, who presented with perimesencephalic blood pattern and even 80% of those patients with additional intraventricular hemorrhage but the good clinical condition of Hunt-Hess I/II were discharged without neurological deficits. We recommend the obligatory 4-vessel catheter-angiography (DSA) in all patients with spontaneous SAH, independent of the blood pattern on initial CT, and one control in the presence of other than perimesencephalic subarachnoid hemorrhage, CTA might be reserved for additional controls. PMID:12458439

  13. Potentials of magnesium treatment in subarachnoid haemorrhage

    NARCIS (Netherlands)

    van den Bergh, W M; Dijkhuizen, R M; Rinkel, G J E

    2004-01-01

    Subarachnoid hemorrhage from a ruptured aneurysm is a subset of stroke. The young age (median 55 years) and poor outcome (50% of patients die; 30% of survivors remain dependent) explain why in the population the loss of productive life years from aneurysmal subarachnoid hemorrhage (SAH) is as large

  14. The need for repeat angiography in subarachnoid haemorrhage

    International Nuclear Information System (INIS)

    This study was designed to assess the necessity for a second angiogram study in patients in whom initial angiography after primary subarachnoid haemorrhage (SAH) was negative. During a 12-year period, 122 of 694 patients (17.5 %) had negative initial angiograms. CT, available for 98 patients, showed a preponderance of subarachnoid blood in the perimesencephalic cisterns in 50 of 73 patients (68.5 %) in whom blood was visible on CT. Angiography, repeated in 67 patients, revealed an aneurysm in 4 (6 %): 2 had an aneurysm of the anterior communicating artery, 1 of the posterior inferior cerebellar artery, and 1 of the P2 segment of the posterior cerebral artery. CT showed subarachnoid blood in the interpeduncular and ambient cisterns in this last case, and a preponderance of subarachnoid blood outside the perimesencephalic cisterns in the remaining 3 patients. (orig.)

  15. The need for repeat angiography in subarachnoid haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Urbach, H.; Solymosi, L. [Department of Neuroradiology, University of Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn (Germany); Zentner, J. [Department of Neurosurgery, University of Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn (Germany)

    1998-01-01

    This study was designed to assess the necessity for a second angiogram study in patients in whom initial angiography after primary subarachnoid haemorrhage (SAH) was negative. During a 12-year period, 122 of 694 patients (17.5 %) had negative initial angiograms. CT, available for 98 patients, showed a preponderance of subarachnoid blood in the perimesencephalic cisterns in 50 of 73 patients (68.5 %) in whom blood was visible on CT. Angiography, repeated in 67 patients, revealed an aneurysm in 4 (6 %): 2 had an aneurysm of the anterior communicating artery, 1 of the posterior inferior cerebellar artery, and 1 of the P2 segment of the posterior cerebral artery. CT showed subarachnoid blood in the interpeduncular and ambient cisterns in this last case, and a preponderance of subarachnoid blood outside the perimesencephalic cisterns in the remaining 3 patients. (orig.) With 2 figs., 1 tab., 32 refs.

  16. Clinical Practice Guidelines for Subarachnoid Haemorrhage Treatment

    OpenAIRE

    José Ramón Tejera del Valle; Danny Barrueta Reyes; Joaquín Aguilar Trujillo; José Gómez Cruz; Líder Tejera Sánchez

    2009-01-01

    Clinical Practice Guidelines for Subarachnoid Haemorrhage Treatment. The concept, diagnosis, classification and treatment are reviewed in its different stages, including aspects of the neurosurgical treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  17. Vasopressin in plasma and CSF of patients with subarachnoid haemorrhage.

    OpenAIRE

    Mather, H. M.; Ang, V; Jenkins, J. S.

    1981-01-01

    Arginine vasopressin was measured in the blood and cerebrospinal fluid (CSF) of 42 patients with subarachnoid haemorrhage. Increased concentrations of vasopressin were present in 10 patients, of whom eight had bled from an anterior communicating artery aneurysm. In three patients high blood vasopressin values were associated with gross hyponatraemia. Five patients were found to have increased CSF vasopressin concentrations in the presence of normal plasma values and in all of these the level ...

  18. [Treatment of aneurysmal subarachnoid hemorrhage].

    Science.gov (United States)

    Proust, François; Douvrin, Françoise; Gilles-Baray, Marie; Levêque, Sophie

    2007-01-01

    The incidence of subarachnoid hemorrhages is about 10.5/100,000 persons/year. Early obliteration of the aneurysmal sac is necessary to avoid rebleeding. The neurovascular staff meeting must decide the appropriate obliteration procedure for each patient. Intraoperative morbidity is 8% after endovascular coiling and 10% after microsurgical clipping. Endovascular coiling leads to complete obliteration of the aneurysm in 60% of patients and microsurgical clipping in 95%. Delayed ischemic deficits may be prevented by volemic expansion and calcium channel blockers. Hospitalization and general prophylaxis against deep venous thrombosis, pain and seizures are essential. Curative treatment is required against common complications such as intraparenchymatous hematoma, hydrocephalus, and delayed ischemic deficit. PMID:17296483

  19. Acute subarachnoid haemorrhage: Is a negative CT angiogram enough?

    International Nuclear Information System (INIS)

    Aim: To determine the negative predictive value of 16 channel multisection computed tomography angiography (CTA) for detecting aneurysms in spontaneous subarachnoid haemorrhage (SAH), using digital subtraction angiography (DSA) as the reference standard. Materials and methods: The prospectively collected cerebral angiogram database of Department of Neuroradiology, Atkinson Morley Regional Neuroscience Centre was used to identify 200 consecutive patients who had undergone DSA for SAH. Of these, 176 had undergone CTA prior to DSA. Clinical details and radiology reports were correlated and images of positive investigations reviewed. Results: DSA showed one or more cerebral aneurysms in 105 (60%) patients. These were correctly reported on CTA in 100. CTA was reported negative for aneurysms in 74 patients. Of these five were false negative and had aneurysms detected on DSA. In the CTA/DSA negative group, 11 (16%) patients had classical perimesencephalic clinical syndrome and blood distribution. There were two false positives at CTA. For ruptured cerebral aneurysms, CTA had 95.2% sensitivity, 97.2% specificity, 98.1% positive predictive value, and 93.2% negative predictive value. Conclusion: The sensitivity and negative predictive value of CTA for ruptured aneurysms remains imperfect. Continued use of DSA is recommended in most patients with a negative CTA after acute SAH. Confirmation of a negative CTA result with DSA may not be routinely required in patients with perimesencephalic syndrome

  20. Temporary alopecia after subarachnoid haemorrhage.

    Science.gov (United States)

    Nannapaneni, R; Behari, S; Mendelow, D; Gholkar, A

    2007-02-01

    Primary endovascular intervention is increasingly the first choice of treatment for cerebral aneurysms, particularly for those with complex anatomy in the posterior circulation. However, their clinical management and follow-up continue to be predominantly in the hands of neurosurgeons. In this report, the development of alopecia following the coiling of posterior circulation aneurysms is described. The alopecia was transient and lasted for approximately 6 months, and occurred in the occipital and suboccipital regions of the scalp. This report aims to highlight this condition, which has not been previously reported in the neurosurgical literature. The potential hazards of irradiation should be borne in mind while carrying out complex endovascular procedures. The patient should be counselled and all necessary steps undertaken to limit radiation exposure. PMID:17107802

  1. Diffuse, non-traumatic, non-aneurysmal subarachnoid haemorrhage during bevacizumab treatment of high grade glioma: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Arosha S. Dissanayake, MBBS

    2015-06-01

    Full Text Available Background: Bevacizumab is a monoclonal antibody against vascular endothelial growth factor approved by the United States Food and Drug Administration for the treatment of various cancers including refractory high grade glioma. There are case reports of subarachnoid haemorrhage (SAH during bevacizumab treatment though the causative role of the drug in these cases has been obscured by the presence of alternative aetiologies or incomplete investigation. Furthermore, there is no consensus regarding the risk of Central Nervous System (CNS haemorrhage during bevacizumab treatment due to limited available study data. Case Description: A 53 year old female with recurrent gliosarcoma refractory to standard, temozolamide based chemo-radiotherapy presented to our facility in a post-ictal state 16 days after her second dose of intravenous bevacizumab. A Fisher grade III SAH was found on computerised tomography scanning with no causative vascular lesion found on two subsequent digital subtraction angiograms separated by a 10 day period and a Magnetic Resonance Imaging (MRI scan 20 days post-bleed. Given the resolution of symptoms over an uncomplicated 13 day admission, she was discharged home with bevacizumab ceased prior to her scheduled third dose. Conclusion: We discuss here a case of diffuse, non-traumatic SAH during bevacizumab treatment of recurrent gliosarcoma in which alternative aetiologies of haemorrhage were excluded, to our knowledge the first such case in the English language literature. This adverse event is compatible with the known molecular mechanisms of bevacizumab and clinicians should be cognisant of the potential risk of CNS haemorrhage until larger studies are available to quantify this risk.

  2. Late cerebral ischaemia after subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Edvinsson, L; Povlsen, G K

    2011-01-01

    Late cerebral ischaemia after subarachnoid haemorrhage (SAH) carries high morbidity and mortality because of reduced cerebral blood flow (CBF) and subsequent cerebral ischaemia. This is associated with upregulation of contractile receptors in cerebral artery smooth muscles via the activation of...... intracellular signalling. In addition, delayed cerebral ischaemia after SAH is associated with inflammation and disruption of the blood-brain barrier (BBB). This article reviews recent evidence concerning the roles of vasoconstrictor receptor upregulation, inflammation and BBB breakdown in delayed cerebral...... ischaemia after SAH. In addition, recent studies investigating the role of various intracellular signalling pathways in these processes and the possibilities of targeting signalling components in SAH treatment are discussed. Studies using a rat SAH model have demonstrated that cerebral arteries increase...

  3. Timing of Surgery for Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Enayatollah Abbas Nejad

    2012-05-01

    Full Text Available Despite the many studies about timing for surgery in subarachnoid hemorrhage (SAH, the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4% in early period after SAH (first 4 days and in 20 cases (28.6% in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54±13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2% of patients had clinical grade I or II. 92.9% of aneurysms were single. Hypertension was the most common associated disease (34.3%. The most common site of aneurysms was anterior communicating artery (41.4%, followed by middle cerebral artery (35.7%. The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46±9.36 vs. 22.5±7.97 days; P=0.01. The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm.

  4. C-arm flat detector computed tomography parenchymal blood volume imaging: the nature of parenchymal blood volume parameter and the feasibility of parenchymal blood volume imaging in aneurysmal subarachnoid haemorrhage patients

    Energy Technology Data Exchange (ETDEWEB)

    Kamran, Mudassar; Byrne, James V. [University of Oxford, Nuffield Department of Surgical Sciences, Oxford (United Kingdom)

    2015-09-15

    C-arm flat detector computed tomography (FDCT) parenchymal blood volume (PBV) measurements allow assessment of cerebral haemodynamics in the neurointerventional suite. This paper explores the feasibility of C-arm computed tomography (CT) PBV imaging and the relationship between the C-arm CT PBV and the MR-PWI-derived cerebral blood volume (CBV) and cerebral blood flow (CBF) parameters in aneurysmal subarachnoid haemorrhage (SAH) patients developing delayed cerebral ischemia (DCI). Twenty-six patients with DCI following aneurysmal SAH underwent a research C-arm CT PBV scan using a biplane angiography system and contemporaneous MR-PWI scan as part of a prospective study. Quantitative whole-brain atlas-based volume-of-interest analysis in conjunction with Pearson correlation and Bland-Altman tests was performed to explore the agreement between C-arm CT PBV and MR-derived CBV and CBF measurements. All patients received medical management, while eight patients (31 %) underwent selective intra-arterial chemical angioplasty. Colour-coded C-arm CT PBV maps were 91 % sensitive and 100 % specific in detecting the perfusion abnormalities. C-arm CT rPBV demonstrated good agreement and strong correlation with both MR-rCBV and MR-rCBF measurements; the agreement and correlation were stronger for MR-rCBF relative to MR-rCBV and improved for C-arm CT PBV versus the geometric mean of MR-rCBV and MR-rCBF. Analysis of weighted means showed that the C-arm CT PBV has a preferential blood flow weighting (∼60 % blood flow and ∼40 % blood volume weighting). C-arm CT PBV imaging is feasible in DCI following aneurysmal SAH. PBV is a composite perfusion parameter incorporating both blood flow and blood volume weightings. That PBV has preferential (∼60 %) blood flow weighting is an important finding, which is of clinical significance when interpreting the C-arm CT PBV maps, particularly in the setting of acute brain ischemia. (orig.)

  5. Rebleeding After Aneurysmal Subarachnoid Hemorrhage

    DEFF Research Database (Denmark)

    Larsen, Carl Christian; Astrup, Jens

    2013-01-01

    OBJECTIVE: To summarize the current knowledge of the mechanisms leading to rebleeding and the prevention of rebleeding after subarachnoid hemorrhage (SAH). METHODS: A literature search was performed to investigate factors associated with rebleeding after SAH. RESULTS: The review of the literature...

  6. Subarachnoid hemorrhage with blister aneurysms: Endovascular management

    Directory of Open Access Journals (Sweden)

    Swati Dayanand Chinchure

    2014-01-01

    Full Text Available Blister aneurysms of are rare lesions representing a real challenge for diagnosis and management. They typically show small size, hemispherical shape, fragile wall, broad neck, and are arising from non-branching sites of intracranial arteries. Materials and Methods: We retrospectively reviewed all aneurysms treated at our institution. Seventeen patients (6 male, 11 female with 17 blister aneurysms were identified (mean age 53.3, range 41-63 years. Clinical, procedural, angiographic data as well as follow up data were evaluated. Results: All patients presented with aneurysmal subarachnoid hemorrhage. Majority of the blister aneurysms were located in ICA while 1 was located at posterior cerebral artery, 1 at vertebral and 1 involving basilar artery. All patients were treated using single or overlapping stents and if possible additional coiling. There was no intra-operative rupture. Good outcome (mrs 0-2 was seen in 14 patients. Poor clinical outcome (mrs 3-5 was seen in 2 patients due to vasospasm induced ischemic deficits at discharge, both of them improved on follow up (mrs 1 on follow up. There were 3 mortalities, One patient died of rebleeding while other 2 died due to SAH induced complications. Follow-up angiography was available in 16 patients (one patient died before follow up angiogram and revealed complete or near complete aneurysm occlusion in 11, incomplete obliteration in 1 and no change in 2 cases. Two cases showed post-treatment angiographic aneurysm recurrence. Both cases were managed with repeat coiling and overlapping stent placement. Conclusion: Endovascular management using single/overlapping stent and if possible coil placement is technically safe and feasible in blister aneurysms. Overlapping stents lead to better aneurysm occlusion than a single stent. Blister aneurysm in dorso-medial ICA showed higher tendency of continued growth/recurrence, higher incidence of clinical vasospasm and in these cases early angiographic follow

  7. Continuous EEG Monitoring in Aneurysmal Subarachnoid Hemorrhage

    DEFF Research Database (Denmark)

    Kondziella, Daniel; Friberg, Christian Kærsmose; Wellwood, Ian;

    2015-01-01

    BACKGROUND: Continuous EEG (cEEG) may allow monitoring of patients with aneurysmal subarachnoid hemorrhage (SAH) for delayed cerebral ischemia (DCI) and seizures, including non-convulsive seizures (NCSz), and non-convulsive status epilepticus (NCSE). We aimed to evaluate: (a) the diagnostic...... accuracy of cEEG as a confirmatory test, (b) the prognostic value of EEG patterns suggestive of seizures and DCI, and (c) the effectiveness of intensified neuromonitoring using cEEG in terms of improved clinical outcome following SAH. METHODS: A systematic review was performed with eligible studies...... selected from multiple indexing databases through June 2014. The methodological quality of these studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. RESULTS: Eighteen studies were identified, including cEEG data from 481 patients with aneurysmal SAH. NCSz were diagnosed in 7...

  8. Transcranial Doppler velocimetry in aneurysmal subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Staalsø, J M; Edsen, T; Romner, B;

    2013-01-01

    .02, logistic regression). CONCLUSIONS: /st>TCCD measurement variability is wider in patient measurements than in controls. This discrepancy can largely be explained by a higher degree of error in patients with angiographic vasospasm. Despite the considerable measurement variability in TCCD, values...

  9. Aneurysmal Subarachnoid Hemorrhage and Neuroinflammation: A Comprehensive Review

    Science.gov (United States)

    Lucke-Wold, Brandon P.; Logsdon, Aric F.; Manoranjan, Branavan; Turner, Ryan C.; McConnell, Evan; Vates, George Edward; Huber, Jason D.; Rosen, Charles L.; Simard, J. Marc

    2016-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) can lead to devastating outcomes including vasospasm, cognitive decline, and even death. Currently, treatment options are limited for this potentially life threatening injury. Recent evidence suggests that neuroinflammation plays a critical role in injury expansion and brain damage. Red blood cell breakdown products can lead to the release of inflammatory cytokines that trigger vasospasm and tissue injury. Preclinical models have been used successfully to improve understanding about neuroinflammation following aneurysmal rupture. The focus of this review is to provide an overview of how neuroinflammation relates to secondary outcomes such as vasospasm after aneurysmal rupture and to critically discuss pharmaceutical agents that warrant further investigation for the treatment of subarachnoid hemorrhage. We provide a concise overview of the neuroinflammatory pathways that are upregulated following aneurysmal rupture and how these pathways correlate to long-term outcomes. Treatment of aneurysm rupture is limited and few pharmaceutical drugs are available. Through improved understanding of biochemical mechanisms of injury, novel treatment solutions are being developed that target neuroinflammation. In the final sections of this review, we highlight a few of these novel treatment approaches and emphasize why targeting neuroinflammation following aneurysmal subarachnoid hemorrhage may improve patient care. We encourage ongoing research into the pathophysiology of aneurysmal subarachnoid hemorrhage, especially in regards to neuroinflammatory cascades and the translation to randomized clinical trials. PMID:27049383

  10. Xanthochromia revisited: a re-evaluation of lumbar puncture and CT scanning in the diagnosis of subarachnoid haemorrhage.

    OpenAIRE

    MacDonald, A; Mendelow, A D

    1988-01-01

    The CT and cerebrospinal fluid (CSF) findings of 100 patients with ruptured intracranial aneurysms were reviewed. Forty six percent of the 68 patients who had a lumbar puncture had blood stained CSF but with no xanthochromia. There was no blood visible on the CT scan in 20 patients: seven of these 20 had blood in their CSF, but no xanthochromia. It is concluded that it is blood stained CSF that is important in the diagnosis of subarachnoid haemorrhage (SAH), and not xanthochromia, and that a ...

  11. Postinterventional subarachnoid haemorrhage after endovascular stroke treatment with stent retrievers

    International Nuclear Information System (INIS)

    The purpose of this paper is to investigate the clinical significance of postinterventional subarachnoid hyperdensities (PSH) after endovascular mechanical thrombectomy in acute ischemic stroke. We analysed clinical and radiological data of 113 consecutive patients who received postinterventional CT scans within 4.5 h after mechanical thrombectomy. PSH was present in 27 of 113 patients (24 %). Extravasation of contrast agent was observed during intervention in only 6 of 27 cases (22 %). There was consecutive haemorrhagic transformation in four patients with PSH (p = 0.209, Fisher's exact test). Preinterventional predictors for the occurrence of PSH in our series were a long interval between clinical onset and recanalization (p = 0.028), a long procedure time (p = 0.010), and a high number of recanalization attempts (p = 0.001). PSH had no significant impact on clinical outcome (modified Rankin Scale) at discharge (p = 0.419) or at 3 months (p = 0.396). There were no significant correlations between PSH and thrombectomy devices (Solitaire: p = 0.433, Trevo Pro: p = 0.124). PSH after endovascular mechanical thrombectomy in acute ischemic stroke are likely to occur in complicated cases in which more than one revascularisation attempt is performed. PSH per se do not appear to be associated with an impaired clinical outcome or an elevated risk for consecutive haemorrhage. (orig.)

  12. Postinterventional subarachnoid haemorrhage after endovascular stroke treatment with stent retrievers

    Energy Technology Data Exchange (ETDEWEB)

    Nikoubashman, Omid [Uniklinik Aachen, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany); Institute for Neuroscience and Medicine 4, Juelich (Germany); Reich, Arno; Jungbluth, Michael [Uniklinik Aachen, Klinik fuer Neurologie, Aachen (Germany); Pjontek, Rastislav; Wiesmann, Martin [Uniklinik Aachen, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany)

    2014-12-15

    The purpose of this paper is to investigate the clinical significance of postinterventional subarachnoid hyperdensities (PSH) after endovascular mechanical thrombectomy in acute ischemic stroke. We analysed clinical and radiological data of 113 consecutive patients who received postinterventional CT scans within 4.5 h after mechanical thrombectomy. PSH was present in 27 of 113 patients (24 %). Extravasation of contrast agent was observed during intervention in only 6 of 27 cases (22 %). There was consecutive haemorrhagic transformation in four patients with PSH (p = 0.209, Fisher's exact test). Preinterventional predictors for the occurrence of PSH in our series were a long interval between clinical onset and recanalization (p = 0.028), a long procedure time (p = 0.010), and a high number of recanalization attempts (p = 0.001). PSH had no significant impact on clinical outcome (modified Rankin Scale) at discharge (p = 0.419) or at 3 months (p = 0.396). There were no significant correlations between PSH and thrombectomy devices (Solitaire: p = 0.433, Trevo Pro: p = 0.124). PSH after endovascular mechanical thrombectomy in acute ischemic stroke are likely to occur in complicated cases in which more than one revascularisation attempt is performed. PSH per se do not appear to be associated with an impaired clinical outcome or an elevated risk for consecutive haemorrhage. (orig.)

  13. Fahr′s disease Presenting with Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Hosam Al-Jehani

    2012-01-01

    Full Text Available Fahr′s disease is a rare disorder of slowly progressive cognitive, psychiatric, and motor decline associated with idiopathic basal ganglia calcification (IBGC and widespread calcification in the brain and cerebellum. Acute presentation of IBGC is most often as a seizure disorder; however, we present a case of an acute IBCG presentation in which the cause of the deterioration was an aneurysmal subarachnoid hemorrhage.

  14. Non-traumatic cortical subarachnoid haemorrhage: diagnostic work-up and aetiological background

    International Nuclear Information System (INIS)

    Only 15% of all subarachnoid haemorrhages (SAHs) are not of aneurysmal origin. Among those, circumscribed SAHs along the cortical convexity are rare and have only been described in singular case reports so far. Here, we present a collection of 12 cases of SAH along the convexity, of non-traumatic origin. Over a period of 10 years, 12 cases of circumscribed SAH along the convexity were identified at our clinic. The clinical presentations, neuroradiological SAH characteristics, further diagnostic work-up to identify the underlying aetiologies, the therapy and clinical outcome were analysed. The patients' chief complaints were unspecific cephalgia, focal or generalised seizures and focal neurological deficits. Typical signs of basal SAH, such as nuchal rigidity, thunderclap-headache or alteration of consciousness, were rare. Magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) revealed different aetiologies, namely postpartal posterior encephalopathy (three), cerebral vasculitis (two), dural sinus thrombosis (two), cortical venous thrombosis (one), intracerebral abscesses (one) and cerebral cavernoma (one). Two cases remained unresolved. Treatment of the underlying disease and symptomatic medication led to good clinical outcome in almost all cases. On the basis of these findings, we demonstrate that the clinical presentation, localisation and aetiology of cortical SAH differ clearly from other SAHs. A diagnostic work-up with MRI and eventually DSA is essential. Mostly, the causative disease can be identified, and specific treatment allows a favourable outcome. (orig.)

  15. N-Butyl 2-Cyanoacrylate Embolization of Spinal Dural Arteriovenous Fistula: Presenting with Subarachnoid Haemorrhage

    OpenAIRE

    Kwon, B.J.; Kim, T.-K.; Seo, S.I.; Kyung, J.B.; Seol, H.Y.; Han, M.H.

    2005-01-01

    We report an unusual case of spinal dural arteriovenous fistula (SDAVF) presenting with subarachnoid haemorrhage (SAH). Cure was achieved with endovascular treatment with n-butyl 2-cyanoacrylate (NBCA). A review of the literature revealed five cases of cervical SDAVF that presented with SAH. None of these cases were treated with NBCA.

  16. The effects of continuous prostacyclin infusion on regional blood flow and cerebral vasospasm following subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Rasmussen, Rune; Wetterslev, Jørn; Stavngaard, Trine;

    2012-01-01

    One of the main causes of mortality and morbidity following subarachnoid haemorrhage (SAH) is the development of cerebral vasospasm, a frequent complication arising in the weeks after the initial bleeding. Despite extensive research, to date no effective treatment of vasospasm exists. Prostacycli...

  17. Matrix Metalloproteinases in Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Vivek Mehta

    2013-01-01

    Full Text Available Delayed cerebral vasospasm is a significant cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH. While the cellular mechanisms underlying vasospasm remain unclear, it is believed that inflammation may play a critical role in vasospasm. Matrix metalloproteinasees (MMPs are a family of extracellular and membrane-bound proteases capable of degrading the blood-rain barrier (BBB. As such, MMP upregulation following SAH may result in a proinflammatory extravascular environment capable of inciting delayed cerebral vasospasm. This paper presents an overview of MMPs and describes existing data pertinent to delayed cerebral vasospasm.

  18. [A case of peduncular hallucination after aneurysmal subarachnoid hemorrhage].

    Science.gov (United States)

    Nakagawa, N; Akai, F; Niiyama, K; Asai, T; Tanada, M

    1999-01-01

    We reported a case of peduncular hallucination after aneurysmal subarachnoid hemorrhage (SAH). The patient underwent endovascular embolization of an intracranial aneurysm using the Guglielmi detachable coils (GDCs) 9 days after SAH. On the 11th day, she reported visual hallucination: a maggot was on the ceiling, or a soldier who wore green clothes was standing by a locker. The hallucination was vivid, well-formed and associated with insomnia, suggesting peduncular hallucination. A computed tomographic (CT) scan revealed small infarctions of right frontal lobe, which were not responsible for the visual hallucination. Hyperdynamic therapy relieved the visual hallucination 23 days after SAH. It was conceivable that vasospasm was the cause of the infarction and visual hallucination. Only 4 cases with peduncular hallucination after SAH were reported in conjunction with vasospasm. The symptom may be concealed by disturbance of consciousness. Visual hallucination should be considered as a sign of cerebral vasospasm, and an appropriate treatment should be done at right time. PMID:10065463

  19. Role of carotid body for neuronal protection in experimental subarachnoid haemorrhage

    Directory of Open Access Journals (Sweden)

    Mehmet Dumlu Aydın

    2013-01-01

    Full Text Available Objective: Carotid bodies are known as main arterialchemoregulatory units. Despite well known that carotidbodies have an important role in cerebral circulation andblood pH regulation, their roles has not been investigatedin subarachnoid haemorrhage. We investigated whetherthere is neuroprotective effect of neuron density of carotidbodies on the brain in subarachnoid haemorrhage.Methods: Twenty hybrid rabbits were studied. Four ofthem were used as reference group (n=4 and the remainingwas obliged to subarachnoid haemorrhage by injectingautologous blood into their cisterna magna (n=16and sacrificed after one month. All carotid bodies andbrains examined histopathologically using by stereologicmethods. The relationship between the neuronal densityof carotid body and degenerated neuron density of thehippocampus were compared statistically.Results: Five rabbits with subarachnoid haemorrhagedead during the follow-up time (n=5. The average neuronaldensity of carotid body was 4500±500 cells/mm3and of hippocampus 170.000±17.000 cell/mm3 in normalrabbit family. The degenerated neuron density ofthe hippocampus was 20.000±3.000 cells/mm3 in rabbitswith have high neuron density of carotid body and was65.000±8.000 cells/mm3 in rabbits with low neuron densityof carotid body. The differences between the neuronaldensity of carotid body and the degenerated neuron numbersof the hippocampus were significant.Conclusion: The neuron density of carotid body mayplay an important role on the protection of brain in subarachnoidhaemorrhage.Key words: Subarachnoid haemorrhage, carotid body,hippocampus, neurodegeneration, cerebral ischemia

  20. Early rebleeding in patients with subarachnoid haemorrhage under intensive blood pressure management.

    Science.gov (United States)

    Oheda, Motoki; Inamasu, Joji; Moriya, Shigeta; Kumai, Tadashi; Kawazoe, Yushi; Nakae, Shunsuke; Kato, Yoko; Hirose, Yuichi

    2015-08-01

    The objective of this study was to report the frequency and clinical characteristics of early rebleeding in subarachnoid haemorrhage (SAH) patients who underwent intensive blood pressure (BP) management. Patients with aneurysmal SAH frequently present to the emergency department (ED) with elevated BP. Intensive BP management has been recommended to lower the risk of early rebleeding. However, few studies have reported the frequency of early rebleeding in SAH patients undergoing BP management. In our institution, SAH patients with systolic BP (SBP)>140 mmHg received continuous intravenous nicardipine to maintain their SBP within 120±20 mmHg after diagnosis. An attempt to implement intensive BP management was made on 309 consecutive SAH patients who presented to our ED within 48 hours of SAH onset. Overall, 24 (7.8%) of the 309 patients sustained early rebleeding. Fifteen patients sustained early rebleeding before the implementation of BP management, and the other nine sustained early rebleeding after the implementation of BP management. Therefore, the frequency of early rebleeding under BP management was 3.1% (9/294). When the 309 patients were dichotomised using ED SBP of 140 mmHg as a cut off (SBP>140 mmHg; n=239 versus SBP⩽140 mmHg; n=70), the latter counter-intuitively exhibited a significantly higher frequency of early rebleeding (5.9% versus 14.2%; p=0.04). This relatively low frequency of early rebleeding under BP management may be acceptable. However, early rebleeding is not eradicated even with strict BP control as factors other than elevated BP are involved. ED SBP within the target range (SBP⩽140 mmHg) does not negate the risk of early rebleeding. Other treatment options that reduce the risk should also be explored. PMID:26077940

  1. Prevalence of superficial siderosis following singular, acute aneurysmal subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Lummel, N.; Bochmann, K. [Ludwig-Maximilian-University, Department of Neuroradiology, Klinikum Grosshadern, Munich (Germany); Bernau, C. [Leibniz-Rechenzentrum, Munich (Germany); Thon, N. [Ludwig-Maximilian-University, Department of Neurosurgery, Klinikum Grosshadern, Munich (Germany); Linn, J. [Technical University, Department of Neuroradiology, Klinikum Dresden, Dresden (Germany)

    2015-04-01

    Superficial siderosis is presumably a consequence of recurrent bleeding into the subarachnoid space. The objective of this study was to assess the prevalence of superficial siderosis after singular, aneurysmal subarachnoid hemorrhage (SAH) in the long term. We retrospectively identified all patients who presented with a singular, acute, aneurysmal SAH at our institution between 2010 and 2013 and in whom a magnetic resonance imaging (MRI) including T2*-weighted imaging was available at least 4 months after the acute bleeding event. MRI scans were judged concerning the presence and distribution of superficial siderosis. Influence of clinical data, Fisher grade, localization, and cause of SAH as well as the impact of neurosurgical interventions on the occurrence of superficial siderosis was tested. Seventy-two patients with a total of 117 MRIs were included. Mean delay between SAH and the last available MRI was 47.4 months (range 4-129). SAH was Fisher grade 1 in 2 cases, 2 in 4 cases, 3 in 10 cases, and 4 in 56 cases. Superficial siderosis was detected in 39 patients (54.2 %). In all patients with more than one MRI scan, localization and distribution of superficial siderosis did not change over time. Older age (p = 0.02) and higher degree of SAH (p = 0.03) were significantly associated with the development of superficial siderosis. Superficial siderosis develops in approximately half of patients after singular, aneurysmal SAH and might be more common in patients with an older age and a greater amount of blood. However, additional factors must play a role in whether a patient is prone to develop superficial siderosis or not. (orig.)

  2. A "novel" reading therapy programme for reading difficulties after a subarachnoid haemorrhage

    OpenAIRE

    Cocks, N.; M. Pritchard; Cornish, H.; Johnson, N; Cruice, M.

    2013-01-01

    Background: Although several treatments for acquired reading difficulties exist, few studies have explored the effectiveness of treatment for mild reading difficulties and treatment for reading difficulties associated with cognitive impairment. Aims: This study explored the effectiveness of an individual strategy-based reading treatment of 11 sessions given to a female participant (IW) who had mild reading difficulties following a subarachnoid haemorrhage (SAH). The impact of treatment on...

  3. Effect of Aneurysmal Subarachnoid Hemorrhage on Word Generation

    Directory of Open Access Journals (Sweden)

    Daniella Ladowski

    2014-01-01

    Full Text Available Background. Aneurysmal subarachnoid hemorrhage (aSAH survivors commonly exhibit impairment on phonemic and semantic fluency tests; however, it is unclear which of the contributing cognitive processes are compromised in aSAH patients. One method of disentangling these processes is to compare initial word production, which is a rapid, semiautomatic, frontal-executive process, and late phase word production, which is dependent on more effortful retrieval and lexical size and requires a more distributed neural network. Methods. Seventy-two individuals with aSAH and twenty-five control subjects were tested on a cognitive battery including the phonemic and semantic fluency task. Demographic and clinical information was also collected. Results. Compared to control subjects, patients with aSAH were treated by clipping and those with multiple aneurysms were impaired across the duration of the phonemic test. Among patients treated by coiling, those with anterior communicating artery aneurysms or a neurological complication (intraventricular hemorrhage, vasospasm, and edema showed worse output only in the last 45 seconds of the phonemic test. Patients performed comparably to control subjects on the semantic test. Conclusions. These results support a “diffuse damage” hypothesis of aSAH, indicated by late phase phonemic fluency impairment. Overall, the phonemic and semantic tests represent a viable, rapid clinical screening tool in the postoperative assessment of patients with aSAH.

  4. Subarachnoid hemorrhage from intracranial aneurysms during pregnancy and the puerperium.

    Science.gov (United States)

    Kataoka, Hiroharu; Miyoshi, Takekazu; Neki, Reiko; Yoshimatsu, Jun; Ishibashi-Ueda, Hatsue; Iihara, Koji

    2013-01-01

    Subarachnoid hemorrhage (SAH) due to the rupture of an intracranial aneurysm (IA) is a rare but serious complication of pregnancy and is responsible for important morbidity and mortality during pregnancy. This study reviewed reports of ruptured IA during pregnancy and the puerperium, and our own cases of ruptured IA in pregnant women. Hemorrhage occurred predominantly during the third trimester of pregnancy, when maternal cardiac output and blood volume increase and reach maximum. Physiological and hormonal changes in pregnancy are likely to affect the risk of IA rupture. Ruptured IAs during pregnancy should be managed based on neurosurgical considerations, and the obstetrical management of women with ruptured IAs should be decided according to the severity of SAH and the gestational age. Emergent cesarean section followed by clipping or coiling of aneurysms is indicated if the maternal condition and the gestational age allow such interventions. Although SAH during pregnancy can result in disastrous outcomes, the necessity of intracranial screening for high-risk pregnant women is still controversial. PMID:23979051

  5. Neuropsychological assessments in patients with aneurysmal subarachnoid hemorrhage, perimesencephalic SAH, and incidental aneurysms.

    Science.gov (United States)

    Krajewski, Kara; Dombek, Susanne; Martens, Tobias; Köppen, Johannes; Westphal, Manfred; Regelsberger, Jan

    2014-01-01

    Subarachnoid hemorrhage (SAH) is known to be associated with long-term cognitive deficits. Neurosurgical manipulation on the brain itself has been reported to have influence on neuropsychological sequelae. The following is a comparative study on perimesencephalic and aneurysmal subarachnoid hemorrhage patients as well as elective aneurysm patients that was carried out to determine the isolated and combined impact of surgical manipulation and hemorrhage, respectively, on long-term neuropsychological outcome. Inclusion criteria were good neurological recovery at discharge (modified Rankin Scale 0 or 1) without focal neurological deficit. Standardized psychological testing covered attention, memory, executive functions, and mood. Thirteen aneurysmal SAH patients, 15 patients undergoing elective clipping, and 14 patients with perimesencephalic SAH were analyzed. Standardized neuropsychological testing and social/professional history questionnaires were performed 2 years (mean) after discharge. Memory impairment and slower cognitive processing were found in the aneurysmal and perimesencephalic SAH groups, while elective aneurysm patients showed signs of impaired attention. However, compared with norm data for age-matched healthy controls, all groups showed no significant test results. In contrast, signs of clinical depression were seen in 9/42 patients, 45 % of all patients complained of stress disorders and 55 % of patients were unable to work in their previous professions. Nearly normal neuropsychological test results on long-term follow-up in SAH patients were unexpected. However, a 50 % rate of unemployment accompanied with stress disorders and depression manifests insufficient social and workplace reintegration. Therefore, even more specific rehabilitation programs are required following inpatient treatment to attain full recovery. PMID:23949148

  6. Subarachnoid hemorrhage without aneurysm; Die Subarachnoidalblutung ohne Aneurysmanachweis

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Forell, W. [Institut fuer Neuroradiologie des Universitaetsklinikums Mainz (Germany); Welschehold, S. [Klinik und Poliklinik fuer Neurochirurgie des Universitaetsklinikums Mainz (Germany); Koehler, J. [Klinik und Poliklinik fuer Neurologie des Universitaetsklinikums Mainz (Germany); Schicketanz, K.H. [Institut fuer Medizinische Biometrie, Epidemiologie und Informatik des Universitaetsklinikums Mainz (Germany)

    2002-11-01

    The rupture and bleeding of intracranial aneurysms is the most common cause of a spontaneous, non-traumatic subarachnoid hemorrhage (SAH). In up to 20% of these patients, no aneurysm is found, but the prognosis of these patients is known to be better than in those with aneurysms. The retrospective evaluation of the initial CT- and angiographic findings of 773 patients with spontaneous SAH, who underwent (up to three) 4-vessel DSA, brought a percentage of 12.4% with negative angiography. We found the favourable prognosis of these patients with negative angiography not only to be dependant from the distribution of the hemorrhage, with preference to perimesencephalic pattern, but the initial clinical state. 85% of our patients, who presented with perimesencephalic blood pattern and even 80% of those patients with additional intraventricular hemorrhage but the good clinical condition of Hunt-Hess I/II were discharged without neurological deficits. We recommend the obligatory 4-vessel catheter-angiography (DSA) in all patients with spontaneous SAH, independent of the blood pattern on initial CT, and one control in the presence of other than perimesencephalic subarachnoid hemorrhage, CTA might be reserved for additional controls. (orig.) [German] Die Aneurysmablutung stellt die haeufigste Ursache einer spontanen, nichttraumatischen Subarachnoidalblutung (SAB) dar, bei einem Teil dieser Patienten kann jedoch kein Aneurysma nachgewiesen werden. Die Prognose dieser Patienten ist, im Vergleich zu denen mit positivem Aneurysmabefund, deutlich guenstiger. Die retrospektive Evaluation der initialen CT- und Angiographiebefunde sowie des klinischen Verlaufs von 773 Patienten, die innerhalb der letzten 11 Jahre nach einer spontanen SAB einer 4-Gefaessangiographie (DSA) unterzogen worden waren, ergab in unserem Krankengut einen Prozentsatz von 12,4% mit endgueltig fehlendem Aneurysmanachweis, wobei bis zu 3 Kontrollangiographien durchgefuehrt worden waren. Der positive Verlauf des

  7. Effect of antiplatelet therapy for endovascular coiling in aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    van den Bergh, Walter M; Kerr, Richard S C; Algra, Ale; Rinkel, Gabriel J E; Molyneux, Andrew J

    2009-01-01

    BACKGROUND AND PURPOSE: Antiplatelets are frequently used during or after endovascular coiling of aneurysm in patients with subarachnoid hemorrhage (SAH). This strategy is based on uncontrolled case series including also patients with unruptured aneurysms or other lesions. We collected data on effec

  8. Hyponatremia after aneurysmal subarachnoid hemorrhage: Implications and outcomes

    Directory of Open Access Journals (Sweden)

    P P Saramma

    2013-01-01

    Full Text Available Background : Hyponatremia is the most common electrolyte abnormality seen in patients with aneurysmal SAH. Clinically significant hyponatremia (Serum Sodium <131 mEq/L which needs treatment, has been redefined recently and there is a paucity of outcome studies based on this. This study aims to identify the mean Serum Sodium (S.Na+ level and its duration among inpatients with SAH and to identify the relationship between hyponatremia and the outcome status of patients undergoing surgery for SAH. Materials and Methods : This outcome study is undertaken in the department of neurosurgery, The Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. Medical records of all patients with SAH from 1 st January to 31 st July 2010 were reviewed. Preoperative status was assessed using World Federation of Neurosurgical Societies (WFNS grading system. Discharge status was calculated using the Glasgow outcome score scale. Results : Fifty nine patients were included in the study and 53 (89.8% of them have undergone surgical treatment. Hyponatremia was observed in 22 of 59 patients (37%. The mean Sodium level of hyponatremic patients was 126.97 mEq/L for a median duration of two days. Glasgow outcome score was good in 89.8% of patients. We lost two patients, one of whom had hyponatremia and vasospasm. Conclusion : Hyponatremia is significantly associated with poor outcome in patients with SAH. Anticipate hyponatremia in patients with aneurysmal subarachnoid hemorrhage, timely detect and appropriately treat it to improve outcome. It is more common in patients who are more than 50 years old and whose aneurysm is in the anterior communicating artery. Our comprehensive monitoring ensured early detection and efficient surgical and nursing management reduced morbidity and mortality.

  9. Intracranial aneurysms and subarachnoid hemorrhage: Clinical studies on diagnosis and treatment

    OpenAIRE

    van der Jagt, Mathieu

    2006-01-01

    textabstractComputerized tomography angiography (CTA) can be performed quicker, safer and cheaper than digital subtraction angiography (DSA) in patients after aneurysmal subarachnoid hemorrhage (SAH). However, DSA is still regarded as the gold standard in the diagnosis of intracranial ruptured aneurysms. No studies have specifically addressed the value of CTA in planning of endovascular treatment of ruptured aneurysms. Mathieu van der Jagt investigates the diagnostic value of CTA for endovasc...

  10. Subarachnoid Hemorrhage from Posterior Cerebral Artery Aneurysm during Puerperium – Case Report and Review of Literature

    OpenAIRE

    Schebesch, Karl-Michael; Schödel, Petra; Rennert, Janine; Mark, Karl-Heinz; Brawanski, Alexander

    2012-01-01

    Subarachnoid hemorrhages (SAH) due to true aneurysms of the Posterior Cerebral Artery (PCA) during puerperium in young and healthy females are extremely rare. We present the case of a 31-year old, healthy woman that experienced a spontaneous SAH due to a PCA aneurysm, arising from the P3 segment, 9 days post-delivery. The aneurysm was successfully treated via an endovascular approach and the patient recovered well. After 21 days she was discharged from hospital without neurological defici...

  11. Pituitary dysfunction following traumatic brain injury or subarachnoid haemorrhage - in "Endocrine Management in the Intensive Care Unit".

    LENUS (Irish Health Repository)

    Hannon, M J

    2012-02-01

    Traumatic brain injury and subarachnoid haemorrhage are important causes of morbidity and mortality in the developed world. There is a large body of evidence that demonstrates that both conditions may adversely affect pituitary function in both the acute and chronic phases of recovery. Diagnosis of hypopituitarism and accurate treatment of pituitary disorders offers the opportunity to improve mortality and outcome in both traumatic brain injury and subarachnoid haemorrhage. In this article, we will review the history and pathophysiology of pituitary function in the acute phase following traumatic brain injury and subarachnoid haemorrhage, and we will discuss in detail three key aspects of pituitary dysfunction which occur in the early course of TBI; acute cortisol deficiency, diabetes insipidus and SIAD.

  12. Intracranial angiolipoma as cause of subarachnoid haemorrhage. Case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Vilela, P.; Saraiva, P.; Goulao, A [Hospital Garcia de Orta, Servico de Neurorradiologia, Almada (Portugal)

    2005-02-01

    A 33-year-old female with a longstanding history of seizures was admitted to our hospital with subarachnoid haemorrhage (SAH). Computed tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) depicted a vascular fat-containing lesion overlying a right frontal cortical polymicrogyria. The diagnosis of angiolipoma was established. Conservatory management was undertaken with full recovery. She has been followed for 5 years since, with neither re-bleeding nor morphologic change of the lesion. This is a rare intracranial lesion, with only 11 intracranial angiolipomas published in the literature, and is the first case reported which is associated with SAH caused by this lesion. (orig.)

  13. A single subcutaneous bolus of erythropoietin normalizes cerebral blood flow autoregulation after subarachnoid haemorrhage in rats

    DEFF Research Database (Denmark)

    Springborg, Jacob Bertram; Ma, XiaoDong; Rochat, Per;

    2002-01-01

    Systemic administration of recombinant erythropoietin (EPO) has been demonstrated to mediate neuroprotection. This effect of EPO may in part rely on a beneficial effect on cerebrovascular dysfunction leading to ischaemic neuronal damage. We investigated the in vivo effects of subcutaneously...... administered recombinant EPO on impaired cerebral blood flow (CBF) autoregulation after experimental subarachnoid haemorrhage (SAH). Four groups of male Sprague-Dawley rats were studied: group A, sham operation plus vehicle; group B, sham operation plus EPO; group C, SAH plus vehicle; group D, SAH plus EPO...

  14. Systematic review of clinical prediction tools and prognostic factors in aneurysmal subarachnoid hemorrhage

    OpenAIRE

    Lo, Benjamin W. Y.; Hitoshi Fukuda; Yusuke Nishimura; Forough Farrokhyar; Lehana Thabane; Mitchell A. H. Levine

    2015-01-01

    Background: Clinical prediction tools assist in clinical outcome prediction. They quantify the relative contributions of certain variables and condense information that identifies important indicators or predictors to a targeted condition. This systematic review synthesizes and critically appraises the methodologic quality of studies that derive both clinical predictors and clinical predictor tools used to determine outcome prognosis in patients suffering from aneurysmal subarachnoid hemorrha...

  15. Intracranial aneurysms and subarachnoid hemorrhage: Clinical studies on diagnosis and treatment

    NARCIS (Netherlands)

    M. van der Jagt (Mathieu)

    2006-01-01

    textabstractComputerized tomography angiography (CTA) can be performed quicker, safer and cheaper than digital subtraction angiography (DSA) in patients after aneurysmal subarachnoid hemorrhage (SAH). However, DSA is still regarded as the gold standard in the diagnosis of intracranial ruptured aneur

  16. Nosocomial infections after aneurysmal subarachnoid hemorrhage : time course and causative pathogens

    NARCIS (Netherlands)

    Laban, Kamil G.; Rinkel, Gabriel J. E.; Vergouwen, Mervyn D. I.

    2015-01-01

    BackgroundNosocomial infections after aneurysmal subarachnoid hemorrhage (aSAH) are associated with prolonged length of stay and poor functional outcome. It remains unclear if infections result in prolonged length of stay or, vice versa, if prolonged length of stay results in more infections. Before

  17. Topiramate attenuates early brain injury following subarachnoid haemorrhage in rats via duplex protection against inflammation and neuronal cell death.

    Science.gov (United States)

    Tian, Yong; Guo, Song-Xue; Li, Jian-Ru; Du, Hang-Gen; Wang, Chao-Hui; Zhang, Jian-Min; Wu, Qun

    2015-10-01

    Early brain injury (EBI) following aneurysmal subarachnoid haemorrhage (SAH) insults contributes to the poor prognosis and high mortality observed in SAH patients. Topiramate (TPM) is a novel, broad-spectrum, antiepileptic drug with a reported protective effect against several brain injuries. The current study aimed to investigate the potential of TPM for neuroprotection against EBI after SAH and the possible dose-dependency of this effect. An endovascular perforation SAH model was established in rats, and TPM was administered by intraperitoneal injection after surgery at three different doses (20mg/kg, 40mg/kg, and 80mg/kg). The animals' neurological scores and brain water content were evaluated, and ELISA, Western blotting and immunostaining assays were conducted to assess the effect of TPM. The results revealed that TPM lowers the elevated levels of myeloperoxidase and proinflammatory mediators observed after SAH in a dose-related fashion, and the nuclear factor-kappa B (NF-κB) signalling pathway is the target of neuroinflammation regulation. In addition, TPM ameliorated SAH-induced cortical neuronal apoptosis by influencing Bax, Bcl-2 and cleaved caspase-3 protein expression, and the effect of TPM was enhanced in a dose-dependent manner. Various dosages of TPM also upregulated the protein expression of the γ-aminobutyric acid (GABA)-ergic signalling molecules, GABAA receptor (GABAAR) α1, GABAAR γ2, and K(+)-Cl(-) co-transporter 2 (KCC2) together and downregulated Na(+)-K(+)-Cl(-) co-transporter 1 (NKCC1) expression. Thus, TPM may be an effective neuroprotectant in EBI after SAH by regulating neuroinflammation and neuronal cell death. PMID:26086367

  18. Spontaneous resolution of an isolated cervical anterior spinal artery aneurysm after subarachnoid hemorrhage

    Science.gov (United States)

    Pahl, Felix Hendrik; de Oliveira, Matheus Fernandes; Rotta, Marcus Alexandre Cavalcanti; Dias, Guilherme Marcos Soares; Rezende, André Luiz; Rotta, José Marcus

    2014-01-01

    Background: Isolated cervical anterior spinal artery aneurysms are extremely rare. Subarachnoid hemorrhage (SAH) secondary to such lesions have been described only in six cases to the best of our knowledge. Case Description: We describe an unusual clinical picture of SAH due to rupture of anterior spinal artery aneurysm in a patient with previous normal angiogram. Due to the location of the aneurysm and clinical status of the patient, conservative management was proposed, and she was discharged to further follow-up. Monthly routine angiograms revealed resolution of the aneurysm 90 days after bleeding, which was highly suggestive of vascular dissection. Conclusion: We highlight the need to consider these aneurysms in the differential diagnosis of SAH, especially when occurring in the posterior fossa and when angiography findings are inconclusive. PMID:25317354

  19. Aneurysmal subarachnoid hemorrhage: outcome of aneurysm clipping versus coiling in anterior circulation aneurysm

    International Nuclear Information System (INIS)

    To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm. Study Design: Comparative study. Place and Duration of Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013. Methodology: Patients aged 14 - 60 years, with ruptured cerebral aneurysm of anterior circulation and World Federation of Neurosurgical Society (WFNS) grades 1, 2 and 3 were included. Patients more than 60 years, medically unfit patient and posterior circulation aneurysms and WFNS grades 4 and 5 were excluded. Aneurysm sac obliteration was done in randomized manner with microsurgical clipping or coiling. Postoperatively, the patients were assessed and followed-up upto one year for outcome parameters on the bases of WFNS grade and Modified Ranking Scale (mRS) as favourable (mRS =2 ) and unfavourable (mRS > 2). Results: Among 140 subjects selected for study, 70 were included in group A, i.e. coiling and other 70 were in group B, i.e. clipping. The median age of patients in group A was 52.5 ± 10 years and in group B was 51.00 ± years. Overall, 56 (40%) males, 28 (60%) males in each group; and 84 (60%) females, 42 (60%) in each group were included. The male to female ratio in this study was 1:1.5. In group A, i.e. coiling, 27 (38.6%) patients had no disability (grades 1 and 2), 25 (35.7%) were slightly disabled (grade 3) and 18 (25.7%) had moderate disability (grade 4); whereas in group B, i.e. clipping group 23 (32.9%) patients had no disability (grades 1 and 2), 23 (32.9%) were slightly disabled (grade 3) and 24 (34.3%) had moderate disability (grade 4). At one year follow-up, in group A, favourable outcome was achieved in 56 (80%) of patients compared to 48 (68.6%) in group B; whilst, 14 (20%) patients in group A and 22 (33.1%) in group B showed unfavourable outcome. Although mortality rate was higher in clipping (n=3, 4.3%) as compared to coiling (n=1, 1.4%), but was not statistically

  20. Daily life after Subarachnoid Haemorrhage : Identity construction, patients’ and relatives’ statements about patients’ memory, emotional status and activities of living

    OpenAIRE

    Berggren, Elisabeth

    2012-01-01

    The overall aim of this thesis was to describe patients’ experience and reconstruction regarding the onset of, and events surrounding being struck by a Subarachnoid Haemorrhage (SAH), and to describe patients’ and relatives’ views of patients’ memory ability, emotional status and activities of living, in a long-term perspective. Methods: Both inductive and deductive approaches were used. Nine open interviews were carried out in home settings, in average 1 year and 7 seven months after the pat...

  1. Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Chao Tang

    Full Text Available BACKGROUND: Rebleeding is a serious complication of aneurysmal subarachnoid hemorrhaging. To date, there are conflicting data regarding the factors contributing to rebleeding and their significance. METHODS: A systematic review of PubMed and Embase databases was conducted for studies pertaining to aneurysmal subarachnoid hemorrhage (aSAH and rebleeding in order to assess the associated risk factors. Odds ratios (ORs and corresponding 95% confidence intervals (CIs were estimated from fourteen studies comprised of a total of 5693 patients that met the inclusion criteria. RESULTS: Higher rebleeding rates were observed 10 mm in size (OR  = 1.70, 95% CI  = 1.35-2.14. CONCLUSIONS: Aneurysmal rebleeding occurs more frequently within the first 6 hours after the initial aSAH. Risk factors associated with rebleeding include high systolic pressure, the presence of an intracerebral or intraventricular hematoma, poor Hunt-Hess grade (III-IV, aneurysms in the posterior circulation, and an aneurysm >10 mm in size.

  2. Mitral endocarditis due to Rothia aeria with cerebral haemorrhage and femoral mycotic aneurysms, first French description.

    Science.gov (United States)

    Collarino, R; Vergeylen, U; Emeraud, C; Latournèrie, G; Grall, N; Mammeri, H; Messika-Zeitoun, D; Vallois, D; Yazdanpanah, Y; Lescure, F-X; Bleibtreu, A

    2016-09-01

    Rothia aeria is a Rothia species from the Micrococcaceae family. We report here the first French R. aeria endocarditis complicated by brain haemorrhage and femoral mycotic aneurysms. Altogether, severity and antimicrobial susceptibility should make us consider the management of R. aeria endocarditis as Staphylococcus aureus methicillin-susceptible endocarditis. PMID:27408740

  3. 3D-CT angiography in high-grade aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    We analyzed the role of 3D-CT angiography (3D-CTA) in the management of high-grade patients with severe subarachnoid hemorrhage (SAH) who were classified as Grade 5 by the Hunt-Kosnik grading system. From February 1995 to January 1997, 86 out of 92 patients with SAH were studied using 3D-CTA. There were 30 Grade 5 SAH patients (32.6%) including 5 patients who arrived in cardiopulmonary arrest (CPA). There were 13 men and 17 women, ranging in age from 46 to 89 years. Two-thirds were older than age 65 years. All patients underwent CT scan and were diagnosed with SAH. Excluding 5 CPA patients and one other patient, the remaining 24 patients successfully underwent 3D-CTA. As a result, ruptured aneurysms responsible for the SAH were clearly delineated in 19 patients (79.2%), and their anatomical relationships to the surrounding vessels were easily assessed. There were 8 patients with ICA aneurysms, 5 with MCA aneurysms, 2 with ACoA aneurysms, 2 with VA aneurysms, 1 with distal ACA aneurysm and 1 with distal PICA aneurysm. Intracranial vessels were not seen in 4 patients, 3 of whom had huge intracerebral hematomas associated with severe SAH. Proximal clipping was performed in a 46-years-old man with dissecting VA aneurysm. He later gained consciousness and became a surgical candidate. A 62-years-old woman underwent coil embolization for the large ICPC aneurysm after the level of her consciousness improved slightly following ventricular drainage. In conclusion, 3D-CTA can be performed safely and has a high detection rate of ruptured aneurysm even in patients with severe SAH. The results from these studies may gain further insight into epidemiology of SAH and ruptured aneurysms. (author)

  4. CT angiography for evaluation of cerebral vasospasm following acute subarachnoid haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Shankar, Jai Jai Shiva [Dalhousie University, Division of Neuroradiology, Department of Diagnostic Imaging, QEII Health Sciences Center, Halifax (Canada); Tan, Irene Y.L.; Krings, Timo; Terbrugge, Karel; Agid, Ronit [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada)

    2012-03-15

    Cerebral vasospasm (CV) is one of the most dreaded complications in patients who survive acute subarachnoid haemorrhage (SAH), and conventional cerebral angiography (DSA) is the gold standard for its diagnosis. We evaluated CT angiography (CTA) as a non-invasive alternative for diagnosis of CV and assessed if CTA could have a role in choosing appropriate treatment. Consecutive patients with SAH and suspected vasospasm were included when DSA was performed within 24 h from CTA. Two neuro-radiologists retrospectively analysed CTA and DSA studies independently. Assessment included presence of central and peripheral vasospasm and grading of severity of central CV. A treatment recommendation based on CTA was compared to actual treatment received. Final analysis included 34 patients. CTA was more accurate for diagnosis of central then for peripheral CV with high sensitivity (reader 1, 91%; reader 2, 92%), specificity (reader 1, 73%; reader 2, 90%), accuracy, positive predictive value and negative predictive value for central vasospasm. For grading the severity of CV CTA's sensitivity, specificity and accuracy were high for most central arteries. The reader's recommendation of angioplasty according to CTA was significantly predictive of actual receipt of angioplasty but overestimated actual receipt of triple H treatment. CTA is adequate for detecting central vasospasm in symptomatic SAH patients. A negative result should not prevent further investigation especially when evaluating arterial segments adjacent to metal artefacts from coils or clips. CTA is helpful in treatment decision making specifically regarding the need for balloon angioplasty. (orig.)

  5. [Neurologic manifestations of subarachnoid and parenchymatous hemorrhages caused by arterial aneurysm].

    Science.gov (United States)

    Bykovnikov, L D

    1991-01-01

    Overall 155 patients with subarachnoidal and parenchymatous hemorrhages from arterial aneurysms, mainly of the anterior part of the circle of Willis, were examined. The intensity of subarachnoidal and parenchymatous hemorrhages varied, with the ++diencephalo-hypothalamic area being largely involved. The volume of intraparenchymatous hemorrhages ranged from 10 to 90 ml. Massive basal SAH was accompanied, in a number of cases, by blood congestion in the fourth ventricle. Correlations were established between the gravity of the health status, clinical cerebral decompensation, and the intensity of hemorrhage to the basal subarachnoidal space and cerebral parenchyma. Three variants of clinical decompensation of the brain were revealed: it ran a torpid course in the majority of cases (64%), it increased dramatically in every fourth patient, and gradually regressed in every 10th patient. PMID:1661472

  6. Trends in blood pressure, osmolality and electrolytes after subarachnoid hemorrhage from aneurysms.

    Science.gov (United States)

    Disney, L; Weir, B; Grace, M; Roberts, P

    1989-08-01

    Daily trends in blood pressure, osmolality and electrolytes were analyzed in a series of 173 operated aneurysm cases who had subarachnoid hemorrhage (SAH) and were admitted within 4 days of the ictus. High blood pressure was associated with a greater risk of mortality and the development of clinically significant vasospasm (VSP). High osmolality shortly after admission was related to mortality but not VSP. Changes in sodium and potassium had no obvious relationship to mortality or VSP. PMID:2766122

  7. Remote Ischemic Conditioning Alters Methylation and Expression of Cell Cycle Genes in Aneurysmal Subarachnoid Hemorrhage

    OpenAIRE

    Nikkola, E; Laiwalla, A; Ko, A; Alvarez, M; Connolly, M; Ooi, YC; Hsu, W; Bui, A.; Pajukanta, P; Gonzalez, NR

    2015-01-01

    © 2015 American Heart Association, Inc. Background and Purpose - Remote ischemic conditioning (RIC) is a phenomenon in which short periods of nonfatal ischemia in 1 tissue confers protection to distant tissues. Here we performed a longitudinal human pilot study in patients with aneurysmal subarachnoid hemorrhage undergoing RIC by limb ischemia to compare changes in DNA methylation and transcriptome profiles before and after RIC. Methods - Thirteen patients underwent 4 RIC sessions over 2 to 1...

  8. Intracranial infective aneurysms presenting with haemorrhage: An analysis of angiographic findings, management and outcome

    International Nuclear Information System (INIS)

    AIM: This study is an analysis of angiographic findings in 17 patients with infective aneurysms who presented with intracranial haemorrhage and reviews the management and outcome in the context of the existing literature. MATERIALS AND METHODS: A retrospective study of infective aneurysms in 17 patients was carried out. Cranial angiography was performed in all patients. The location, size and outline of aneurysms were analysed. Ten patients were managed conservatively and six patients underwent surgery for the ruptured infective aneurysms and were followed up for a period of 35.8 months and 23 months, respectively. RESULTS: Twenty-two aneurysms were identified (five unruptured) in 17 patients. Twenty aneurysms (90.9%) were distal in location and two (9.1%) proximal. Sixty percent were in the posterior circulation with 55% in the posterior cerebral artery (PCA) territory, 27.3% in the middle cerebral artery (MCA) territory and 9.1% in the anterior cerebral artery (ACA) territory. Fourteen aneurysms were small (3-5 mm) and eight were medium sized (6-9 mm). 72.7% of aneurysms had irregular outline and 27.3% regular outline. Out of the 10 ruptured aneurysms managed conservatively, eight resolved. One patient died, presumably due to rebleed, and one had infarction due to parent vessel thrombosis. Six aneurysms were surgically managed with good results. Of the five unruptured aneurysms one was surgically managed and the remaining four conservatively managed patients did not bleed during follow-up. CONCLUSION: Patients with ruptured infective aneurysms fared well with medical management and the outcome in this series is better than that reported in literature. Patients on conservative management, however, need closer monitoring with angiographic follow-up. Active management is required with enlarging or persisting aneurysms. Venkatesh, S.K. (2000)

  9. CT of intracerebral haemorrhage due to mycotic aneurysms

    International Nuclear Information System (INIS)

    The CT findings in a case of intracerebral haematoma due to rupture of a mycotic aneurysm are presented. In addition to the haematoma, CT demonstrated small focal areas of cortical enhancement, which correspond to the peripheral aneurysms seen on angiography. Such findings are thought to be characteristic; a brief differential diagnosis is discussed. (orig.)

  10. Procedure-related haemorrhage in embolisation of intracranial aneurysms with Guglielmi detachable coils

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, B.J.; Kim, K.H. [Department of Radiology, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Han, M.H.; Chang, K.H. [Department of Radiology, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Clinical Research Institute, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Institute of Radiation Medicine, Seoul National University Medical Research Centre, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Seoul National University College of Medicine (Korea); Oh, C.W. [Department of Neurosurgery, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea)

    2003-08-01

    We reviewed the haemorrhagic complications of the endovascular treatment of intracranial aneurysms, in terms of frequency, pre-embolisation clinical status, clinical and radiological manifestations, management and prognosis. In 275 patients treated for 303 aneurysms over 7 years we had seven (one man and six women - 2.3%) with haemorrhage during or immediately after endovascular treatment. All procedures were performed with a standardised protocol of heparinisation and anaesthesia. Four had ruptured aneurysms, two at the tip of the basilar artery, and one ach on the internal carotid and posterior cerebral artery, treated after 12, 5, 14, and 2 days, respectively, three were in Hunt and Hess grade 2 and one in grade 1. Bleeding occurred during coiling in three, after placement of at least four coils, and during manipulation of the guidewire to enter the aneurysm in the fourth. Haemorrhage was manifest as extravasation of contrast medium, with a sudden rise in systolic blood pressure in three patients. The other three patients had unruptured aneurysms; they had stable blood pressure and angiographic findings during the procedure, but one, under sedation, had seizures immediately after insertion of four coils, and the other two had seizures, headache and vomiting on the day following the procedure. Heparin reversal with protamine sulphate was started promptly started when bleeding was detected in four patients, and the embolisation was completed with additional coils in three. Emergency ventricular drainage was performed in the two patients with ruptured aneurysm and one with an unruptured aneurysm who had abnormal neurological responses or hydrocephalus. The bleeding caused a third nerve palsy in one patient, which might have been due to ischaemia and progressively improved. (orig.)

  11. Procedure-related haemorrhage in embolisation of intracranial aneurysms with Guglielmi detachable coils

    International Nuclear Information System (INIS)

    We reviewed the haemorrhagic complications of the endovascular treatment of intracranial aneurysms, in terms of frequency, pre-embolisation clinical status, clinical and radiological manifestations, management and prognosis. In 275 patients treated for 303 aneurysms over 7 years we had seven (one man and six women - 2.3%) with haemorrhage during or immediately after endovascular treatment. All procedures were performed with a standardised protocol of heparinisation and anaesthesia. Four had ruptured aneurysms, two at the tip of the basilar artery, and one ach on the internal carotid and posterior cerebral artery, treated after 12, 5, 14, and 2 days, respectively, three were in Hunt and Hess grade 2 and one in grade 1. Bleeding occurred during coiling in three, after placement of at least four coils, and during manipulation of the guidewire to enter the aneurysm in the fourth. Haemorrhage was manifest as extravasation of contrast medium, with a sudden rise in systolic blood pressure in three patients. The other three patients had unruptured aneurysms; they had stable blood pressure and angiographic findings during the procedure, but one, under sedation, had seizures immediately after insertion of four coils, and the other two had seizures, headache and vomiting on the day following the procedure. Heparin reversal with protamine sulphate was started promptly started when bleeding was detected in four patients, and the embolisation was completed with additional coils in three. Emergency ventricular drainage was performed in the two patients with ruptured aneurysm and one with an unruptured aneurysm who had abnormal neurological responses or hydrocephalus. The bleeding caused a third nerve palsy in one patient, which might have been due to ischaemia and progressively improved. (orig.)

  12. Management of Agitation Following Aneurysmal Subarachnoid Hemorrhage: Is There a Role for Beta-Blockers?

    Directory of Open Access Journals (Sweden)

    Fayaz Ibrahim

    2012-01-01

    Full Text Available Introduction. Stroke is a leading cause of mortality and morbidity in the United States. About 20% of the stroke is hemorrhagic and about 50% of these is due to aneurysmal subarachnoid hemorrhage. A troublesome neuropsychiatric complication of subarachnoid hemorrhage is agitation/aggression. Case Presentation. A 45-year-old man with no prior psychiatric history, sustained subarachnoid hemorrhage. After initial stabilization for 2 days, he underwent craniotomy and clipping of anterior cerebral communicating artery aneurysm. Treatment was continued with labetalol, nimodipine, and levetiracetam. Beginning postoperative day 4, patient developed episodes of confusion and agitation/aggression. Switching of Levetiracetam to valproate did not show any improvement. Psychiatry team tried to manage him with intense nursing intervention and different medications like olanzapine, valproate, lorazepam, and haloperidol. However, patient continued to be agitated and aggressive. Switching from labetalol to metoprolol resulted in dramatic improvement within 3 days. Discussion. Antipsychotics and benzodiazepines are often not sufficiently effective in the control of agitation/aggression in patients with traumatic brain injury and similar conditions. Our case report and the literature review including a cochrane review suggests that beta-blockers may be helpful in this situation.

  13. Frequency and appearance of hemosiderin depositions after aneurysmal subarachnoid hemorrhage treated by endovascular therapy

    Energy Technology Data Exchange (ETDEWEB)

    Falter, Bernhard; Wiesmann, Martin; Freiherr, Jessica; Nikoubashman, Omid; Mull, Michael [University Hospital Aachen RWTH, Department of Neuroradiology, Aachen (Germany)

    2015-10-15

    It is still unclear how often subarachnoid hemorrhage (SAH) leads to chronic hemosiderin depositions. In this study, we aimed to determine the frequency of chronic hemosiderin depositions after aneurysmal SAH in patients who did not undergo surgery. Furthermore, we analyzed typical MRI patterns of chronic SAH and sought to obtain information on the temporal course of MRI signal changes. We retrospectively analyzed 90 patients who had undergone endovascular treatment for acute aneurysmal SAH. In all patients, initial CT studies and at least one T2*-weighted MRI obtained 6 months or later after SAH were analyzed for the presence and anatomical distribution of SAH or chronic hemosiderin depositions. In total, 185 T2*-weighted MRI studies obtained between 2 days and 148 months after SAH were evaluated (mean follow-up 30.2 months). On MRI studies obtained later than 6 months after SAH, subpial hemosiderin depositions were found in 50 patients (55.5 %). Most frequent localizations were the parenchyma adjacent to the frontal and parietal sulci and the insular cisterns. While the appearance of hemosiderin depositions was dynamic within the first 3 months, no changes were found during subsequent follow-up. MR signal changes were not only conclusive with subarachnoid hemosiderin depositions but in many cases also resembled those that have been associated with cortical hemosiderosis. T2*-weighted MRI is an effective means of diagnosing prior SAH. Our study suggests that chronic hemosiderin depositions can be found in a considerable number of patients after a single event of subarachnoid hemorrhage. (orig.)

  14. Symptomatic vasospasm after subarachnoid haemorrhage: assessment of brain damage by diffusion and perfusion-weighted MRI and single-photon emission computed tomography

    International Nuclear Information System (INIS)

    Our purpose was to assess the usefulness of diffusion- and perfusion-weighted MRI for the detection of ischaemic brain damage in patients with suspected vasospasm after subarachnoid haemorrhage (SAH). We studied 11 patients admitted with a ruptured aneurysm of the anterior circulation and suspected of intracranial vasospasm on clinical examination and transcranial Doppler sonography (TCD). All were investigated by technetium-hexamethyl-propylene amine oxime (Tc-HMPAO) single photon emission computed tomography (SPECT) and diffusion and perfusion-weighted MRI (DWI, PWI) within 2 weeks of their SAH. Trace images and TTP maps were interpreted by two examiners and compared with clinical and imaging follow-up. PWI revealed an area of slowed flow in seven patients, including four with major and three with minor hypoperfusion on SPECT. In two patients, PWI did not demonstrate any abnormality, while SPECT revealed major hypoperfusion in one and a minor deficit hypoperfusion in the other. Two patients with high signal on DWI had a permanent neurological deficit. (orig.)

  15. Rare anatomical variations of persistent trigeminal artery in two patients with non-aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Samaniego, Edgar A; Dabus, Guilherme; Andreone, Vincenzo; Linfante, Italo

    2011-09-01

    Carotid-basilar anastomoses are remnants of the fetal circulation and although rare, they may become symptomatic and should be recognized during cerebral angiography. Two patients are described with non-aneurysmal subarachnoid hemorrhage and persistent trigeminal arteries (PTA) found on cerebral angiography. In the first patient, the PTA ended in the anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery. The second patient had a PTA terminating in the AICA and superior cerebellar artery. These rare anatomical PTA variants should be recognized on cerebral angiography. PMID:21990842

  16. Usage of innovative precipitating liquid embolics for the endovascular occlusion of broadbased intracranial aneurysms

    OpenAIRE

    Tesmer, Kai

    2011-01-01

    Intracranial aneurysms do not usually become clinically apparent before their rupture. This medical emergency is connected with high morbidity and mortality. An aneurysm rupture is typically accompanied by a subarachnoid haemorrhage (SAH) as bleeding in the external CSF spaces between the arachnoid und pia mater. The primary aim when treating a patient with aneurismal SAH is the speedy elimination of the ruptured aneurysm in order to prevent an often fatal recurrence of the haemorrhaging. In ...

  17. Nimodipine in aneurysmal subarachnoid hemorrhage: a randomized study of intravenous or peroral administration

    DEFF Research Database (Denmark)

    Kronvall, Erik; Undrén, Per; Rommer, Bertil Roland;

    2009-01-01

    alternative and the preferred mode of treatment in many centers. It is unknown whether the route of administration is of any importance for the clinical efficacy of the drug. METHODS: One hundred six patients with acute aneurysmal SAH were randomized to receive either peroral or intravenous nimodipine...... patients with new infarctions on MR imaging. CONCLUSIONS: The results suggest that there is no clinically relevant difference in efficacy between peroral and intravenous administration of nimodipine in preventing DINDs or cerebral vasospasm following SAH.......OBJECT: The calcium antagonist nimodipine has been shown to reduce the incidence of ischemic complications following aneurysmal subarachnoid hemorrhage (SAH). Although most randomized studies have been focused on the effect of the peroral administration of nimodipine, intravenous infusion is an...

  18. The Role of Bone Subtraction Computed Tomographic Angiography in Determining Intracranial Aneurysms in Non-Traumatic Subarachnoid Hemorrhage

    OpenAIRE

    Kayhan, Aysegul; Koc, Osman; Keskin, Suat; Keskin, Fatih

    2014-01-01

    Background: The presence of blood in the subarachnoid space is an acute pathology with a serious risk of death and complications. The most common etiology (approximately 80%) is intracranial aneurysm. Objectives: The aim of this study was to assess the role of bone subtracted computed tomographic angiography (BSCTA), a novel and noninvasive method for determining and characterizing intracranial aneurysms. Patients and Methods: Sixty consecutive patients with clinically suspected non-traumatic...

  19. Aneurysmal subarachnoid hemorrhage prognostic decision-making algorithm using classification and regression tree analysis

    Science.gov (United States)

    Lo, Benjamin W. Y.; Fukuda, Hitoshi; Angle, Mark; Teitelbaum, Jeanne; Macdonald, R. Loch; Farrokhyar, Forough; Thabane, Lehana; Levine, Mitchell A. H.

    2016-01-01

    Background: Classification and regression tree analysis involves the creation of a decision tree by recursive partitioning of a dataset into more homogeneous subgroups. Thus far, there is scarce literature on using this technique to create clinical prediction tools for aneurysmal subarachnoid hemorrhage (SAH). Methods: The classification and regression tree analysis technique was applied to the multicenter Tirilazad database (3551 patients) in order to create the decision-making algorithm. In order to elucidate prognostic subgroups in aneurysmal SAH, neurologic, systemic, and demographic factors were taken into account. The dependent variable used for analysis was the dichotomized Glasgow Outcome Score at 3 months. Results: Classification and regression tree analysis revealed seven prognostic subgroups. Neurological grade, occurrence of post-admission stroke, occurrence of post-admission fever, and age represented the explanatory nodes of this decision tree. Split sample validation revealed classification accuracy of 79% for the training dataset and 77% for the testing dataset. In addition, the occurrence of fever at 1-week post-aneurysmal SAH is associated with increased odds of post-admission stroke (odds ratio: 1.83, 95% confidence interval: 1.56–2.45, P decision making. This prognostic decision-making algorithm also shed light on the complex interactions between a number of risk factors in determining outcome after aneurysmal SAH. PMID:27512607

  20. Protein kinase C inhibition prevents upregulation of vascular ET(B) and 5-HT(1B) receptors and reverses cerebral blood flow reduction after subarachnoid haemorrhage in rats

    DEFF Research Database (Denmark)

    Beg, Saema S; Hansen-Schwartz, Jacob A; Vikman, Petter J;

    2007-01-01

    The pathogenesis of cerebral ischaemia after subarachnoid haemorrhage (SAH) still remains elusive. The purpose of the present study was to examine whether specific protein kinas C (PKC) inhibition in rats could alter the transcriptional SAH induced Endothelin (ET) type B and 5-hydroxytryptamine t...

  1. Risk factors and outcome in 100 patients with aneurysmal subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Bonilha Leonardo

    2001-01-01

    Full Text Available OBJECTIVE: Clinical and surgical outcome of patients with subarachnoid hemorrhage (SAH due to ruptured aneurysm were assessed in comparison to pre-operative data and risk factors such as previous medical history, clinical presenting condition, CT findings and site of bleeding. METHODS: We evaluated 100 consecutive patients with aneurysmal SAH. Gender, color, history of hypertension, smoking habit, site and size of aneurysm, admittance and before surgery Hunt Hess scale, need for cerebro-spinal fluid shunt, presence of complications during the surgical procedure, Glasgow Outcome Scale, presence of vasospasm and of rebleeding were assessed and these data matched to outcome. For statistical analysis, we applied the chi-squared test or Fisher's test using the pondered kappa coeficient. Kruskal-Wallis test was used for comparison of continue variables. Tendency of proportion was analyzed through Cochran-Armitage test. Significance level adopted was 5%. RESULTS: Patients studied were mainly white, female, without previous history of hypertension and non-smokers. Upon hospital admittance, grade 2 of Hunt-Hess scale was most frequently observed (34%, while grade 3 of Fisher scale was the most prevalent. Single aneurysms were most frequent at anterior circulation, between 12 and 24 mm. The most frequent Glasgow Outcome Scale observed was 5 (60%. Hunt Hess upon the moment of surgery and presence of complications during surgical procedure showed positive correlation with clinical outcome (p=0.00002 and p=0.001, respectively. Other variables were not significantly correlated to prognosis. Tendency of proportion was observed between Hunt-Hess scale and Fisher scale. CONCLUSION: Among variables such as epidemiological data, previous medical history and presenting conditions of patients with ruptured aneurysms, the Hunt-Hess scale upon the moment of surgery and the presence of surgical adversities are statistically related to degree of disability.

  2. Hyponatremia in aneurysmal subarachnoid hemorrhage is due to the syndrome of inappropriate antidiuresis and acute glucocorticoid deficiency

    LENUS (Irish Health Repository)

    Hannon, M J

    2011-06-01

    Hyponatraemia is the most common electrolyte abnormality following subarachnoid haemorrhage (SAH) and contributes to increased morbidity and mortality. Retrospective data suggests that the syndrome of inappropriate diuresis (SIAD) is the most common cause of hyponatraemia in SAH, though cerebral salt wasting has been postulated by some workers to be the predominant abnormality. Data which has shown acute glucocorticoid deficiency following SAH has suggested that some cases of euvolaemic hyponatraemia may also be caused by this mechanism.We prospectively studied the hormonal and haemodynamic influences involved in the development of hyponatraemia in 100 patients (61% female, median age 53 (range 16-82)) with non-traumatic aneurysmal SAH. Each patient had plasma sodium (pNa), urea, osmolality, glucose and 0900h cortisol (PC), and urinary sodium and osmolality measured on days 1, 2, 3, 4, 6, 8, 10 and 12 following SAH. Fluid balance and haemodynamic parameters were recorded daily. Results were compared with 15 patients admitted to ITU following vascular surgery. A PC<300nmol\\/L in a patient in ITU was regarded clinically as inappropriately low.49% of patients developed hyponatraemia (pNa<135 mmol\\/L), including 14% who developed clinically significantly hyponatraemia (pNa<130 mmol\\/L). 36\\/49 (73.4%) developed hyponatraemia between days 1 and 3 post SAH. The median duration of hyponatraemia was 3 days (range 1–10 days).In 35\\/49 (71.4%), hyponatraemia was due to SIAD as defined by standard diagnostic criteria. 14% of SAH patients had at least one PC<300nmol\\/L; 5 of these (35.7%) developed hyponatraemia. In 4 patients hyponatraemia was preceded by acute cortisol deficiency and responded to hydrocortisone treatment. In contrast, all controls had PC>500 nmol\\/L on day 1, and >300 nmol on days 3–12. There were no cases of cerebral salt wasting. There was no relationship between the incidence of hyponatraemia and the defined anatomical territory or severity of

  3. Role of calcitonin gene-related peptide in cerebral vasospasm, and as a therapeutic approach to subarachnoid haemorrhage

    Directory of Open Access Journals (Sweden)

    Stelios eKokkoris

    2012-11-01

    Full Text Available Calcitonin gene-related peptide (CGRP is one of the most potent microvascular vasodilators identified to date. Vascular relaxation and vasodilation is mediated via activation of the CGRP receptor. This atypical receptor is made up of a G-protein-coupled receptor called calcitonin receptor-like receptor (CLR, a single transmembrane protein called receptor activity-modifying protein (RAMP, and an additional protein that is required for Gas coupling, known as receptor component protein (RCP. Several mechanisms involved in CGRP mediated relaxation have been identified. These include nitric oxide (NO-dependent endothelium-dependent mechanisms or cAMP-mediated endothelium-independent pathways; the latter being more common. Subarachnoid haemorrhage (SAH is associated with cerebral vasoconstriction that occurs several days after the haemorrhage and is often fatal. The vasospasm occurs in 30–40% of patients and is the major cause of death from this condition. The vasoconstriction is associated with a decrease in CGRP levels in nerves and an increase in CGRP levels in draining blood, suggesting that CGRP is released from nerves to oppose the vasoconstriction. This evidence has led to the concept that exogenous CGRP may be beneficial in a condition that has proven hard to treat. The present article reviews: a the pathophysiology of delayed ischaemic neurologic deficit after SAH b the basics of the CGRP receptor structure, signal transduction and vasodilatation mechanisms and c the studies that have been conducted so far using CGRP in both animals and humans with SAH.

  4. Endovascular Coiling of Multiple (More than Four) Intracranial Aneurysms: Case Report

    OpenAIRE

    Kim, Y J; Song, K. Y.

    2004-01-01

    The incidence of multiple intracranial aneurysms has been reported from 5% to 35%. But over four multiple aneurysms are extremely rare. Sometimes it is very difficult to draw a clear line between ruptured ones and unruptured others especially in multiple aneurysm cases with even distribution of subarachnoid haemorrhage on basal cistern. We present two cases of multiple aneurysms, more than four, which were successfully treated by endovascular coiling at the same time. Our experience suggests ...

  5. Effects of continuous prostacyclin infusion on regional blood flow and cerebral vasospasm following subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Rasmussen, Rune; Juhler, Marianne; Wetterslev, Jørn

    2014-01-01

    BACKGROUND: One of the main causes of mortality and morbidity following subarachnoid hemorrhage (SAH) is the development of cerebral vasospasm, a frequent complication arising in the weeks after the initial bleeding. Despite extensive research, no effective treatment of vasospasm exists to date. ...

  6. Association of Fisher scale and changes of language in patients with aneurysmal subarachnoid hemorrhage

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    Moysés Loiola Ponte de Souza

    2014-11-01

    Full Text Available Cognitive deficits caused by subarachnoid hemorrhage (SAH after rupture of cerebral aneurysms are common, as approximately half of patients have severe, or at least striking, declines in one or more functions of the cognitive domain. The Fisher Scale is associated with the development of vasospasm and thus with the final performance of the patient after SAH. The association of this scale with language disorders in the period preceding the treatment has not been reported yet in the literature. Associate the presence of language deficits with varying degrees of the Fisher Scale in patients with SAH in the period preceding the treatment of aneurysm, as well as compare the various degrees of this scale, identifying the Fisher Scale degrees more associated with the decline of language. The database of 185 preoperative evaluations of language was studied, through the Montreal Toulouse Protocol Alpha version and verbal fluency through CERAD battery, of patients of Hospital da Restauração with aneurysmal SAH. The data relating to the Fisher Scale, the location of the aneurysm, the age and the gender of patients were obtained through review of medical records. Patients were divided according to the Fisher Scale (Fisher I, II, III or IV and compared with a control group of individuals considered normal. Disorders in language and verbal fluency in patients with SAH in the preoperative period were evidenced. The classification of the patients according to the Fisher Scale allowed to identify differences between the sub-groups and to conclude that patients with bulkier bleeding (Fisher III and IV have larger declines in the analyzed functions.

  7. Copeptin as a marker for severity and prognosis of aneurysmal subarachnoid hemorrhage.

    Directory of Open Access Journals (Sweden)

    Christian Fung

    Full Text Available BACKGROUND: Grading of patients with aneurysmal subarachnoid hemorrhage (aSAH is often confounded by seizure, hydrocephalus or sedation and the prediction of prognosis remains difficult. Recently, copeptin has been identified as a serum marker for outcomes in acute ischemic stroke and intracerebral hemorrhage (ICH. We investigated whether copeptin might serve as a marker for severity and prognosis in aSAH. METHODS: Eighteen consecutive patients with aSAH had plasma copeptin levels measured with a validated chemiluminescence sandwich immunoassay. The primary endpoint was the association of copeptin levels at admission with the World Federation of Neurological Surgeons (WFNS grade score after resuscitation. Levels of copeptin were compared across clinical and radiological scores as well as between patients with ICH, intraventricular hemorrhage, hydrocephalus, vasospasm and ischemia. RESULTS: Copeptin levels were significantly associated with the severity of aSAH measured by WFNS grade (P = 0.006, the amount of subarachnoid blood (P = 0.03 and the occurrence of ICH (P = 0.02. There was also a trend between copeptin levels and functional clinical outcome at 6-months (P = 0.054. No other clinical outcomes showed any statistically significant association. CONCLUSIONS: Copeptin may indicate clinical severity of the initial bleeding and may therefore help in guiding treatment decisions in the setting of aSAH. These initial results show that copeptin might also have prognostic value for clinical outcome in aSAH.

  8. A case of cerebral aneurysm rupture and subarachnoid hemorrhage associated with air travel

    Directory of Open Access Journals (Sweden)

    Cui V

    2014-04-01

    Full Text Available Victoria Cui,1,2 Timur Kouliev,1 Jason Wood1 1Beijing United Family Hospital, Beijing, People's Republic of China; 2Department of Biological Sciences, Columbia University, New York, NY, USA Abstract: During air travel, passengers are exposed to unique conditions such as rapid ascent and descent that can trigger significant physiological changes. In addition, the cabins of commercial aircraft are only partially pressured to 552–632 mmHg or the equivalent terrestrial altitudes of 1,500–2,500 m (5,000–8,000 feet above sea level. While studies in high-altitude medicine have shown that all individuals experience some degree of hypoxia, cerebral edema, and increased cerebral blood flow, the neurological effects that accompany these changes are otherwise poorly understood. In this study, we report a case of acute subarachnoid hemorrhage from a ruptured cerebral aneurysm associated with travel on commercial aircraft. We then review relevant cases of neurological incidents with possible air travel-related etiology and discuss the physiological factors that may have contributed to the patient's acute subarachnoid hemorrhage. In the future, this report may serve as reference for more detailed and conservative medical guidelines and recommendations regarding air travel. Keywords: high-altitude, cabin pressure, emergency, cerebral edema, triage, neurological

  9. [A case of HELLP syndrome resulting in eclampsia with non-aneurysmal subarachnoid hemorrhage].

    Science.gov (United States)

    Yoshikane, Tsutomu; Miyazaki, Takeshi; Aoki, Showa; Kambara, Mizuki; Hagiwara, Shinya; Miyazaki, Kohji; Akiyama, Yasuhiko

    2013-02-01

    It is known that hemorrhagic stroke at the perinatal period are caused by specifics conditions like eclampsia as well as by the existing abnormal vessels. We treated a case of HELLP syndrome resulting in eclampsia with non-aneurysmal, convexity subarachnoid hemorrhage. A 34-year-old female, who had been pointed out to have a high level of urinal protein at the 37th week, was seen in the emergency department because of severe headache, vomiting and respiratory discomfort. Her systolic blood pressure was over 190mmHg, and caesarean section was selected. On the way to the operating room, she had a generalized convulsion with loss of consciousness. The delivery was carried out. The CT immediately after the caesarean section revealed faint and localized subarachnoid hemorrhage in the bilateral convexity areas. Additionally, the FLAIR image of MRI demonstrated increased intensity in the bilateral cerebellar hemispheres, basal ganglion and subcortical area, suggesting vasogenic edema. The patient had a good clinical course and the abnormal signal of MRI also recovered by treatment with oral iron and zinc. Here, we report a speculation for the mechanism of this case and precautions against stroke in the perinatal period. PMID:23378389

  10. Single Phase Dual-energy CT Angiography: One-stop-shop Tool for Evaluating Aneurysmal Subarachnoid Hemorrhage

    Science.gov (United States)

    Ni, Qian Qian; Tang, Chun Xiang; Zhao, Yan E; Zhou, Chang Sheng; Chen, Guo Zhong; Lu, Guang Ming; Zhang, Long Jiang

    2016-01-01

    Aneurysmal subarachnoid hemorrhages have extremely high case fatality in clinic. Early and rapid identifications of ruptured intracranial aneurysms seem to be especially important. Here we evaluate clinical value of single phase contrast-enhanced dual-energy CT angiograph (DE-CTA) as a one-stop-shop tool in detecting aneurysmal subarachnoid hemorrhage. One hundred and five patients who underwent true non-enhanced CT (TNCT), contrast-enhanced DE-CTA and digital subtraction angiography (DSA) were included. Image quality and detectability of intracranial hemorrhage were evaluated and compared between virtual non-enhanced CT (VNCT) images reconstructed from DE-CTA and TNCT. There was no statistical difference in image quality (P > 0.05) between VNCT and TNCT. The agreement of VNCT and TNCT in detecting intracranial hemorrhage reached 98.1% on a per-patient basis. With DSA as reference standard, sensitivity and specificity on a per-patient were 98.3% and 97.9% for DE-CTA in intracranial aneurysm detection. Effective dose of DE-CTA was reduced by 75.0% compared to conventional digital subtraction CTA. Thus, single phase contrast-enhanced DE-CTA is optimal reliable one-stop-shop tool for detecting intracranial hemorrhage with VNCT and intracranial aneurysms with DE-CTA with substantial radiation dose reduction compared with conventional digital subtraction CTA. PMID:27222163

  11. Dissecting Aneurysms of Bilateral Anterior Cerebral Artery Complicated by Subarachnoid Hemorrhage After Cerebral Infarction: A Case Report

    Directory of Open Access Journals (Sweden)

    Akihiro Kurosu

    2008-01-01

    Full Text Available Introduction: Intracranial dissecting aneurysms have been increased due to recent advancements in diagnostic imaging. However there have been little article with subarachnoid hemorrhage and cerebral infarction occurring almost at the same time. We performed the surgical treatment and obtained good result.Case presentation: A 47-year-old male presented to our hospital with chief complaints of sudden headache and mild paralysis of the left lower extremity. Brain imaging at admission revealed cerebral infarction in the right frontal lobe and subarachnoid hemorrhage in the frontal convexy and anterior interhemispheric fissure. The left and right internal carotid angiography showed a bulging cerebral aneurysm at the left A1–A2 junction and stenosis and arterial dissections in the peripheral of the bilateral anterior cerebral artery. Wrapping was performed for the dissecting aneurysm of the left anterior cerebral artery. For the right anterior cerebral artery, trapping was performed at the A2 segment without vascular anastomosis. The patient’s postoperative course was uneventful.Conclusion: A consensus has not been reached on the treatment for intracranial dissecting aneurysms. Proximal trapping without vascular reconstruction was performed for the right anterior cerebral artery without vascular anastomosis to prevent rebleeding. However no symptoms of neurological deficiency were observed. Proximal trapping of dissecting aneurysm seems to be a good option when patient’s functional and life prognosis are taken into account in case that vascular reconstruction will be anticipated difficulty.

  12. Serum magnesium levels and clinical outcome of aneurysmal subarachnoid hemorrhage: a study in 60 patients

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    Habibi Z

    2008-06-01

    Full Text Available Background: Hypomagnesemia is commonly encountered in patients with a wide variety of diseases including subarachnoid hemorrhage (SAH, cardiovascular emergencies, head trauma, migraine attacks, seizure and preeclampsia. It seems to be associated with a poor clinical outcome. This study considers the prevalence and temporal distribution of hypomagnesemia after aneurysmal SAH and its correlation with the severity of SAH, delayed cerebral ischemia (DCI as well as the neurological outcome after a period of three months.Methods: Between 2003 and 2008, 60 patients were admitted to the emergency ward of Imam Khomeini Hospital with acute SAH. Serum magnesium levels were measured during the first 72 hours, days 4-7, and second and third weeks after SAH. The three-month outcome was assessed according to the Glasgow Outcome Scale (GOS. Clinical SAH grading was performed according to the criteria of the World Federation of Neurological Surgeons (WFNS and the patients were allocated to "Good" (GOS = 4, 5 and "Poor" (GOS= 1-3 outcome groups. The prevalence of hypomagnesemia was assessed in both patient groups. Fisher exact test was used to analyze data.Results: Hypomagnesemia occurred in 22% of patients during the first 72 hours after SAH. It was associated with more prevalent DCI (p<0.05, whereas low serum magnesium levels during days 4-7 17% of patients and the second week (22% of patients after SAH were correlated with poor clinical outcome (p<0.05. No correlation was found between first 72 hour-hypomagnesemia and poor clinical outcome at three months.Conclusion: Hypomagnesemia occurs after aneurysmal SAH and it may predict the occurrence of DCI, while low serum magnesium levels during days 4-7 and within the second week of event predict poor clinical outcome at three months. Treatment of this electrolyte disturbance may have a favourable effect on the clinical outcome of patients with aneurysmal SAH.

  13. Predictors and outcomes of shunt-dependent hydrocephalus in patients with aneurysmal sub-arachnoid hemorrhage

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    Wang Yi-Min

    2012-07-01

    Full Text Available Abstract Background Hydrocephalus following spontaneous aneurysmal sub-arachnoid hemorrhage (SAH is often associated with unfavorable outcome. This study aimed to determine the potential risk factors and outcomes of shunt-dependent hydrocephalus in aneurysmal SAH patients but without hydrocephalus upon arrival at the hospital. Methods One hundred and sixty-eight aneurysmal SAH patients were evaluated. Using functional scores, those without hydrocephalus upon arrival at the hospital were compared to those already with hydrocephalus on admission, those who developed it during hospitalization, and those who did not develop it throughout their hospital stay. The Glasgow Coma Score, modified Fisher SAH grade, and World Federation of Neurosurgical Societies grade were determined at the emergency room. Therapeutic outcomes immediately after discharge and 18 months after were assessed using the Glasgow Outcome Score. Results Hydrocephalus accounted for 61.9% (104/168 of all episodes, including 82 with initial hydrocephalus on admission and 22 with subsequent hydrocephalus. Both the presence of intra-ventricular hemorrhage on admission and post-operative intra-cerebral hemorrhage were independently associated with shunt-dependent hydrocephalus in patients without hydrocephalus on admission. After a minimum 1.5 years of follow-up, the mean Glasgow outcome score was 3.33 ± 1.40 for patients with shunt-dependent hydrocephalus and 4.21 ± 1.19 for those without. Conclusions The presence of intra-ventricular hemorrhage, lower mean Glasgow Coma Scale score, and higher mean scores of the modified Fisher SAH and World Federation of Neurosurgical grading on admission imply risk of shunt-dependent hydrocephalus in patients without initial hydrocephalus. These patients have worse short- and long-term outcomes and longer hospitalization.

  14. Early CT perfusion changes and blood-brain barrier permeability after aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Early brain injury (EBI) can occur within 72 h of aneurysmal subarachnoid hemorrhage (aSAH). The objective of this study was to determine if there are differences in early CTP parameters (<72 h) with respect to delayed cerebral ischemia (DCI), cerebral infarction, and functional outcome. We performed a prospective cohort study of aSAH patients admitted to a single tertiary care center. MTT, CBF and blood-brain barrier permeability (PS) were quantified with CTP within 72 h of aneurysm rupture. Primary outcomes were functional outcome by the Modified Rankin Scale (mRS) at 3 months and cerebral infarction. Secondary outcome was the development of DCI. Differences between early CTP parameters were determined with respect to primary and secondary outcomes. Fifty aSAH patients were included in the final analysis. MTT was significantly higher in patients who developed DCI (6.7 ± 1.2 vs 5.9 ± 1.0; p = 0.03) and cerebral infarction (7.0 ± 1.2 vs 5.9 ± 0.9; p = 0.007); however, no difference in MTT was found between patients with and without a poor outcome (mRS > 2). Early CBF and PS did not differ with respect to functional outcome, DCI, and cerebral infarction. Elevated MTT within 72 h of aneurysm rupture is associated with DCI and cerebral infarction but not with long-term functional outcome. Blood-brain barrier permeability, as assessed by CT perfusion, was not associated with DCI or worse outcome in this cohort. (orig.)

  15. Serum and cerebrospinal fluid concentrations of E-selectin in patients with aneurysmal subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    T. Tanriverdi

    2005-11-01

    Full Text Available The goal of the present study was to determine concentrations of E-selectin in both cerebrospinal fluid (CSF and serum of patients with aneurysmal subarachnoid hemorrhage (SAH and to evaluate the correlation between the clinical parameters and E-selectin levels. Both CSF and serum samples obtained from 12 patients with aneurysmal SAH and 8 patients with hydrocephalus (control group without any other known central nervous system disease were assayed for E-selectin by quantitative enzyme-linked immunosorbent assay and the results were compared between the two groups. Mean levels of soluble forms of E-selectin within the first 3 days and on the 5th and 7th days of SAH were 4.0 ± 7.9, 2.8 ± 5.2, and 3.1 ± 4.9 ng/ml in the patient's CSF, and 33.7 ± 9.2, 35.1 ± 7.0, and 35.2 ± 8.7 ng/ml in serum, respectively. In contrast, mean E-selectin levels were 0.1 ± 0.2 ng/ml in CSF and 8.7 ± 5.0 ng/ml in serum of control patients. The difference between groups was statistically significant regarding both CSF and serum E-selectin levels (P < 0.05. Thus, we have demonstrated a marked increase of E-selectin concentration in both CSF and serum of patients with aneurysmal SAH compared with control and suggest that blocking the interaction between E-selectin and vascular endothelium may have a beneficial effect on vasospasms.

  16. Early CT perfusion changes and blood-brain barrier permeability after aneurysmal subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, Amanda; Bharatha, Aditya [University of Toronto, Department of Medical Imaging, Toronto, ON (Canada); De Oliveira Manoel, Airton Leonardo; Kouzmina, Ekaterina [St. Michael' s Hospital, Toronto (Canada); Burgers, Kyle; Lee, Ting [Robarts Research Institute, London (Canada); Macdonald, R.L. [St. Michael' s Hospital, Department of Neurosurgery, Toronto (Canada)

    2015-08-15

    Early brain injury (EBI) can occur within 72 h of aneurysmal subarachnoid hemorrhage (aSAH). The objective of this study was to determine if there are differences in early CTP parameters (<72 h) with respect to delayed cerebral ischemia (DCI), cerebral infarction, and functional outcome. We performed a prospective cohort study of aSAH patients admitted to a single tertiary care center. MTT, CBF and blood-brain barrier permeability (PS) were quantified with CTP within 72 h of aneurysm rupture. Primary outcomes were functional outcome by the Modified Rankin Scale (mRS) at 3 months and cerebral infarction. Secondary outcome was the development of DCI. Differences between early CTP parameters were determined with respect to primary and secondary outcomes. Fifty aSAH patients were included in the final analysis. MTT was significantly higher in patients who developed DCI (6.7 ± 1.2 vs 5.9 ± 1.0; p = 0.03) and cerebral infarction (7.0 ± 1.2 vs 5.9 ± 0.9; p = 0.007); however, no difference in MTT was found between patients with and without a poor outcome (mRS > 2). Early CBF and PS did not differ with respect to functional outcome, DCI, and cerebral infarction. Elevated MTT within 72 h of aneurysm rupture is associated with DCI and cerebral infarction but not with long-term functional outcome. Blood-brain barrier permeability, as assessed by CT perfusion, was not associated with DCI or worse outcome in this cohort. (orig.)

  17. Relationship between brain interstitial fluid tumor necrosis factor-α and cerebral vasospasm after aneurysmal subarachnoid hemorrhage

    OpenAIRE

    Hanafy, Khalid A.; Stuart, R Morgan; Khandji, Alexander G.; Connolly, E. Sander; Badjatia, Neeraj; Mayer, Stephan A; Schindler, Christian

    2010-01-01

    Tumor necrosis factor-α (TNF-α) has a crucial role in the onset of hemolysis-induced vascular injury and cerebral vasoconstriction. We hypothesized that TNF-α measured from brain interstitial fluid would correlate with the severity of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). Methods and results: From a consecutive series of 10 aSAH patients who underwent cerebral microdialysis (MD) and evaluation of vasospasm by CT angiogram (CTA) or digital subtraction angiography (DSA)...

  18. New angiographic measurement tool for analysis of small cerebral vessels: application to a subarachnoid haemorrhage model in the rat

    International Nuclear Information System (INIS)

    Exact quantification of vasospasm by angiography is known to be difficult especially in small vessels. The purpose of the study was to develop a new method for computerized analysis of small arteries and to demonstrate feasibility on cerebral angiographies of rats acquired on a clinical angiography unit. A new software tool analysing grey values and subtracting background noise was validated on a vessel model. It was tested in practice in animals with subarachnoid haemorrhage (SAH). A total of 28 rats were divided into four groups: SAH untreated, SAH treated with local calcium antagonist, SAH treated with placebo, and sham-operated. The diameters of segments of the internal carotid, caudal cerebral, middle cerebral, rostral cerebral and the stapedial arteries were measured and compared to direct measurements of the diameters on magnified images. There was a direct correlation between the cross-sectional area of vessels measured in a phantom and the measurements acquired using the new image analysis method. The spread of repeated measurements with the new software was small compared to the spread of direct measurements of vessel diameters on magnified images. Application of the measurement tool to experimental SAH in rats showed a statistically significant reduction of vasospasm in the SAH groups treated with nimodipine-releasing pellets in comparison to all the other groups combined. The presented computerized method for analysis of small intracranial vessels is a new method allowing precise relative measurements. Nimodipine-releasing subarachnoidal pellets reduce vasospasm, but further testing with larger numbers is necessary. The tool can be applied to human angiography without modification and offers the promise of substantial progress in the diagnosis of vasospasm after SAH. (orig.)

  19. Cerebral blood flow velocities after subarachnoid haemorrhage in relation to the amount of blood clots in the initial computed tomography

    International Nuclear Information System (INIS)

    In 72 patients with acute subarachnoid haemorrhage (SAH) the relationship between the amount of subarachnoid blood clots detected by initial cranial computed tomography (CCT) up to 48 hours after bleeding and the later development of vasospasm, established by blood flow velocity measurement with transcranial Doppler ultrasound (TCD) was investigated. The serial Doppler examinations started within the first 72 hours after SAH and were carried out every second day up to three weeks. Each Doppler recording was accompanied by a neurological examination. Patients classified as Hunt and Hess grade V were excluded from the study. All patients with remarkable brain oedema in CCT or with intracranial pressure above 25 mmHg were also excluded. Because of the well known agedependence of vasospasm after SAH, two age groups were formed. A statistically significant correlation (p > 0.05) between blood flow velocities and blood load after SAH was not found. The mean age of the investigated 72 individuals was 48.9 years (14 up to 76 years). 47 patients were younger than 56 years. Linear regression analysis indicated a correlation with a quite low significance level (r = 0.350, p 0.05) between these two variables could be established in the 25 patients older than 55 years. In a second step an intra-individual comparison of side-to-side differences in TCD and CCT was made. There were no significant differences in blood flow velocities between subjects with or without side-to-side differences in cisternal blood load. It is concluded that the amount of blood visible on initial CCT after SAH is not a powerful predictor of cerebral blood flow velocities measured by TCD. (author)

  20. Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature

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    Skrifvars Markus B

    2012-11-01

    Full Text Available Abstract Introduction The prevalence of cardiac arrest among patients with subarachnoid haemorrhage [SAH], and the prevalence of SAH as the cause following out-of-hospital cardiac arrest [OHCA] or in-hospital cardiac arrest [IHCA] is unknown. In addition it is unclear whether cardiopulmonary resuscitation [CPR] and post-resuscitation care management differs, and to what extent this will lead to meaningful survival following cardiac arrest [CA] due to SAH. Aim We reviewed the literature in order to describe; 1.The prevalence and predisposing factors of CA among patients with SAH 2.The prevalence of SAH as the cause of OHCA or IHCA and factors characterising CPR 3.The survival and management of SAH patients with CA. Material and methods The following sources, PubMed, CinAHL and The Cochrane DataBase were searched using the following Medical Subheadings [MeSH]; 1. OHCA, IHCA, heart arrest and 2. subarachnoid haemorrhage. Articles containing relevant data based on the abstract were reviewed in order to find results relevant to the proposed research questions. Manuscripts in other languages than English, animal studies, reviews and case reports were excluded. Results A total of 119 publications were screened for relevance and 13 papers were included. The prevalence of cardiac or respiratory arrest among all patients with SAH is between 3-11%, these patients commonly have a severe SAH with coma, large bleeds and evidence of raised intracerebral pressure on computed tomography scans compared to those who did not experience a CA. The prevalence of patients with SAH as the cause of the arrest among OHCA cases vary between 4 to 8% among those who die before hospital admission, and between 4 to 18% among those who are admitted. The prevalence of SAH as the cause following IHCA is low, around 0.5% according to one recent study. In patients with OHCA survival to hospital discharge is poor with 0 to 2% surviving. The initial rhythm is commonly asystole or

  1. Cerebral Blood Flow Changes after Shunt in Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage: Analysis by statistical Parametric Mapping

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the changes of regional cerebral blood flow (rCBF) after shunt operation in patients with hydrocephalus after aneurysmal subarachnoid hemorrhage ba statistical parametric mapping (SPM). Seven patients (4 male, mean age 54 years) with hydrocephalus after aneurysmal subarachnoid hemorrhage underwent a shunt operation. Tc-99m HMPAO SPECT was performed within I week before, and 2 weeks after the shunt operation. All of the SPECT images were spatially transformed to standard space, smoothed, and globally normalized. After spatial and count normalization, rCBF of pre- and post- shunting Tc- 99m HMPAO SPECT was estimated at every voxel using t statistics. The voxels with a P value of less than 0.001 were considered to be significantly different. The shunt operation was effective in all patients. Pre-shunting Tc-99m HMPAO SPECT showed hypoperfusion, predominantly in the periventricular area. After shunt operation, periventricular low perfusion was disappeared. The results of this study show that periventricular CBF is impaired in hydrocephalus after aneurysmal subarachnoid hemorrhage. Significant increase of periventricular CBF after shunt operation suggests the evaluation of periventricular CBF by SPM might be of value for the prediction of shunt effectiveness in hydrocephalus

  2. Pediatric intracranial aneurysms

    OpenAIRE

    Tripathy L; Singh S

    2009-01-01

    The incidence of subarachnoid haemorrhage from intracranial aneurysms in the paediatric age group is extremely rare. Interestingly, occurrence of vasospasm has been reported to be less in comparison to the adults. Both coiling and clipping have been advocated in selected cases. Because of the thinness of the wall of the arteries, utmost care should be taken while handling these arteries during surgery. The overall results of surgery in children have been reported to be better than their adult...

  3. Common Variants of the ACE Gene and Aneurysmal Subarachnoid Hemorrhage in a Danish Population: A Case-control Study

    DEFF Research Database (Denmark)

    Staalsø, Jonatan Myrup; Nielsen, Morten; Edsen, Troels BS;

    2011-01-01

    /D polymorphism are associated with aneurysmal subarachnoid hemorrhage. METHODS: The hypothesis was tested with a case-control design in 176 patients with aneurysmal subarachnoid hemorrhage and with 498 hospital controls. Through the pairwise tagging principle, single nucleotide polymorphisms (rs4291 A/T, rs4295...... C/G, rs4305 C/T, rs4311 C/T, rs4331 T/C, rs4343 C/T) in the ACE gene were genotyped along with the I/D polymorphism. Haplotypes were estimated using the PHASE software. RESULTS: Fifty-five haplotypes were identified with 3 of these having a frequency above 5%: ACCCCIT (41.6±0.4%), TGTTTDC (32...... groups of aneurysm location, we found a trend toward an association between homozygotes of the ACCCCIT haplotype and middle cerebral artery aneurysms, odds ratio=2.9 (1.0 to 7.6), which however proved insignificant (P=0.22) after correction for multiple testing. CONCLUSION: In this Danish population, ACE...

  4. Daily trends in white blood cell count and temperature after subarachnoid hemorrhage from aneurysm.

    Science.gov (United States)

    Weir, B; Disney, L; Grace, M; Roberts, P

    1989-08-01

    A retrospective analysis of the cases of 173 patients operated on for aneurysms and admitted to a neurosurgical service early after subarachnoid hemorrhage was conducted with respect to white blood cell (WBC) count and highest daily temperature. Daily trends for the development of clinically significant vasospasm (VSP) as well as mortality during the hospitalization were analyzed. An admission WBC count greater than 15 x 10(9)/l was associated with 55% mortality as opposed to 25% mortality for those with a lower WBC count. The mortality of those with a temperature greater than 37.5 degrees C on Day 0 was 60%, compared with 35% for those with a lower temperature. A WBC count greater than 15 x 10(9)/l on Day 0 was associated with a VSP rate of 40%; a lower WBC count was associated with a VSP rate of 30% Day 0 temperatures greater than 37.5 degrees C were associated with a VSP rate of 40%, while patients with lower temperature had a VSP rate of 30%. By Day 6, the patients with temperatures greater than 37.5 degrees C had a VSP rate of 60%, double that of the VSP rate of those with temperatures less than 37.5 degrees C. WBC count was apparently more closely linked to the chance of dying than the chance of developing VSP. The development of fever after a few days is related to both increased mortality and increased chance of developing VSP. PMID:2770982

  5. Determining rural risk for aneurysmal subarachnoid hemorrhages: A structural equation modeling approach

    Directory of Open Access Journals (Sweden)

    Linda Jayne Nichols

    2016-01-01

    Full Text Available An aneurysmal subarachnoid hemorrhage (aSAH carries a high disability burden. The true impact of rurality as a predictor of outcome severity is unknown. Our aim is to clarify the relationship between the proposed explanations of regional and rural health disparities linked to severity of outcome following an aSAH. An initial literature search identified limited data directly linking geographical location, rurality, rural vulnerability, and aSAH. A further search noting parallels with ischemic stroke and acute myocardial infarct literature presented a number of diverse and interrelated predictors. This a priori knowledge informed the development of a conceptual framework that proposes the relationship between rurality and severity of outcome following an aSAH utilizing structural equation modeling. The presented conceptual framework explores a number of system, environmental, and modifiable risk factors. Socioeconomic characteristics, modifiable risk factors, and timely treatment that were identified as predictors of severity of outcome following an aSAH and within each of these defined predictors a number of contributing specific individual predictors are proposed. There are considerable gaps in the current knowledge pertaining to the impact of rurality on the severity of outcome following an aSAH. Absent from the literature is any investigation of the cumulative impact and multiplicity of risk factors associated with rurality. The proposed conceptual framework hypothesizes a number of relationships between both individual level and system level predictors, acknowledging that intervening predictors may mediate the effect of one variable on another.

  6. Evidence that a panel of neurodegeneration biomarkers predicts vasospasm, infarction, and outcome in aneurysmal subarachnoid hemorrhage.

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    Robert Siman

    Full Text Available Biomarkers for neurodegeneration could be early prognostic measures of brain damage and dysfunction in aneurysmal subarachnoid hemorrhage (aSAH with clinical and medical applications. Recently, we developed a new panel of neurodegeneration biomarkers, and report here on their relationships with pathophysiological complications and outcomes following severe aSAH. Fourteen patients provided serial cerebrospinal fluid samples for up to 10 days and were evaluated by ultrasonography, angiography, magnetic resonance imaging, and clinical examination. Functional outcomes were assessed at hospital discharge and 6-9 months thereafter. Eight biomarkers for acute brain damage were quantified: calpain-derived α-spectrin N- and C-terminal fragments (CCSntf and CCSctf, hypophosphorylated neurofilament H,14-3-3 β and ζ, ubiquitin C-terminal hydrolase L1, neuron-specific enolase, and S100β. All 8 biomarkers rose up to 100-fold in a subset of patients. Better than any single biomarker, a set of 6 correlated significantly with cerebral vasospasm, brain infarction, and poor outcome. Furthermore, CSF levels of 14-3-3β, CCSntf, and NSE were early predictors of subsequent moderate-to-severe vasospasm. These data provide evidence that a panel of neurodegeneration biomarkers may predict lasting brain dysfunction and the pathophysiological processes that lead to it following aSAH. The panel may be valuable as surrogate endpoints for controlled clinical evaluation of treatment interventions and for guiding aSAH patient care.

  7. Cerebrospinal Fluid from Patients with Subarachnoid Haemorrhage and Vasospasm Enhances Endothelin Contraction in Rat Cerebral Arteries

    Science.gov (United States)

    Assenzio, Barbara; Martin, Erica L.; Stankevicius, Edgaras; Civiletti, Federica; Fontanella, Marco; Boccaletti, Riccardo; Berardino, Maurizio; Mazzeo, AnnaTeresa; Ducati, Alessandro; Simonsen, Ulf; Mascia, Luciana

    2015-01-01

    Introduction Previous studies have suggested that cerebrospinal fluid from patients with subarachnoid hemorrhage (SAH) leads to pronounced vasoconstriction in isolated arteries. We hypothesized that only cerebrospinal fluid from SAH patients with vasospasm would produce an enhanced contractile response to endothelin-1 in rat cerebral arteries, involving both endothelin ETA and ETB receptors. Methods Intact rat basilar arteries were incubated for 24 hours with cerebrospinal fluid from 1) SAH patients with vasospasm, 2) SAH patients without vasospasm, and 3) control patients. Arterial segments with and without endothelium were mounted in myographs and concentration-response curves for endothelin-1 were constructed in the absence and presence of selective and combined ETA and ETB receptor antagonists. Endothelin concentrations in culture medium and receptor expression were measured. Results Compared to the other groups, the following was observed in arteries exposed to cerebrospinal fluid from patients with vasospasm: 1) larger contractions at lower endothelin concentrations (p<0.05); 2) the increased endothelin contraction was absent in arteries without endothelium; 3) higher levels of endothelin secretion in the culture medium (p<0.05); 4) there was expression of ETA receptors and new expression of ETB receptors was apparent; 5) reduction in the enhanced response to endothelin after ETB blockade in the low range and after ETA blockade in the high range of endothelin concentrations; 6) after combined ETA and ETB blockade a complete inhibition of endothelin contraction was observed. Conclusions Our experimental findings showed that in intact rat basilar arteries exposed to cerebrospinal fluid from patients with vasospasm endothelin contraction was enhanced in an endothelium-dependent manner and was blocked by combined ETA and ETB receptor antagonism. Therefore we suggest that combined blockade of both receptors may play a role in counteracting vasospasm in patients

  8. Improvement in patient outcomes following endovascular treatment of WFNS grade V subarachnoid haemorrhage from 2000 to 2014.

    Science.gov (United States)

    Inamasu, Joji; Sadato, Akiyo; Oheda, Motoki; Hayakawa, Motoharu; Nakae, Shunsuke; Ohmi, Tatsuo; Adachi, Kazuhide; Nakahara, Ichiro; Hirose, Yuichi

    2016-05-01

    Patient outcomes following grade V subarachnoid haemorrhage (SAH) have been dismal, although they may have improved following recent technological advances in endovascular treatment (EVT). A single-centre, retrospective study was conducted to evaluate whether outcomes have improved from 2000 to 2014 for patients with World Federation of Neurosurgical Societies (WFNS) grade V SAH. Coiling has been the preferred first-line treatment for grade V SAH patients in our institution since 2000. Patients who underwent EVT (n=115) were grouped on the basis of their hospital admission year: 2000-2004 (n=44), 2005-2009 (n=37) and 2010-2014 (n=34). Patient demographics, outcomes and in-hospital mortality rates were compared between the groups. Patient outcomes at discharge were evaluated using the Glasgow Outcome Scale (GOS), with GOS scores of 4-5 defined as favourable outcomes. There were no significant intergroup differences in patient demographics. In addition, there were no significant differences in the frequencies of favourable outcomes (14% in 2000-2004, 16% in 2005-2009 and 26% in 2010-2014). Mortality rates were 52% in 2000-2004, 43% in 2005-2009 and 24% in 2010-2014, with a significantly lower mortality rate in 2010-2014 than in 2000-2004 (p=0.01). Both perioperative rebleeding and delayed cerebral ischaemia decreased over time; however, multivariate regression analysis showed that the former contributed more to the decrease in mortality. Age was the only variable associated with favourable outcomes. The results of this study indicate that EVT is an appropriate therapeutic option for grade V SAH patients. However, multi-centre, prospective trials are required to provide evidence-based verification of the efficacy of EVT. PMID:26778358

  9. Cerebrospinal fluid and plasma cytokines after subarachnoid haemorrhage: CSF interleukin-6 may be an early marker of infection

    Directory of Open Access Journals (Sweden)

    Hopkins Stephen J

    2012-11-01

    Full Text Available Abstract Background Cytokines and cytokine receptor concentrations increase in plasma and cerebrospinal fluid (CSF of patients following subarachnoid haemorrhage (SAH. The relationship between plasma and CSF cytokines, and factors affecting this, are not clear. Methods To help define the relationship, paired plasma and cerebrospinal fluid (CSF samples were collected from patients subject to ventriculostomy. Concentrations of key inflammatory cytokines, interleukin (IL-1ß, IL-1 receptor antagonist (IL-1Ra, IL-1 receptor 2, IL-6, IL-8, IL-10, tumour necrosis factor (TNF-α, and TNF receptors (TNF-R 1 and 2 were determined by immunoassay of CSF and plasma from 21 patients, where samples were available at three or more time points. Results Plasma concentrations of IL-1ß, IL-1Ra, IL-10, TNF-α and TNF-R1 were similar to those in CSF. Plasma TNF-R2 and IL-1R2 concentrations were higher than in CSF. Concentrations of IL-8 and IL-6 in CSF were approximately10 to 1,000-fold higher than in plasma. There was a weak correlation between CSF and plasma IL-8 concentrations (r = 0.26, but no correlation for IL-6. Differences between the central and peripheral pattern of IL-6 were associated with episodes of ventriculostomy-related infection (VRI. A VRI was associated with CSF IL-6 >10,000 pg/mL (P = 0.0002, although peripheral infection was not significantly associated with plasma IL-6. Conclusions These data suggest that plasma cytokine concentrations cannot be used to identify relative changes in the CSF, but that measurement of CSF IL-6 could provide a useful marker of VRI.

  10. Different CT perfusion algorithms in the detection of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Cremers, Charlotte H.P. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Room G03.232, Brain Center Rudolf Magnus Department of Neurology and Neurosurgery, PO Box 85500, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Dankbaar, Jan Willem; Bennink, Edwin; Velthuis, Birgitta K.; Schaaf, Irene C. van der [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Vergouwen, Mervyn D.I.; Rinkel, Gabriel J.E. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Room G03.232, Brain Center Rudolf Magnus Department of Neurology and Neurosurgery, PO Box 85500, Utrecht (Netherlands); Vos, Pieter C. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands)

    2015-05-01

    Tracer delay-sensitive perfusion algorithms in CT perfusion (CTP) result in an overestimation of the extent of ischemia in thromboembolic stroke. In diagnosing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), delayed arrival of contrast due to vasospasm may also overestimate the extent of ischemia. We investigated the diagnostic accuracy of tracer delay-sensitive and tracer delay-insensitive algorithms for detecting DCI. From a prospectively collected series of aSAH patients admitted between 2007-2011, we included patients with any clinical deterioration other than rebleeding within 21 days after SAH who underwent NCCT/CTP/CTA imaging. Causes of clinical deterioration were categorized into DCI and no DCI. CTP maps were calculated with tracer delay-sensitive and tracer delay-insensitive algorithms and were visually assessed for the presence of perfusion deficits by two independent observers with different levels of experience. The diagnostic value of both algorithms was calculated for both observers. Seventy-one patients were included. For the experienced observer, the positive predictive values (PPVs) were 0.67 for the delay-sensitive and 0.66 for the delay-insensitive algorithm, and the negative predictive values (NPVs) were 0.73 and 0.74. For the less experienced observer, PPVs were 0.60 for both algorithms, and NPVs were 0.66 for the delay-sensitive and 0.63 for the delay-insensitive algorithm. Test characteristics are comparable for tracer delay-sensitive and tracer delay-insensitive algorithms for the visual assessment of CTP in diagnosing DCI. This indicates that both algorithms can be used for this purpose. (orig.)

  11. Different CT perfusion algorithms in the detection of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Tracer delay-sensitive perfusion algorithms in CT perfusion (CTP) result in an overestimation of the extent of ischemia in thromboembolic stroke. In diagnosing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), delayed arrival of contrast due to vasospasm may also overestimate the extent of ischemia. We investigated the diagnostic accuracy of tracer delay-sensitive and tracer delay-insensitive algorithms for detecting DCI. From a prospectively collected series of aSAH patients admitted between 2007-2011, we included patients with any clinical deterioration other than rebleeding within 21 days after SAH who underwent NCCT/CTP/CTA imaging. Causes of clinical deterioration were categorized into DCI and no DCI. CTP maps were calculated with tracer delay-sensitive and tracer delay-insensitive algorithms and were visually assessed for the presence of perfusion deficits by two independent observers with different levels of experience. The diagnostic value of both algorithms was calculated for both observers. Seventy-one patients were included. For the experienced observer, the positive predictive values (PPVs) were 0.67 for the delay-sensitive and 0.66 for the delay-insensitive algorithm, and the negative predictive values (NPVs) were 0.73 and 0.74. For the less experienced observer, PPVs were 0.60 for both algorithms, and NPVs were 0.66 for the delay-sensitive and 0.63 for the delay-insensitive algorithm. Test characteristics are comparable for tracer delay-sensitive and tracer delay-insensitive algorithms for the visual assessment of CTP in diagnosing DCI. This indicates that both algorithms can be used for this purpose. (orig.)

  12. The comparative study on diagnostic validity of cerebral aneurysm by computed tomography angiography versus digital subtraction angiography after subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Masih Saboori

    2011-01-01

    Full Text Available Background: In order to declare the preoperative diagnostic value of brain aneurysms, two radiological modalities, computed tomographic angiography and digital subtraction angiography were compared. Methods: In this descriptive analytic study, diagnostic value of computed tomographic angiography (CTA was com-pared with digital subtraction angiography (DSA. Sensitivity, specificity, positive and negative predictive values were calculated and compared between the two modalities. All data were analyzed with SPSS software, version 16. Results: Mean age of patients was 49.5 ± 9.13 years. 57.9 % of subjects were female. CTA showed 89% sensitivity and 100% specificity whereas DSA demonstrated 74% sensitivity and 100% specificity. Positive predictive value of both methods was 100%, but negative predictive value of CTA and DSA was 85% and 69%, respectively. Conclusions: Based on our data, CTA is a valuable diagnostic modality for detection of brain aneurysm and su-barachnoid hemorrhage.

  13. Diagnostic accuracy of contrast enhancement MRI versus CTA in diagnosis of intracranial aneurysm in patients with non-traumatic subarachnoid hemorrhage

    OpenAIRE

    Gihan Hassan Gamal

    2015-01-01

    Aim of the study: The most common cause of spontaneous SAH is the rupture of cerebral aneurysm. So it is very important to exclude it from circulation as soon as possible using endovascular therapy. The aim was to determine whether contrast enhancement magnetic resonance angiography (CEMRA) is preferable to computed tomography angiography (CTA) in detection of intracranial aneurysm in patients presenting with non-traumatic subarachnoid hemorrhage (SAH). Patients and methods: Twenty-five pa...

  14. Impaired endothelial function after aneurysmal subarachnoid haemorrhage correlates with arginine:asymmetric dimethylarginine ratio

    DEFF Research Database (Denmark)

    Bergström, A; Staalsø, J M; Romner, B; Olsen, N V

    2014-01-01

    and arginine:ADMA ratio (r=0.43, P<0.005), but not with nitrite/nitrate, VMCA, or S-100B. CONCLUSIONS: Peripheral flow-mediated vasodilation is attenuated in the first days after SAH indicating acute systemic endothelial dysfunction. Impairment of endothelial function after SAH correlates with...

  15. Detection and assessment of circle of Willis aneurysms in acute subarachnoid hemorrhage with three-dimensional computed tomographic angiography: correlation with digital substraction angiography findings.

    Science.gov (United States)

    Lai, P H; Yang, C F; Pan, H B; Chen, C; Ho, J T; Hsu, S S

    1999-10-01

    In this retrospective study, we examined the usefulness of computed tomographic angiography (CTA) for the detection and assessment of circle of Willis aneurysms in patients with acute nontraumatic subarachnoid hemorrhage (SAH), using selective digital substraction angiography (DSA) as the gold standard. Thirty-five patients who presented with acute, nontraumatic SAH, diagnosed on the basis of unenhanced computed tomography or lumbar puncture findings or both, underwent both CTA and DSA. The CTA images were interpreted for the presence, location, size, and shape of the aneurysm, presence of a neck, and relationship of the aneurysm to adjacent arterial branches. The CTA and DSA images were then compared, with the latter images serving as the gold standard. DSA revealed 37 aneurysms in 32 patients and ruled out intracranial aneurysms in the remaining three. The sensitivity and specificity of CTA for aneurysm detection were 97% and 100%, respectively. The size of the smallest aneurysm shown was 4 mm, and the largest aneurysm was 21 mm. The size and lobularity of the aneurysms estimated from CTA images corresponded well with those estimated from DSA images. In addition, CTA provided a three-dimensional representation of the aneurysmal lesion, which was considered useful for surgical planning. Our results confirm the accuracy of CTA in comparison with DSA. Because of its reliability, minimal invasiveness, and rapidity, CTA may become the technique of choice for neuroradiologic work-up of SAH patients. DSA then would be used to diagnose intracranial aneurysms only in selected, questionable cases. PMID:10575836

  16. Systematic review of reviews of risk factors for intracranial aneurysms

    International Nuclear Information System (INIS)

    Systematic reviews of systematic reviews identify good quality reviews of earlier studies of medical conditions. This article describes a systematic review of systematic reviews performed to investigate factors that might influence the risk of rupture of an intracranial aneurysm. It exemplifies the technique of this type of research and reports the finding of a specific study. The annual incidence of subarachnoid haemorrhage resulting from the rupture of intracranial aneurysms is estimated to be nine per 100,000. A large proportion of people who have this bleed, will die or remain dependent on the care of others for some time. Reliable knowledge about the risks of subarachnoid haemorrhage in different populations will help in planning, screening and prevention strategies and in predicting the prognosis of individual patients. If the necessary data were available in the identified reviews, an estimate for the numerical relationship between a particular characteristic and the risk of subarachnoid haemorrhage was included in this report. The identification of eligible systematic reviews relied mainly on the two major bibliographic databases of the biomedical literature: PubMed and EMBASE. These were searched in 2006, using specially designed search strategies. Approximately 2,000 records were retrieved and each of these was checked carefully against the eligibility criteria for this systematic review. These criteria required that the report be a systematic review of studies assessing the risk of subarachnoid haemorrhage in patients known to have an unruptured intracranial aneurysm or of studies that had investigated the characteristics of people who experienced a subarachnoid haemorrhage without previously being known to have an unruptured aneurysm. Reports which included more than one systematic review were eligible and each of these reviews was potentially eligible. The quality of each systematic review was assessed. In this review, 16 separate reports were

  17. Brain aneurysm repair

    Science.gov (United States)

    ... aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm ... Your scalp, skull, and the coverings of the brain are opened. A metal clip is placed at ...

  18. Risk factors responsible for the volume of hemorrhage in aneurysmal subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Jianfeng Liu

    2016-01-01

    Conclusion: Preadmission DBP, multiple aneurysms, and aneurysms of the ACOA are associated with markedly increased volume of hemorrhage as evaluated by the revised Fisher grades. Thus, patients harboring an intracranial aneurysm having the above mentioned features should seek an early intervention in order to prevent the occurrence of aSAH.

  19. Detection of intracranial aneurysms with unenhanced and echo contrast enhanced transcranial power Doppler

    OpenAIRE

    Turner, C.; Kirkpatrick, P

    2000-01-01

    OBJECTIVE—To assess transcranial power Doppler and the effect of an intravenous ultrasonic contrast agent for detecting intracranial aneurysms in patients admitted with a subarachnoid haemorrhage
METHODS—203 patients with subarachnoid haemorrhage were examined with the operator blind to the results of the admission CT and subsequent digital subtraction angiogram (DSA). In 98 cases patients were imaged using unenhanced transcranial power Doppler, and in 105cases, patients ...

  20. Effect of intra arterial nimodipine infusion for the treatment of symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage

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    Lee, Jin Young; Shin, Hwa Seon; Choi, Hye Young; Chung, Sung Hoon; You, Jin Jong; Choi, Dae Seob; Son, Seung Nam [Gyeongsang National Univ. Hospital/Gyeongsang National Univ. School of Medicine, Jinju (Korea, Republic of); Ryu, Jae Wook [Samsung Seoul Hospital, Seoul (Korea, Republic of)

    2012-06-15

    Symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage (SAH) is one of the major factors which cause morbidity and mortality of patients. The purpose of this study was to evaluate the effectiveness of intra-arterial nimodipine (IAN) infusion therapy in patients with symptomatic cerebral vasospasm. Between February 2005 and April 2011, fifty patients with symptomatic cerebral vasospasm following an aneurysmal SAH were treated with IAN infusion. After selective arterial catheterization, nimodipine was infused at a rate of 0.1 mg/min and a total of 2-3 mg per vessel was infused. We retrospectively reviewed the immediate angiographic results and clinical outcome at discharge. A grade of 5 and 4 in the Glasgow Outcome Scale (GOS) were considered favorable outcomes. In 50 patients, 117 procedures of IAN infusion (1-7; mean, 2.3)were done. After the treatment, immediate angiographic improvement was achieved in 113 (96.6%) of 117 procedures. No major complications occurred. At discharge, 38 (76%) patients showed a favorable clinical outcome in the GOS. IAN infusion therapy is safe and effective for the treatment of cerebral vasospasm following an aneurysmal SAH. However, the limitation is that repeated treatment is needed.

  1. Effect of intra arterial nimodipine infusion for the treatment of symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage (SAH) is one of the major factors which cause morbidity and mortality of patients. The purpose of this study was to evaluate the effectiveness of intra-arterial nimodipine (IAN) infusion therapy in patients with symptomatic cerebral vasospasm. Between February 2005 and April 2011, fifty patients with symptomatic cerebral vasospasm following an aneurysmal SAH were treated with IAN infusion. After selective arterial catheterization, nimodipine was infused at a rate of 0.1 mg/min and a total of 2-3 mg per vessel was infused. We retrospectively reviewed the immediate angiographic results and clinical outcome at discharge. A grade of 5 and 4 in the Glasgow Outcome Scale (GOS) were considered favorable outcomes. In 50 patients, 117 procedures of IAN infusion (1-7; mean, 2.3)were done. After the treatment, immediate angiographic improvement was achieved in 113 (96.6%) of 117 procedures. No major complications occurred. At discharge, 38 (76%) patients showed a favorable clinical outcome in the GOS. IAN infusion therapy is safe and effective for the treatment of cerebral vasospasm following an aneurysmal SAH. However, the limitation is that repeated treatment is needed

  2. Spontaneous disappearance and reappearance of a ruptured cerebral aneurysm: one case found in a group of 33 consecutive patients with subarachnoid hemorrhage who underwent repeat angiography.

    Science.gov (United States)

    Nakajima, Y; Yoshimine, T; Mori, H; Nakamuta, K; Fujimura, I; Sakashita, K; Kohmura, E; Hayakawa, T; Yokota, J

    2000-09-01

    The spontaneous disappearance and reappearance of a ruptured cerebral aneurysm is generally assumed to be a rare phenomenon although the actual incidence is unknown. Among 39 consecutive cases of acute subarachnoid hemorrhage (SAH), 33 were studied by three-dimensional computed tomographic angiography (CTA) within 6 h after the onset of SAH, followed by digital subtraction angiography (DSA) within 24 h after the ictus. Of those patients, one, a 58-year-old woman, had a saccular aneurysm at the distal anterior cerebral artery; the aneurysm was clearly demonstrated by CTA 2.5 h after the SAH onset, but was not shown by a subsequent DSA performed 8.5 h after the ictus. A follow-up DSA detected the neck of aneurysm on day 11, and the whole aneurysm was visualized on day 19. The observations in this particular case suggest that the spontaneous disappearance of a ruptured cerebral aneurysm may occur during the ultra-early stage of SAH and that reappearance may follow during the next few weeks. The patient did not suffer complications such as vasospasm or systemic hypotension nor was she treated with antifibrinolytic agents. The aneurysmal shape and the surrounding clot are considered as putative factors possibly related to the intermittent appearance of the aneurysm. PMID:11045020

  3. Neurovascular lessons from a pair of identical twins with cerebral aneurysms

    OpenAIRE

    Sharma, P.; Brown, M.

    2001-01-01

    A pair of hypertensive identical twins are reported, one of whom was non-compliant with her antihypertension medication, and after a subarachnoid haemorrhage was found to have multiple cerebral aneurysms. The other asymptomatic compliant twin was noted to have only a single small cerebral aneurysm. As both identical twins are likely to share the same cerebral vascular architecture it is suggested that good control of blood pressure contributed to the cerebral vascular integrity of the asympto...

  4. Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage

    International Nuclear Information System (INIS)

    Background. If detected in time, delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) may be treated by balloon angioplasty or chemical vasospasmolysis in order to enhance cerebral blood flow (CBF) and protect the brain from ischemic damage. This study was conceived to compare the diagnostic accuracy of detailed neurological examination, Transcranial Doppler Sonography (TCD), and Perfusion-CT (PCT) to detect angiographic vasospasm. Methods. The sensitivity, specificity, positive and negative predictive values of delayed ischemic neurological deterioration (DIND), pathological findings on PCT-maps, and accelerations of the mean flow velocity (MVF) were calculated. Results. The accuracy of DIND to predict angiographic vasospasm was 0.88. An acceleration of MFV in TCD (>140 cm/s) had an accuracy of 0.64, positive PCT-findings of 0.69 with a higher sensitivity, and negative predictive value than TCD. Interpretation. Neurological assessment at close intervals is the most sensitive and specific parameter for cerebral vasospasm. PCT has a higher accuracy, sensitivity and negative predictive value than TCD. If detailed neurological evaluation is possible, it should be the leading parameter in the management and treatment decisions. If patients are not amenable to detailed neurological examination, PCT at regular intervals is a helpful tool to diagnose secondary vasospasm after aneurysmal SAH

  5. Contrast Extravasation on Computed Tomography Angiography Imitating a Basilar Artery Trunk Aneurysm in Subsequent Conventional Angiogram-Negative Subarachnoid Hemorrhage: Report of Two Cases with Different Clinical Courses

    OpenAIRE

    Cho, Won Ho; Choi, Hyuk Jin; Nam, Kyoung Hyup; Lee, Jae Il

    2015-01-01

    Contrast extravasation on computed tomography angiography (CTA) is rare but becoming more common, with increasing use of CTA for various cerebral vascular diseases. We report on two cases of spontaneous subarachnoid hemorrhage (SAH) in which the CTA showed an upper basilar trunk saccular lesion suggesting ruptured aneurysm. However, immediate subsequent digital subtraction angiography (DSA) failed to show a vascular lesion. In one case, repeated follow up DSA was also negative. The patient wa...

  6. Contrast Extravasation on Computed Tomography Angiography Imitating a Basilar Artery Trunk Aneurysm in Subsequent Conventional Angiogram-Negative Subarachnoid Hemorrhage: Report of Two Cases with Different Clinical Courses

    OpenAIRE

    Cho, Won Ho; Choi, Hyuk Jin; Nam, Kyoung Hyup; Lee, Jae Il

    2015-01-01

    Contrast extravasation on computed tomography angiography (CTA) is rare but becoming more common, with increasing use of CTA for various cerebral vascular diseases. We report on two cases of spontaneous subarachnoid hemorrhage (SAH) in which the CTA showed a saccular lesion of the upper basilar trunk suggesting a ruptured aneurysm. However, no vascular lesion was observed on immediate subsequent digital subtraction angiography (DSA). In one case, repeated follow up DSA was also negative. The ...

  7. Poor outcome is associated with less negative fluid balance in patients with aneurysmal subarachnoid hemorrhage treated with prophylactic vasopressor-induced hypertension

    OpenAIRE

    Sakr, Yasser; Dünisch, Pedro; Santos, Clesar; Matthes, Lena; Zeidan, Mohamed; Reinhart, Konrad; Kalff, Rolf; Ewald, Christian

    2016-01-01

    Background Aneurysmal subarachnoid hemorrhage (SAH) is a serious condition associated with high mortality rates and long-term disability. We investigated the impact of fluid balance on neurologic outcome after adjustment for possible confounders related to intensive care therapy and extra-cerebral organ failure during the early phase after SAH. Methods In this retrospective study, we analyzed data from all 142 adult patients admitted to our university hospital surgical intensive care unit (IC...

  8. Risk–benefit analysis of the treatment of unruptured intracranial aneurysms

    Science.gov (United States)

    Vindlacheruvu, R; Mendelow, A; Mitchell, P

    2005-01-01

    Objectives: To determine under what circumstances repair of unruptured intracranial aneurysms may be beneficial. Methods: A life expectancy analysis of patients with unruptured aneurysms with and without repair based on prospective data from the International Study of Unruptured Intracranial Aneurysms (ISUIA). Results: Life years are lost at all ages by repairing anterior circulation aneurysms under 7 mm in diameter in patients with no history of a subarachnoid haemorrhage from another aneurysm (incidental). For all other aneurysms the number of life years saved by repair is dependent on the patient's age at the time when repair is undertaken. Between 2 and 40 years are saved by repairing aneurysms in patients aged 20 years. These benefits fall to 0 when remaining life expectancy falls below 15–35 years, corresponding to the age range of 45–70 years. Conclusions: Repair of unruptured aneurysms benefits patients harbouring them by improving life expectancy except in certain circumstances. The exceptions are patients with remaining life expectancy less than 15–35 years or aged 45–70 (depending on aneurysm size and location) and patients with aneurysms of the anterior circulation under 7 mm in diameter with no history of a previous subarachnoid haemorrhage. These results are based on the findings of the ISUIA and are dependent on their accuracy. PMID:15654039

  9. Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling

    OpenAIRE

    Westerlaan, H. E.; Gravendeel, J.; Fiore, D; Metzemaekers, J. D. M.; Groen, R. J. M.; Mooij, J.J.A.; Oudkerk, M.

    2007-01-01

    Introduction We sought to establish whether CT angiography (CTA) can be applied to the planning and performance of clipping or coiling in ruptured intracranial aneurysms without recourse to intraarterial digital subtraction angiography (IA-DSA). Methods Over the period April 2003 to January 2006 in all patients presenting with a subarachnoid haemorrhage CTA was performed primarily. If CTA demonstrated an aneurysm, coiling or clipping was undertaken. IA-DSA was limited to patients with negativ...

  10. Outcome after emergency surgery without angiography in patients with intracerebral haemorrhage after aneurysm rupture

    DEFF Research Database (Denmark)

    Bergdal, Ove; Springborg, Jacob; Hauerberg, John;

    2009-01-01

    aneurysm occlusion without preoperative angiography. METHODS: We retrospectively identified 13 consecutive patients. We recorded clinical data and evaluated mortality and morbidity with the Glasgow Outcome Score (GOS) and Telephone Interview of Cognitive Status (TICS). FINDINGS: At follow up seven of...

  11. Prognosis Predicting Score for Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage: A Risk Modeling Study for Individual Elderly Patients.

    Science.gov (United States)

    Duan, Guoli; Yang, Pengfei; Li, Qiang; Zuo, Qiao; Zhang, Lei; Hong, Bo; Xu, Yi; Zhao, Wenyuan; Liu, Jianmin; Huang, Qinghai

    2016-02-01

    The elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) have a greater risk of poor clinical outcome after endovascular treatment (EVT) than younger patients do. Hence, it is necessary to explore which factors are associated with poor outcome and develop a predictive score specifically for elderly patients with aSAH receiving EVT. The aim of this study was to develop and validate a predictive score for 1-year outcomes in individual elderly patients with aSAH underwent EVT.In this 10-year prospective study, 520 consecutive aSAH elderly (age ≥ 60 years) patients underwent EVT in a single center were included. The risk factors, periprocedural, and 1-year follow-up data of all patients were entered in a specific prospective database. The modified Rankin scale was used for evaluating clinical outcome. To optimize the model's predictive capacity, the original matrix was randomly divided in 2 submatrices (learning and testing). The predictive score was developed using Arabic numerals for all variables based on the variable coefficients (β) of multivariable logistic regression analysis in the learning set and the predictive performance evaluation was assessed in the testing set. The risk classes were constructed using classification criteria based on sensitivity and specificity. The poor outcome rate at 1 year was 26.15%. Six risk factors, including age, hypertension, Hunt-Hess scale, Fisher scale, aneurysm location, and periprocedural complications, were independently associated with poor outcome and assembled the Changhai score. The discriminative power analysis with the area under the receiver operating characteristic curve (AUC) of the Changhai score was statistically significant (0.864, 0.824-0.904, P EVT. In combination with these risk factors, the Changhai score can be a useful tool in the prediction of clinical outcome but needs to be validated in various centers before it can be recommended for application. PMID:26886607

  12. Matched Cohort Analysis of the Effects of Limb Remote Ischemic Conditioning in Patients with Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Laiwalla, Azim N; Ooi, Yinn Cher; Liou, Raymond; Gonzalez, Nestor R

    2016-02-01

    Remote ischemic conditioning (RIC) is a powerful innate response to transient subcritical ischemia that protects against severe ischemic insults at distant sites. We have previously shown the safety and feasibility of limb RIC in aneurysmal subarachnoid hemorrhage (aSAH) patients, along with changes in neurovascular and cerebral metabolism. In this study, we aim to detect the potential effect of an established lower-limb conditioning protocol on clinical outcomes of aSAH patients. Neurologic outcome (modified Rankin Scale (mRS)) of patients enrolled in a prospective trial (RIPC-SAH) was measured. A matching algorithm was applied to identify control patients with aSAH from an institutional departmental database. RIC patients underwent four lower-limb conditioning sessions, consisting of four 5-min cycles per session over nonconsecutive days. Good functional outcome was defined as mRS of 0 to 2. The study population consisted of 21 RIC patients and 61 matched controls. There was no significant intergroup difference in age, gender, aneurysm location, clipping vs coiling, Fisher grades, Hunt and Hess grades, or vasospasm. RIC was independently associated with good outcome (OR 5.17; 95% confidence interval (CI) 1.21-25.02). RIC also showed a trend toward lower incidence of stroke (28.6 vs. 47.5%) and death (4.8 vs. 19.7%). Lower-limb RIC following aSAH appears to have a positive effect in the functional outcomes of patients with aSAH. While this effect is consistent with prior preclinical studies, future trials are necessary to conclusively evaluate the effects of RIC for aSAH. PMID:26630942

  13. Fusiform aneurysm of a persistent trigeminal artery associated with rare intracranial arterial variations and subarachnoid hemorrhage.

    Science.gov (United States)

    Kimball, David; Ples, Horia; Kimball, Heather; Miclaus, Gratian D; Matusz, Petru; Loukas, Marios

    2015-01-01

    The trigeminal artery is one of four primitive anastomoses between the internal carotid artery and vertebrobasilar system that regresses in the sixth week of fetal development. A persistent trigeminal artery (PTA) is generally an incidental finding but may also be associated with intracranial vascular pathologies such as aneurysms, arteriovenous malformations, and cranial nerve compression syndromes. We present an extremely rare case of a right PTA with an associated bleeding fusiform aneurysm located in the carotidian (lateral) part of the PTA. In addition, this rare anatomic variation was associated with bilateral absence of the posterior communicating arteries, a left posterior cerebral artery originating from the left internal carotid artery, and agenesis of the A1 segment of the left anterior cerebral artery. PMID:25053265

  14. Cerebral angiography in the rat with mammographic equipment: a simple, cost-effective method for assessing vasospasm in experimental subarachnoid haemorrhage

    International Nuclear Information System (INIS)

    We report quantification of vasospasm following subarachnoid haemorrhage (SAH) and the effect of a new antivasospastic free radical scavenger (AVS) in rats, using an angiographic technique developed in our laboratory. We acquired single-exposure angiograms with mammographic equipment, using a 0.1 mm diameter focal spot and single-emulsion mammographic films. Contrast medium was injected through a PE50 catheter in the common carotid artery, after the external carotid artery had been ligated to divert flow towards the internal carotid artery territory. Measurements of the M1 and A1 segments and of the middle third of the basilar artery were made by projecting the angiograms directly as slides and using the endovascular catheter as an internal reference. We tested the technique on 40 male albino Sprague-Dawley rats divided into four groups: sham-operated+saline, SAH+saline, sham-operated+AVS and SAH+AVS. We were able to measure the diameter of the principal intracranial arteries in all the animals. With our technique, which is cost-effective when compared to many of those reported recently, we could detect intracranial vasospasm in all untreated rats with SAH, and confirm antivasospastic effects of AVS. (orig.)

  15. Massive upper gastrointestinal haemorrhage due to direct visceral erosion of splenic artery aneurysm.

    Directory of Open Access Journals (Sweden)

    Shahani R

    1994-10-01

    Full Text Available Six male patients (age group: 30-60 years with aneurysm of the splenic artery presented with massive upper gastrointestinal tract hemorrhage. Five patients presented with hematemesis and one with melena. Chronic pancreatitis was noted in all the patients, four of whom were chronic alcoholics. Endoscopy was not useful in diagnosis. Bleeding through the Ampulla of Vater was seen in the patient with melena. Angiography was diagnostic in all. Pancreatic resection including the aneurysm(2, and bipolar ligation with underrunning of the aneurysm (3 were the operative procedures. Distal pancreatectomy with pancreatogastrostomy was carried out in the patient with hemosuccus pancreaticus. If endoscopy is inconclusive, angiography and early intervention is recommended to reduce the high mortality associated with conservative management.

  16. Intra-arterial colforsin daropate for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Cerebral vasospasm (CV) remains a major cause of mortality and morbidity in patients with subarachnoid hemorrhage (SAH). Here, we examined the effectiveness and safety of intra-arterial injection of colforsin daropate hydrochloride (CDH). A consecutive series of 29 patients with angiographically confirmed CV received intra-arterial CDH (IAC) therapy. Angiographic changes in spastic vessels and the cerebral circulation time (CCT) were assessed before and after IAC treatment, together with the change in clinical status. IAC treatment was performed in 53 procedures in 29 patients. Angiographic improvement was observed following all procedures (100%), and clinical improvement was observed following 36 of 42 procedures (86%) in symptomatic cases. CCT improved significantly. At the 3-month follow-up, 19 patients (66%) showed good recovery or moderate disability on the Glasgow Outcome Scale. Major adverse effects were headache and increased heart rate. IAC treatment was effective and safe for the treatment of CV after SAH. (orig.)

  17. Quantification of structural cerebral abnormalities on MRI 18 months after aneurysmal subarachnoid hemorrhage in patients who received endovascular treatment

    International Nuclear Information System (INIS)

    Volume measurements performed on brain MRI after aneurysmal subarachnoid hemorrhage (aSAH) may provide insight into the structural abnormalities that underlie the commonly occurring and persistent long-term functional deficits after aSAH. We examined the pattern of long-term cerebral structural changes on MRI in relation to known risk factors for poor functional outcome. We studied MRI scans from 38 patients who received endovascular treatment and were not dependent for activities of daily life at 18 months after aSAH. Risk factors for poor functional outcome (clinical condition, Hijdra score, and bicaudate index on admission; occurrence of hydrocephalus or delayed cerebral infarction during hospitalization) were related to supratentorial cerebral parenchymal and lateral ventricular volumes on MRI with linear regression analyses adjusted for age, sex, and intracranial volume. Clinical condition, Hijdra score, and bicaudate index on admission were not related to cerebral parenchymal volume at 18 months. A higher bicaudate index on admission was related to lateral ventricular enlargement at 18 months after aSAH (Beta; 95%CI: 0.51; 0.14<->0.88). Delayed cerebral infarction was related to smaller cerebral parenchymal volumes (-0.14; -0.25<->-0.04) and to lateral ventricular enlargement (0.49; 0.16<->0.83) at 18 months. Volume measurements of the brain are able to quantify patterns of long-term cerebral damage in relation to different risk factors after aSAH. Application of volumetric techniques may provide more insight into the heterogeneous underlying pathophysiological processes. After confirmation of these results in larger studies, volumetric measures might even be used as outcome measures in future treatment studies. (orig.)

  18. Quantification of structural cerebral abnormalities on MRI 18 months after aneurysmal subarachnoid hemorrhage in patients who received endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Bresser, Jeroen de [University Medical Center Utrecht, Department of Radiology, P.O. Box 85500, Utrecht (Netherlands); Schaafsma, Joanna D.; Luitse, Merel J.A.; Rinkel, Gabriel J.E.; Biessels, Geert Jan [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht (Netherlands); Viergever, Max A. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands)

    2015-03-01

    Volume measurements performed on brain MRI after aneurysmal subarachnoid hemorrhage (aSAH) may provide insight into the structural abnormalities that underlie the commonly occurring and persistent long-term functional deficits after aSAH. We examined the pattern of long-term cerebral structural changes on MRI in relation to known risk factors for poor functional outcome. We studied MRI scans from 38 patients who received endovascular treatment and were not dependent for activities of daily life at 18 months after aSAH. Risk factors for poor functional outcome (clinical condition, Hijdra score, and bicaudate index on admission; occurrence of hydrocephalus or delayed cerebral infarction during hospitalization) were related to supratentorial cerebral parenchymal and lateral ventricular volumes on MRI with linear regression analyses adjusted for age, sex, and intracranial volume. Clinical condition, Hijdra score, and bicaudate index on admission were not related to cerebral parenchymal volume at 18 months. A higher bicaudate index on admission was related to lateral ventricular enlargement at 18 months after aSAH (Beta; 95%CI: 0.51; 0.14<->0.88). Delayed cerebral infarction was related to smaller cerebral parenchymal volumes (-0.14; -0.25<->-0.04) and to lateral ventricular enlargement (0.49; 0.16<->0.83) at 18 months. Volume measurements of the brain are able to quantify patterns of long-term cerebral damage in relation to different risk factors after aSAH. Application of volumetric techniques may provide more insight into the heterogeneous underlying pathophysiological processes. After confirmation of these results in larger studies, volumetric measures might even be used as outcome measures in future treatment studies. (orig.)

  19. Contrast Extravasation on Computed Tomography Angiography Imitating a Basilar Artery Trunk Aneurysm in Subsequent Conventional Angiogram-Negative Subarachnoid Hemorrhage: Report of Two Cases with Different Clinical Courses.

    Science.gov (United States)

    Cho, Won Ho; Choi, Hyuk Jin; Nam, Kyoung Hyup; Lee, Jae Il

    2015-12-01

    Contrast extravasation on computed tomography angiography (CTA) is rare but becoming more common, with increasing use of CTA for various cerebral vascular diseases. We report on two cases of spontaneous subarachnoid hemorrhage (SAH) in which the CTA showed an upper basilar trunk saccular lesion suggesting ruptured aneurysm. However, immediate subsequent digital subtraction angiography (DSA) failed to show a vascular lesion. In one case, repeated follow up DSA was also negative. The patient was treated conservatively and discharged without any neurologic deficit. In the other case, the patient showed sudden mental deterioration on the third hospital day and her brain CT showed rebleeding. The immediate follow up DSA showed contrast stagnation in the vicinity of the upper basilar artery, suggestive of pseudoaneurysm. Double stents deployment at the disease segment was performed. Due to the frequent use of CTA, contrast extravasation is an increasingly common observation. Physicians should be aware that basilar artery extravasation can mimic the appearance of an aneurysm. PMID:27066442

  20. Mesenteric ischaemia after endovascular coiling of ruptured cerebral aneurysms.

    LENUS (Irish Health Repository)

    Kamel, M H

    2012-02-03

    Three patients were referred to a national neurosurgical centre following CT evidence of subarachnoid haemorrhage. The three patients, who were referred from different institutions within a seven week period, were Fisher grade 3 and WFNS Grade I at all times. Angiography showed a PCOM aneurysm in one case, a ruptured Basilar tip aneurysm and an unruptured ACOM aneurysm in another case, and an ACOM aneurysm in the third case. It was decided that the aneurysms were suitable for endovascular coiling. These patients had unremarkable intraoperative catheterizations and coiling but subsequently deteriorated post-operatively due to mesenteric ischaemia. Two patients required colectomy for mesenteric ischaemia, and the third arrested secondary to sepsis from bowel perforation. We discuss the various causes that may explain this association, and we alert the neurosurgical community for this complication which has not been reported before.

  1. CT Angiography May Be a More Useful Modality Than Digital Subtractional Angiography in the Diagnosis of Patients with Subarachnoid Hemorrhage Due to Cerebral Aneurysms

    Directory of Open Access Journals (Sweden)

    Masih Saboori

    2011-05-01

    Full Text Available Background/Objective: The preoperative diagnostic"nvalidity of two radiological modalities (computed"ntomographic angiography and digital subtractional"nangiography in the diagnosis of brain aneurysms were"ncompared."nPatients and Methods: During 2 years of study,"nreferred patients with signs of SAH to the emergency"nward underwent routine CT scan and after SAH was"nfirmly diagnosed, CTA and DSA methods were done"nand patients with correct indications were operated."nAfter surgery and detecting the existence of aneurysms"nand their location, the data were recorded in a"nchecklist. Sensitivity, specificity, positive and negative"npredictive values were calculated and compared in"nboth methods."nResults: The mean age of the 30 patients were"n49.5±9.13 years. 57.9 % of the subjects were female"nand the others were male. On CTA reports 100% true"npositive, 0% false positive, 85% true negative, and 15%"nfalse negative were calculated. DSA reports were true"npositive, false positive, true negative and false negative"nin 100%, 0%, 69% and 31%, respectively. CTA showed"n89% of sensitivity, and 100% of specificity in contrast"nto 74% sensitivity and 100% specificity of DSA."nPositive predictive values of both methods were 100%,"nbut negative predictive values of CTA and DSA were"n85% and 69%, respectively."nConclusion: Based on our data, CTA is more preferable"ndiagnostic modality for the brain aneurysm's site and"nanatomy in patients with subarachnoid hemorrhage"nthan DSA."nKeywords: CT Scan Angiography, Digital Subtraction"nAngiography, Cerebral Aneurysm, Subarachnoid"nHemorrhage

  2. Delayed postpartum haemorrhage secondary to a ruptured uterine artery pseudo-aneurysm, successfully treated by transarterial embolisation.

    Science.gov (United States)

    Moatti, Zoe; Nisner, Tamar; Saini, Ashish; Karoshi, Mahantesh

    2011-01-01

    A 29-year-old woman (gravida 1, para 1) had an uneventful first pregnancy and a delivery by emergency caesarean section at term. The caesarean section was complicated by a massive obstetric haemorrhage of 5000 ml. After closure, an immediate re-laparotomy was indicated due to heavy vaginal bleeding. The site of bleeding was identified as an extension of the uterine incision, and was sutured. She was stabilised by transfusion of blood and blood products in the intensive therapy unit, and discharged 5 days later. The patient was re-admitted 6 weeks later with brisk, painless vaginal bleeding, passing large clots from a well-contracted uterus. Her haemoglobin decreased from 11.8 to 7.8 g/dl overnight. In view of her history, an urgent CT angiogram was performed, which revealed the presence of a pseudo-aneurysm arising from the left uterine artery. This was successfully occluded by transarterial embolisation, obviating the need for further surgical exploration. PMID:22674937

  3. Delayed postpartum haemorrhage secondary to a ruptured uterine artery pseudo-aneurysm, successfully treated by transarterial embolisation

    Science.gov (United States)

    Moatti, Zoe; Nisner, Tamar; Saini, Ashish; Karoshi, Mahantesh

    2011-01-01

    A 29-year-old woman (gravida 1, para 1) had an uneventful first pregnancy and a delivery by emergency caesarean section at term. The caesarean section was complicated by a massive obstetric haemorrhage of 5000 ml. After closure, an immediate re-laparotomy was indicated due to heavy vaginal bleeding. The site of bleeding was identified as an extension of the uterine incision, and was sutured. She was stabilised by transfusion of blood and blood products in the intensive therapy unit, and discharged 5 days later. The patient was re-admitted 6 weeks later with brisk, painless vaginal bleeding, passing large clots from a well-contracted uterus. Her haemoglobin decreased from 11.8 to 7.8 g/dl overnight. In view of her history, an urgent CT angiogram was performed, which revealed the presence of a pseudo-aneurysm arising from the left uterine artery. This was successfully occluded by transarterial embolisation, obviating the need for further surgical exploration. PMID:22674937

  4. Three-dimensional volume rendering digital subtraction angiography in comparison with two-dimensional digital subtraction angiography and rotational angiography for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Objective: Subarachnoid hemorrhage (SAH), which can cause mortality and severe morbidity, is a serious condition whose underlying cause must be determined. We aimed to compare 2D digital subtraction angiography (2DDSA), rotational angiography (RA) and 3D volume rendering digital subtraction angiography (3DVRDSA) for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage. Materials and methods: After an initial diagnosis of SAH with computed tomography, 122 patients (52 males and 70 females with a mean age of 47.77 ± 12.81 ranging between 20 and 83 years) underwent 2DDSA imaging, RA and 3DVRDSA imaging for detection of aneurysms. The location of the aneurysm, the best working angles, the dome/neck ratios, the largest diameter of the aneurysm, the shape of the aneurysm, the presence of spasms or pseudostenoses, and the relationship to the neighboring arteries were recorded. Results: 2DDSA missed 15.6% of the aneurysms that had a mean size of 2.79 ± 0.74 mm. RA was superior to 2DDSA for detecting aneurysm neck, and 3DVRDSA was superior to RA for detecting aneurysm neck. 3DVRDSA conclusively depicted the shape of the aneurysms in all patients. 3DVRDSA imaging was superior to 2DDSA and RA in the detection of the aneurysm relationship to neighboring arteries. The sensitivity and specificity of 3DVRDSA imaging for the detection of vasospasms were 100 and 84%, respectively. Conclusions: 3DVRDSA imaging is superior to 2DDSA and RA for detecting intracranial aneurysms and their morphological properties, especially those of small, ruptured aneurysms. However, 2DDSA should not be neglected in cases of vasospasm

  5. Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography

    Energy Technology Data Exchange (ETDEWEB)

    Dammert, S.; Krings, T.; Moller-Hartmann, W.; Ueffing, E.; Mull, M.; Thron, A. [Department of Neuroradiology, University Hospital of the Technical University Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany); Hans, F.J. [Department of Neurosurgery, University Hospital of the Technical University Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany); Willmes, K. [Department of Neurology, University Hospital of the Technical University Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany)

    2004-06-01

    We assessed the diagnostic accuracy of multislice CT in detection of intracranial aneurysms in patients presenting with subarachnoid or intracranial haemorrhage. Multislice CT and multiplanar digital subtraction angiography (DSA) images were obtained in 50 consecutive patients presenting with subarachnoid (SAH) and/or intracranial haemorrhage and reviewed by three neuroradiologists for the number, size and site of any aneurysms. The CT data were assessed using multiplanar reformats (MPR), maximum-intensity projections (MIP), surface-shaded display (SSD) and volume-rendering (VRT). In conventional angiography 51 aneurysms were detected in 41 patients. CT angiography (CTA) showed up to 48 aneurysms in 39 patients, depending on the observer. The overall sensitivity of multislice CT was 83.3% for small (<4 mm), 90.6% for medium-size (5-12 mm) and 100% for large (>13 mm) aneurysms. The sensitivity of multislice CTA to medium-size and large intracranial aneurysm is within the upper part of the range reported for helical single-slice CT. However, as small aneurysms may not be found, DSA remains the standard technique for investigation of SAH. (orig.)

  6. Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography.

    Science.gov (United States)

    Dammert, S; Krings, T; Moller-Hartmann, W; Ueffing, E; Hans, F J; Willmes, K; Mull, M; Thron, A

    2004-06-01

    We assessed the diagnostic accuracy of multislice CT in detection of intracranial aneurysms in patients presenting with subarachnoid or intracranial haemorrhage. Multislice CT and multiplanar digital subtraction angiography (DSA) images were obtained in 50 consecutive patients presenting with subarachnoid (SAH) and/or intracranial haemorrhage and reviewed by three neuroradiologists for the number, size and site of any aneurysms. The CT data were assessed using multiplanar reformats (MPR), maximum-intensity projections (MIP), surface-shaded display (SSD) and volume-rendering (VRT). In conventional angiography 51 aneurysms were detected in 41 patients. CT angiography (CTA) showed up to 48 aneurysms in 39 patients, depending on the observer. The overall sensitivity of multislice CT was 83.3% for small ( 13 mm) aneurysms. The sensitivity of multislice CTA to medium-size and large intracranial aneurysm is within the upper part of the range reported for helical single-slice CT. However, as small aneurysms may not be found, DSA remains the standard technique for investigation of SAH. PMID:15105978

  7. Cortical spreading ischaemia is a novel process involved in ischaemic damage in patients with aneurysmal subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Dreier, Jens P; Major, Sebastian; Manning, Andrew;

    2009-01-01

    The term cortical spreading depolarization (CSD) describes a wave of mass neuronal depolarization associated with net influx of cations and water. Clusters of prolonged CSDs were measured time-locked to progressive ischaemic damage in human cortex. CSD induces tone alterations in resistance vessels......-invasive detection of CSD. Low-frequency vascular fluctuations (LF-VF) (f < 0.1 Hz), detectable by functional imaging methods, are determined by the brain's resting neuronal activity. CSD provides a depolarization block of the resting activity, recorded electrophysiologically as spreading depression of high......-frequency-electrocorticography activity. Accordingly, we observed a spreading suppression of LF-VF, which accompanied spreading depression of high-frequency-electrocorticography activity, independently of whether CSD was associated with a physiological, absent or inverse haemodynamic response. Spreading suppressions of LF-VF thus allow...

  8. Multidetector-Row CT Angiography of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Comparison of Bone Subtraction and Standard CT Angiography with Digital Subtraction Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yong Hee; You, Jin Jong; Choi, Ho Cheol; Kim, Ji Eun [Dept. of Radiology, Gyeongsang National University Hospital, Jinju (Korea, Republic of); Choi, Dae Seob [Gyeongsang Institue of Health Science, Gyeongsang National University School of Medicine, Jinju (Korea, Republic of); Ryoo, Jae Wook [Dept. of Radiology, Samsung Seoul Hospital, Seoul (Korea, Republic of)

    2011-10-15

    To evaluate the usefulness of multidetector-row CT angiography (MDCTA) for the diagnosis of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) by comparison of digital subtraction angiography (DSA) and to compare the bone subtraction CT angiography (BS-CTA) and standard CT angiography (S-CTA). Thirty-three patients who were treated with intraarterial nimodipine infusion for the cerebral vasospasm after aneurysmal SAH were evaluated with MDCTA and DSA. BS-CTA images were reconstructed from the S-CTA and unenhanced CT source images. A total of 207 vascular segments were evaluated. A four-step scale for the degree of stenosis was applied for each segment. With DSA as the standard images, BS-CTA and S-CTA images were comparied. On DSA, 56 segments (27%) presented vasospasm. Concordance between the DSA and S-CTA and between DSA and BS-CTA were 94.7% and 82.1%, respectively. Overestimation for the degree of stenosis was shown in 37 segments on BS-CTA and in 8 segments on S-CTA, but underestimated segments were only shown on S-CTA (n = 4). MDCTA with standard technique seems to be a useful imaging tool for the evaluation of the cerebral vasospasm after aneurysmal SAH. However, BS-CTA is not needed because of additional radiation and overestimation of the degree of stenosis.

  9. Evolution of Giant P2-Posterior Cerebral Artery Aneurysm over 16 Years: Saccular to Serpentine. A Case Report.

    Science.gov (United States)

    Sharma, S

    2009-12-14

    Giant intracranial aneurysms account for only about 5% of all intracranial aneurysms. Giant intradural aneurysms are associated with severe natural history, yet remain potentially curable. These aneurysms cause symptoms due to their mass effect, and only 14-35% of cases present with subarachnoid haemorrhage (SAH). The present case report is an imaging evolution of a giant posterior cerebral artery (PCA) aneurysm in a patient who was lost on follow-up from 1992 to 2008 giving insight into the natural history and morphologic evolution of giant serpentine aneurysms. Attempted surgery 16 years previously for a saccular PCA aneurysm produced encephalomalacia and created a more spacious perianeurysmal environment, preventing any mass effect on vital structures in its vicinity. This allowed the patient to have a long symptom-free period and also allowed the aneurysm to follow a morphologic evolution over a long period without causing symptoms which would have called for intervention. This unusual development gave a unique opportunity to study the evolution of a gaint serpentine aneurysm from a saccular aneurysm and also the clinical and morphologic changes in an aneurysm if it can be prevented from producing mass effect. The Coanda effect, or boundary wall effect, has been considered responsible for the development of the serpentine channel in the original globular aneurysm . However many Authors conclude that giant serpentine aneurysms are not derived from saccular aneurysms. PMID:24209407

  10. Intracranial aneurysms: evaluation in 200 patients with spiral CT angiography

    International Nuclear Information System (INIS)

    The goal of this study was to assess the usefulness of spiral CT angiography (CTA) with three- dimensional reconstructions in defining intracranial aneurysms, particularly around the Circle of Willis. Two hundred consecutive patients with angiographic and/or surgical correlation were studied between 1993 and 1998, with CTA performed on a GE HiSpeed unit and Windows workstation. The following clinical situations were evaluated: conventional CT suspicion of an aneurysm; follow-up of treated aneurysm remnants or of untreated aneurysms; subarachnoid haemorrhage (SAH) and negative angiography; family or past aneurysm history; and for improved definition of aneurysm anatomy. Spiral CTA detected 140 of 144 aneurysms, and an overall sensitivity of 97%, including 30 of 32 aneurysms 3 mm or less in size. In 38 patients with SAH and negative angiography, CTA found six of the seven aneurysms finally diagnosed. There was no significant artefact in 17 of 23 patients (74%) with clips. The specificity of CTA was 86% with 8 false-positive cases. Spiral CTA is very useful in demonstrating intracranial aneurysms. (orig.)

  11. Subarachnoid Hemorrhage

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  12. Postpartum cerebral angiopathy presenting with non-aneurysmal subarachnoid hemorrhage and interval development of neurological deficits: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Li Yang

    2013-01-01

    Full Text Available Postpartum cerebral angiopathy (PCA is a cerebrovascular disease that occurs during the postpartum period. It is characterized by reversible multifocal vasoconstriction of the cerebral arteries. We report a patient with PCA proven by cerebral angiography that revealed multifocal, segmental narrowing of the cerebral arteries and non-aneurysmal subarachnoid hemorrhage. The patient suddenly deteriorated with focal neurological deficits on the 5 th day of hospitalization. She was treated with calcium-channel blockers and monitored with daily transcranial Doppler ultrasound. Her symptoms gradually improved and she was discharged on the 11 th day of hospitalization. At 1-month follow-up, patient was completely symptom-free with no neurological deficits.

  13. Depression remitted after subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Lauritsen, Lise; Vinberg, Maj

    2015-01-01

    A 65-year-old man was seen in a specialized ambulatory for mood disorders because of treatment-resistant depression. He was treated throughout a period of three years with selective serotonin reuptake inhibitor, dual action, lithium, nortriptyline, reboxetine, aripiprazole, benzodiazepines...

  14. 老年人蛛网膜下腔出血的误诊分析%Analysis on Misdiagnosis of Elderly Subarachnoid Haemorrhage:a Report of 30 Cases

    Institute of Scientific and Technical Information of China (English)

    郝丽; 邹和苓

    2011-01-01

    目的 探讨蛛网膜下腔出血(SAH)的临床症状及误诊情况.方法 回顾分析误诊的30例SAH病例的临床临床表现、误诊情况及转归.结果 本组30例中,昏迷5例(16.7%),头剧痛8例(27.0%),隐痛4例(13.3%),恶心呕吐11例(37.0%),眩晕5例(16.7%),精神障碍3例(10.0%),发作性抽搐2例(6.7%),嗜睡1例(3.3%),以头痛、恶心呕吐多见;30例患者误诊为急性胃肠炎3例(10.0%),梅尼埃病4例,椎基底动脉供血不足5例(16.7%),颈椎病4例(13.3%),晕厥3例(10.0%),高血压脑病4例(13.3%),自主神经功能紊乱2例(6.7%),癫痫发作2例(6.7%),脑炎1例(3.3%),老年精神病2例(6.7%).延误诊断1 d者16例(53.3%),2 d者9例(30.O%),3 d者4例(13.3%),其中l例(3.3%)误诊时间长达19 d.30例患者经头颅CT或腰穿检查确诊为蛛网膜下腔出血.结论 老年人SAH临床表现不典型,复杂多样,易导致误诊.对于高度怀疑而且头颅CT检查阴性的患者,根据情况行腰穿脑脊液检查,必要时行数字减影血管造影(DSA)检查,以早期明确诊断.%Objective To investigate the clinical features and misdiagnosis of subarachnoid haemorrhage (SAH). Methods The clinical symptoms,misdiagnosis and outcome findings of 30 cases with SAH were analyzed retrospectively. Results Among the 30 misdiagnosed cases:5 cases were with coma( 16.7% ),8 cases with head pain (27.0%),4 cases with dull pain (13.3%), 11 cases with nausea and vomiting (37.0%),5 cases with dizziness (16. 7% ) 3 cases with mental disorders ( 10.0% ) ,2 cases with paroxysmal convulsion(6.7% ), 1 case with lethargy(3.3% ). 3 cases were misdiagnosed as acute gastroenteritis( 10.0% ) ,4 cases as Meniere' s disease,5 cases as vertebral basilar insufficiency( 16.7% ) ,4 cases as cervical disease( 13.3% ) ,3 cases as syncope( 10.0% ) ,4 cases as hypertensive encephalopathy( 13.3% ) ,2 case autonomic nerve dysfunction (6.7 % ) ,2 cases as seizures (6.7%), 1 case as encephalitis (3.3 % ), 2 cases

  15. A ruptured dissecting aneurysm of the vertebral artery: comparison of angiographic and histological findings

    International Nuclear Information System (INIS)

    We present autopsy findings in a patient with a dissecting aneurysm of the vertebral artery causing subarachnoid haemorrhage. We sectioned the artery longitudinally and compared it with the angiogram, which showed the ''pearl-and-string''. Histological examination showed a pseudoaneurysm covered by adventitia alone, forming the ''pearl''. Internal elastic lamina and media were destroyed, and haematoma extended in the subadventitial space of the wall of the pseudoaneurysm. Media thickened by haematoma caused the ''string'', narrowing the parent artery. Alcian blue staining showed that stratified internal elastic lamina in the aneurysm and the parent artery, had undergone marked mucoid degeneration, which may have been responsible for the dissection. (orig.)

  16. Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Vilela, Pedro; Goulao, Augusto [Garcia de Orta Hospital, Neuroradiology Department, Almada (Portugal)

    2006-08-15

    Intracranial aneurysms in the paediatric population are uncommon, accounting for 2% to 6% of all aneurysms, and spontaneous arterial dissection is rarely reported as the cause of aneurysms in children, especially in the posterior cerebral artery. Two cases of paediatric spontaneous posterior cerebral artery dissecting aneurysms are reported, one in a 33-month-old male child presenting with aneurysmal rupture and subarachnoid haemorrhage and the other in a 9-year-old boy with an unruptured aneurysm. The first child was successfully treated by endovascular parent vessel occlusion without neurological deficit and in the second a spontaneous thrombosis of the aneurysm and its parent artery occurred associated with hydrocephalus and a favourable outcome. Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and close follow-up and/or early treatment is warranted. Spontaneous arterial dissection is a rare, probably still under-recognized, cause of intracranial aneurysms that may be responsible for a significant number of aneurysms and spontaneous aneurysmal thromboses in children. (orig.)

  17. Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature

    International Nuclear Information System (INIS)

    Intracranial aneurysms in the paediatric population are uncommon, accounting for 2% to 6% of all aneurysms, and spontaneous arterial dissection is rarely reported as the cause of aneurysms in children, especially in the posterior cerebral artery. Two cases of paediatric spontaneous posterior cerebral artery dissecting aneurysms are reported, one in a 33-month-old male child presenting with aneurysmal rupture and subarachnoid haemorrhage and the other in a 9-year-old boy with an unruptured aneurysm. The first child was successfully treated by endovascular parent vessel occlusion without neurological deficit and in the second a spontaneous thrombosis of the aneurysm and its parent artery occurred associated with hydrocephalus and a favourable outcome. Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and close follow-up and/or early treatment is warranted. Spontaneous arterial dissection is a rare, probably still under-recognized, cause of intracranial aneurysms that may be responsible for a significant number of aneurysms and spontaneous aneurysmal thromboses in children. (orig.)

  18. 动脉瘤性蛛网膜下腔出血的病因诊断%The etiological diagnosis of subarachnoid hemorrhage caused by aneurysm

    Institute of Scientific and Technical Information of China (English)

    钱伟东; 屈洪党; 陈育华; 张扬

    2012-01-01

    目的:探讨CT血管造影(CTA)诊断动脉瘤性蛛网膜下腔出血(SAH)病因的价值.方法:对经CT平扫明确诊断的自发性SAH 24例患者,在入院后均做CTA和数字减影血管造影(DSA),并就CTA和DSA诊断作一比较.结果:24例CTA检查后22例共发现26个脑动脉瘤,CTA能清楚显示动脉瘤的位置、大小、形态、瘤颈位置及周围组织的情况,以DSA作为金标准,CTA灵敏度92.86%,特异度100.00%.结论:CTA可作为蛛网膜下腔出血尤其是危重患者早期病因学诊断的首选方法.%Objective: To explore the value of CT angiography(CTA) in the etiological diagnosis of subarachnoid hemorrhage ( SAH ) caused by aneurysm. Methods; Twenty-four spontaneous SAH patients diagnosed by CT plain scan were detected for comparative analysis using CTA and digital subtraction angiography( DSA). Results: Twenty-two cases with 26 aneurysms in 24 cases were found by CTA. CTA displayed the location,size,shape,neck and surrounding tissue of aneurysm. Using DSA as the gold standard,the sensitivity and specificity of CTA were 92. 86% and 100. 00% respectively. Conclusions: CTA can be a preferred method for the early etiological diagnosis of SAH patients, especially for critical patients.

  19. The changes of von willebrand factor/a disintegrin-like and metalloprotease with thrombospondin type I repeats-13 balance in aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Tang, Qi-Feng; Lu, Shi-Qi; Zhao, Yi-Ming; Qian, Jin-Xian

    2015-01-01

    The aim of this study was to investigate the role of Von Willebrand Factor/thrombospondin type I repeats-13 (VWF/ADAMTS13) balance in aSAH. Fifty eight patients with aSAH at the First Affiliated hospital of Soochow University, Suzhou, China, between January 2012 and January 2014 were eligible for the study. They were divided into delayed cerebral ischemia group (DCI group) and non-delayed cerebral ischemia group (no DCI group), or cerebral vasospasm group (CVS group) and no spasm group (no CVS group), or good outcome group and poor outcome group. The control group consisted of twenty healthy people. All patients underwent CT, DSA, or (and) CTA diagnosed with intracranial subarachnoid hemorrhage which is caused by aneurysm rupture. Venous blood was drawn in tubes at 3 time points: 1 day after SAH (T1), (4±1) days after SAH (T2), and (9±1) days after SAH (T3) to determine plasma concentrations of ADAMTS13, VWF, P-selectin and IL-6 via enzyme-linked immunosorbent assay (ELISA). Transcranial doppler sonography (TCD) was used to measure mean blood flow velocity of the middle cerebral artery (VMCA). Glasgow Outcome Scale (GOS) was measured before discharge. Among 58 patients, 12 (20.7%) had DCI, 40 (68.9%) had TCD evidence of CVS, and 20 (34.5%) had poor outcome. The concentrations of VWF, P-selectin and IL-6 on T1, T2 and T3 after SAH were significantly higher in DCI, CVS and poor outcome groups compared with those of the control group (P 0.05). The results of our study suggest that the increased VWF and decreased ADAMTS13 activity were associated with DCI and poor outcome. The balance of VWF/ADAMTS13 could be used to predict the clinical outcome. The deficiency of ADAMTS13 can not only induce DCI but also accelerate inflammatory reaction. Our results reported in this paper may provide new insights into the possible use of ADAMTS13 as a therapeutic agent in aneurysmal subarachnoid hemorrhage. PMID:25785135

  20. Influence of Fever and Hospital-Acquired Infection on the Incidence of Delayed Neurological Deficit and Poor Outcome after Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    G. Logan Douds

    2012-01-01

    Full Text Available Although fever and infection have been implicated in the causation of delayed neurological deficits (DND and poor outcome after aneurysmal subarachnoid hemorrhage (SAH, the relationship between these two often related events has not been extensively studied. We reviewed these events through of our retrospective database of patients with SAH. Multivariate logistic regression was used to determine independent predictors of DND and poor outcome. A total of 186 patients were analyzed. DND was noted in 76 patients (45%. Fever was recorded in 102 patients (55%; infection was noted in 87 patients (47%. A patient with one infection was more likely to experience DND compared to a patient with no infections (adjusted OR 3.73, 95% CI 1.62, 8.59. For those with more than two infections the likelihood of DND was even greater (adjusted OR 4.24, 95% CI 1.55, 11.56. Patients with 1-2 days of fever were less likely to have a favorable outcome when compared to their counterparts with no fever (adjusted OR 0.19, 95% CI 0.06, 0.62. This trend worsened as the number of days febrile increased. These data suggest that the presence of infection is associated with DND, but that fever may have a stronger independent association with overall outcome.

  1. Subarachnoid hemorrhage in pituitary tumor

    Directory of Open Access Journals (Sweden)

    Ashis Patnaik

    2013-01-01

    Full Text Available Subarachnoid hemorrhage (SAH is the bleeding into the subarachnoid space containing cerebrospinal fluid. The most common cause of SAH is trauma. Rupture of aneurysms, vascular anomalies, tumor bleeds and hypertension are other important etiologies. SAH in the setting of pituitary tumor can result from various causes. It can be due to intrinsic tumor related pathology, injury to surrounding the vessel during the operative procedure or due to an associated aneurysm. We discuss the pathological mechanisms and review relevant literature related to this interesting phenomenon. Early and accurate diagnosis of the cause of the SAH in pituitary tumors is important, as this influences the management.

  2. Pituitary dysfunction in survivors of spontaneous subarachnoid hemorrhage of anterior communicating artery and middle cerebral artery aneurysms: A comparative study

    Directory of Open Access Journals (Sweden)

    Pinaki Dutta

    2012-01-01

    Full Text Available Background: The data on incidence of hypopituitarism after SAH are conflicting. Furthermore, it is still not known whether there is any difference in hormonal deficiencies between SAH due to anterior communicating artery (A-com and middle cerebral artery (MCA aneurysms. Materials and Methods: This study includes both retrospective and prospective arms. The data collected included baseline demographic profile, clinical severity on admission to the hospital by the Hunt and Hess grading system and World Federation of Neurological Surgeons (WFNS grading, radiological severity of bleed by the Fisher′s classification, and treatment details. All the patients underwent detailed hormonal evaluation at baseline and 6 months in prospective group while at the end of 1 year in the retrospective group. Hormonal deficiencies between patients with A-com and MCA aneurysmal SAH were compared using appropriate statistical tests. Results: Of 60 patients studied, 47 patients (A-com: 28 and MCA: 19 were in the retrospective group, while 13 patients (A-com-9, MCA-4 were in the prospective group. The baseline data were comparable between the two groups. At or after 6 months follow-up, 19 (31.6% patients, 10 patients with A-com and 9 patients with MCA aneurysmal SAH, had some form of hormone deficiency. Furthermore, there was no difference in endocrine dysfunctions between the two groups. There was no correlation between the severity of hormonal deficiency and the clinical severity of SAH grade by Hunt and Hess and radiological grade of SAH by Fisher′s grade. Conclusion: Hormonal deficiencies are not uncommon in patients with SAH. There is no difference in hormonal deficiencies and severity of hypopituitarism in patients with SAH due to A-com and MCA bleed.

  3. Subarachnoid Hemorrhage

    Science.gov (United States)

    ... Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke Treatment Caregiver and Patient Resources Home » Patients & Families » About Stroke » Subarachnoid Hemorrhage Subarachnoid Hemorrhage What is a Stroke? ...

  4. Prevention of intracerebral haemorrhage.

    Science.gov (United States)

    Mitchell, Patrick; Mitra, Dipayan; Gregson, Barbara A; Mendelow, A David

    2007-07-01

    Nontraumatic intracerebral haemorrhages arise from a wide range of causes falling into two broad groups: discreet vascular "ictohaemorrhagic" lesions such as aneurysms, arteriovenous malformations, cavernomas, tumours, and dural fistulae; and more generalised amyloid or hypertension related conditions. It is now possible using family history, associated risk factors and gradient echo MRI to predict cases at high risk of hypertensive or amyloid related haemorrhage. There is considerable potential for prevention of hypertensive haemorrhages by treatment of high risk cases with antihypertensive medication. As yet no effective preventative treatment for amyloid angiopathy related ICH has emerged although a variety of drugs are under investigation. Prevention of haemorrhage from ictohaemorrhagic lesions revolves around removal or obliteration of the lesion. Although there is a wide range of such lesions available treatments come down to three modalities. These are surgical excision, stereotactic radiosurgery and endovascular embolisation. PMID:17630936

  5. The clinical profile, management, and overall outcome of aneurysmal subarachnoid hemorrhage at the neurosurgical unit of a tertiary care center in India

    Directory of Open Access Journals (Sweden)

    Harsimrat Bir Singh Sodhi

    2014-01-01

    Full Text Available Background and Purpose: Several studies report good outcomes in selected patients of aneurysmal subarachnoid hemorrhage (aSAH. The purpose of our study is to project the clinical characteristics, management, and overall outcome of patients with aSAH presenting to a tertiary care center in India. Materials and Methods: A prospective study was conducted over a period of 10 months and all patients presenting with aSAH were studied. Patients presenting in all grades and managed with any type of intervention or managed conservatively were included to characterize their clinical and radiological profile at admission, during management, and at discharge. Outcome was assessed with the Glasgow Outcome Score (GOS at 3 months follow-up. Results: Out of the 482 patients [mean age: 51.3 (±13.5; M: F = 1:1], 330 patients were fit to be taken up for intervention of the ruptured aneurysm, while 152 patients were unfit for any intervention. At 3 months follow-up, good outcome (GOS 4 and 5 was observed in 159 (33%, poor outcome (GOS 2 and 3 in 53 (11%, and death in 219 (45.4% patients, while 51 patients (10.6% were lost to follow-up. Most (95% of the patients in the non-intervention group expired, and hence the high mortality rate, as we have analyzed the results of all patients of all grades, regardless of the treatment given. The predictors of poor outcome (GOS 1, 2, and 3 at 3 months follow-up, using multinomial regression model, were: World Federation of Neurological Surgeons (WFNS grade IV and V (at admission and after adequate resuscitation [odds ratio (OR: 35.1, 95% confidence interval (CI: 10.8-114.7] and presence of hypertension as a co-morbid illness [OR: 2.7, 95% CI: 1.6-5.6]. All patients showing acute infarction on computed tomography scan at presentation had a poor outcome. Conclusions: Despite recent advances in the treatment of patients with aSAH, the morbidity and mortality rates have failed to improve significantly in unselected patients and

  6. Delayed postpartum haemorrhage secondary to a ruptured uterine artery pseudo-aneurysm, successfully treated by transarterial embolisation

    OpenAIRE

    Moatti, Zoe; Nisner, Tamar; Saini, Ashish; Karoshi, Mahantesh

    2011-01-01

    A 29-year-old woman (gravida 1, para 1) had an uneventful first pregnancy and a delivery by emergency caesarean section at term. The caesarean section was complicated by a massive obstetric haemorrhage of 5000 ml. After closure, an immediate re-laparotomy was indicated due to heavy vaginal bleeding. The site of bleeding was identified as an extension of the uterine incision, and was sutured. She was stabilised by transfusion of blood and blood products in the intensive therapy unit, and disch...

  7. Correlation between plasma total nitric oxide levels and cerebral vasospasm and clinical outcome in patients with aneurysmal subarachnoid hemorrhage in Indian population

    Directory of Open Access Journals (Sweden)

    Shruthi Shimoga Ramesh

    2014-01-01

    Full Text Available Context: Cerebral vasospasm remains a major cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH. Reduced bioavailability of nitric oxide has been associated with the development of cerebral vasospasm after aSAH. Such data is not available in Indian population. Aims: The objective of the study was to measure the plasma total nitric oxide (nitrite and nitrate-NOx level in aSAH patients and healthy controls treated at a tertiary hospital in India and to investigate a possible association between plasma total nitric oxide level and cerebral vasospasm and clinical outcome following treatment in patients with aSAH. Settings and Design: A case-control study of aSAH patients was conducted. Plasma total NOx levels were estimated in aSAH patients with and without vasospasm and compared the results with NOx levels in healthy individuals. Materials and Methods: aSAH in patients was diagnosed on the basis of clinical and neuro-imaging findings. Plasma total NOx levels in different subject groups were determined by Griess assay. Results: Plasma total NOx level was found to be significantly decreased in patients with aSAH when compared to controls. Plasma total NOx level in the poor-grade SAH group was lower than that in the good-grade SAH group. Plasma total NOx level further reduced in patients with angiographic (P < 0.05 and clinical vasospasm. Conclusions: Reduced plasma NOx level is seen in aSAH patients as compared to normal individuals. In aSAH patients reduced levels are associated with increased incidence of cerebral vasospasm and poor outcome. Plasma total NOx level could be used as a candidate biomarker for predicting vasospasm and outcome for this pathology.

  8. 三维CT血管造影对动脉瘤性蛛网膜下腔出血诊断的可靠性研究%Reliability of 3D CT angiography in diagnosis of aneurysmal subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

      目的评价三维CT血管造影(3D-CTA)在动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)诊断的可靠性。方法对我科2010年12月-2011年11月间192名急性蛛网膜下腔出血患者行CT血管造影检查(CTA)检查并应用3D Slicer软件进行三维重建,与数字减影血管造影(digital subtraction angiography,DSA)或术中实际情况进行对比,评价CTA在动脉瘤性蛛网膜下腔出血诊断中的可靠性。结果192例中,CTA检查出动脉瘤162例,脑血管畸形12例;另有假阴性1例,假阳性1例,均通过DSA及手术证实,3D-CTA在aSAH诊断的灵敏性为96.17%,特异性为94.11%。结论3D-CTA是动脉瘤性蛛网膜下腔出血的首选检查方法。%Objective To evaluate the reliability of 3D-CT angiography (3D-CTA) in diagnosis of aneurysmal subarachnoid hemorrhage (SAH). Methods One hundred and ninety-two patients with acute SAH who underwent CTA in our department from December 2010 to November 2012 were included in this study. Their 3D-CTA images were reconstructed with 3D Slicer software and compared with digital subtraction angiography (DSA) images or intraoperative actual situation. The reliability of CTA was assessed in diagnosis of aneurysmal SAH. Results 3D-CTA showed aneurysm in 162 patients, cerebral vascular malformation in 12 patients, false negative aneurysm in 1 patient, and false-positive aneurysm in 1 patient, which were confirmed by DSA or surgery, with a sensitivity of 96.17%and a specificity of 94.11%. Conclusion 3D-CTA is the first choice of method in diagnosis of aneurysmal SAH.

  9. Giant aneurysms of the internal carotid artery: endovascular treatment and long-term follow-up

    International Nuclear Information System (INIS)

    We report the long-term follow-up of 18 patients with giant aneurysms of the internal carotid artery (ICA) referred for endovascular occlusion of the parent vessel. There were 10 aneurysms involving the infra- and/or supraclinoid cavernous segment, six the ophthalmic segment, one the petrous segment and one the bifurcation. One patient who did not tolerate test occlusion was treated medically. Clinical and imaging follow-up were obtained in 16 patients for a mean of 30 months, range 6-80 months. Endovascular treatment led to excellent clinical outcome in 16 patients. One 34-year-old woman, who presented with subarachnoid haemorrhage (SAH), died from bilateral middle cerebral artery infarcts due to severe vasospasm 4 days after treatment. The patient treated medically died from SAH. Long-term imaging follow-up in 16 patients revealed a markedly smaller aneurysm sac in all cases. (orig.)

  10. Risk of Familial Intracranial Aneurysm

    OpenAIRE

    J Gordon Millichap; Millichap, John J.

    2014-01-01

    Investigators at University Medical Center Utrecht, Netherlands, studied the yield of long-term (up to 20 years) screening for intracranial aneurysms in individuals with a positive family history (2 or more first-degree relatives) of aneurysmal subarachnoid hemorrhage (aSAH) or unruptured intracranial aneurysm (1993-2013).

  11. CT对动脉瘤破裂所致蛛网膜下腔出血的诊断价值%Diagnostic value of CT in subarachnoid hemorrhage induced by aneurysm rupture

    Institute of Scientific and Technical Information of China (English)

    宋同均; 魏建功; 王士强; 刘道斌; 董世节

    2013-01-01

    Objective To explore the diagnosis value of CT in subarachnoid hemorrhage(SAH) induced by aneurysm rupture.Methods The clinical and CT data of 119 patients with SAH induced by aneurysm rupture were analyzed respectively.Results The CT characteristic of SAH induced by aneurysm rupture was full of hyperderse in sulcus and schizenceplay,or accompaning intracerebral hematoma in the straight gyrus of frontal lobe and the hippocampal gyrus of parietal lobe.Conclusion The CT has important value for diagnosing SAH induced by aneurysm rupture in the location and the nature.But it is indispensable that the CTA or DSA must be done for ascertaining the artery of responsibility of rupturing aneurysm.%目的 探讨CT对动脉瘤破裂所致蛛网膜下腔出血(SAH)的诊断价值.方法 回顾性分析119例动脉瘤破裂所致SAH患者的临床和CT影像资料.结果 动脉瘤破裂所致的SAH的CT表现为侧裂、纵裂、脑池铸型高密度影,或伴有额叶直回、侧裂周围的额、颞叶血肿.结论 头颅CT在动脉瘤破裂所致SAH的定性诊断中具有一定的重要价值,根据CT显示颅内特定部位的SAH,还可以间接推测颅内动脉瘤的部位.但确定动脉瘤的责任血管来源还需行CTA或DSA检查.

  12. Bilateral vertebral artery balloon occlusion for giant vertebrobasilar aneurysms

    International Nuclear Information System (INIS)

    We describe the clinical presentation, radiological and clinical results in six consecutive patients with a giant vertebrobasilar aneurysm treated by bilateral vertebral artery balloon occlusion. Five patients presented with headache and signs of brain-stem compression and one with subarachnoid haemorrhage. In all patients vertebral artery balloon occlusion was performed. In four, this followed successful test occlusion. In one patient, who did not tolerate the test occlusion, a bypass from the external carotid to the posterior cerebral artery preceded definitive vertebral artery occlusion. One patient underwent bypass surgery prior to test occlusion. At 6-22 months follow-up three patients had a good functional outcome and showed unchanged size or shrinkage of the aneurysm on MRI. Three other patients died; one from recurrent haemorrhage, and two probably from delayed brain-stem ischaemia. The presence of two large posterior communicating arteries predicted good functional outcome, which was also related to the clinical condition at presentation, and the degree of brain-stem compression and oedema on MRI. Bilateral vertebral artery balloon occlusion can be considered in patients with otherwise untreatable giant vertebrobasilar aneurysms. If test occlusion is not tolerated, a surgical bypass to the posterior circulation can be considered. (orig.)

  13. Three-dimensional computed tomographic angiography in four patients with dissecting aneurysms of the vertebrobasilar system

    International Nuclear Information System (INIS)

    Recently, three-dimensional computed angiography (CTA) has been used for the diagnosis and treatment planning of cerebral aneurysm presenting with or without sub-arachnoid haemorrhage, but the diagnostic value of CTA has not been established. This study evaluated the vertebrobasilar system. Four patients with acute dissecting aneurysms were examined by CTA, including 3 women and 1 man with a mean age of 60.5 ± 8.5 years (range: 52-67 years). There were three patients with subarachnoid haemorrhage and one patient presenting with ischaemia. One patient underwent CTA twice and digital subtraction angiography (DSA) once, while one patient had both examinations three times. CTA was performed with a nonionic contrast medium (100 ml of iomeprol 350 mg I/ml) administrated via an auto-injector into an antecubital vein at 1.5-1.7 ml/s. To reconstruct three-dimensional images, the volume rendering method was utilized. All initial CTA studies were performed safely within 5 hours after onset. In patients with subarachnoid haemorrhage, all lesions were demonstrated by finding either the 'pear and string sign' or a 'double shadow' on CTA. In the patient presenting with ischaemia, 'pearl and string sign' and ' double shadow' was shown after the second CTA, and follow-up CTA was able to demonstrate the change of the lesion morphology. All lesions had more irregular luminal surfaces than the non-lesional segment of the involved vessels. CTA was safe in patients with acute vertebrobasilar dissection and demonstrated either the 'pearl and string sign' or a 'double shadow' which were commonly showed on DSA. An 'irregular luminal surface sign' on CTA seems to be one of the characteristics of vertebrobasilar dissection. The view shown by CTA is not less useful than that by DSA to diagnosis and treatment planning in the acute phase of vertebrobasilar dissection, and can be employed to follow the changes of lesion morphology over time. (author)

  14. Cardiac abnormalities after subarachnoid hemorrhage

    OpenAIRE

    Bilt, I.A.C. van der

    2016-01-01

    Aneurysmal subarachnoid hemorrhage(aSAH) is a devastating neurological disease. During the course of the aSAH several neurological and medical complications may occur. Cardiac abnormalities after aSAH are observed often and resemble stress cardiomyopathy or Tako-tsubo cardiomyopathy(Broken Heart Syndrome) that has been described after acute stress. It is a reversible cardiac dysfunction with distinct imaging features(the echocardiographic or left ventricular angiographic image resembles a Tak...

  15. Early surgery of ruptured anterior circulation aneurysm based on multislice helical computerised tomography angiography.

    Science.gov (United States)

    Hui, Ma; Dong, Wang Xiao; Ciceri, E; Marras, C; Tao, Sun; Chun, Xia He; Zheng, Li Zong; Fang, Li Guo

    2007-12-01

    The purpose of this study is to evaluate the utility of three-dimensional computed tomographic angiography (3D-CTA) as the primary diagnostic investigation in patients with spontaneous subarachnoid haemorrhage (SAH) from anterior circulation aneurysms, and to correlate the results with digital subtraction angiography (DSA) and intraoperative findings. From May 2005 to May 2007 a total of 38 consecutive patients admitted for SAH, suspicious for ruptured anterior circulation cerebral aneurysm, underwent 3D-CTA. Inclusion criteria were a SAH confirmed by a non-contrast head computed tomographic scan or by lumbar puncture. Exclusion criteria were: previous DSA, severe contrast medium allergy and severe renal failure. All patients underwent early surgical clipping of the aneurysm. The mean time between SAH onset and surgery was 43.6 h (range, 14-74 h). The 3D-CTA was performed in all cases; and in 13 out of 38 patients (34%) represented the only preoperative exam. In all patients that underwent surgery with the sole 3D-CTA, the images collected allowed a good visualisation of the morphology of aneurysms and of the anatomical relationship with the vascular structures. 3D-CTA allows accurate diagnosis with an excellent visualisation of ruptured aneurysms of the anterior circulation. Our results suggest that, in selected cases, ruptured anterior circulation aneurysms could be successfully treated on the basis of 3D-CTA alone. PMID:18175079

  16. Detection and characterization of intracranial aneurysms: magnetic resonance angiography versus digital subtraction angiography

    International Nuclear Information System (INIS)

    Objective: To compare magnetic resonance angiography (MRA) with Intra-arterial digital subtraction angiography (IA-DSA) in detection and characterization of intracranial aneurysms. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Diagnostic Imaging, Lahore General Hospital, Lahore, from January to June 2007. Methodology: Thirty patients presented with aneurysmal subarachnoid haemorrhage (SAH) and focal neurological signs were selected by convenience sampling. Three dimensional time of flight (3D TOF) MRA using maximum intensity projection (MIP) was performed on all patients along with DSA. Results of 3D TOF MRA were compared with those of IA-DSA taking IA-DSA as Gold standard. Results: Out of 30 patients 14 (46.7%) were males and 16 (53.3%) were females with mean age of 41+-14.1 years. MRA detected 29 out of 30 aneurysmal lesions with sensitivity of 96.7%. Regarding characterization of aneurysms results of MRA were comparable to those of IA-DSA. Conclusion: 3D TOF MRA technique showed a high sensitivity in this study. This technique can be used as a non-invasive screening test for intracranial aneurysms and as a suitable alternative primary examination to IA-DSA prior to aneurysmal surgery. (author)

  17. Subarachnoid Hemorrhage from a Dissecting Aneurysm of the Posterior Cerebral Artery in a Child : Rebleeding after Stent-Assisted Coiling Followed by Stent-Within-Stent Technique

    OpenAIRE

    Lee, Ji Yeoun; Kwon, Bae Ju; Kang, Hyun-Seung; Wang, Kyu-Chang

    2011-01-01

    Pediatric patients with dissecting aneurysms usually present with ischemia rather than bleeding. We report a case of a 15-year-old boy with a dissecting aneurysm of the posterior cerebral artery (PCA) presenting with hemorrhage. He was first treated with stent-assisted coil embolization, in an attempt to avoid trapping of the PCA and preserve the perforators. After the procedure, he recovered well from general anesthesia, but rebleeding occurred from the same lesion 6 hours after the procedur...

  18. Antithrombotic drugs and subarachnoid haemorrhage risk

    DEFF Research Database (Denmark)

    Pottegård, A; García Rodríguez, L A; Poulsen, F R;

    2015-01-01

    period-matched population controls. Conditional logistic regression models were used to estimate odds ratios (aOR), adjusted for comorbidity, education level, and income. Low-dose aspirin (ASA) use for < 1 month was associated with an increased risk of SAH (aOR 1.75, 95 % confidence interval [CI] 1...... associated with an aOR of SAH of 1.13 (95 %CI: 0.86-1.49). Short-term use (< 1 month) of vitamin K-antagonists (VKA) yielded an aOR of 1.85 (95 %CI 0.97-3.51) which dropped after 3+ years to 1.24, 95 %CI: 0.86-1.77. The risk of SAH was higher in subjects in dual antithrombotic treatment (aOR 2.08, 95 %CI: 1.......26-3.44), and in triple antithrombotic treatment (aOR 5.74, 95 %CI: 1.76-18.77). In conclusion, use of aspirin,clopidogrel and VKA were only associated with an increased risk of SAH in the first three months after starting treatment. Long-term aspirin use carried no reduced SAH risk. Results should be...

  19. 64排CT血管造影在动脉瘤性蛛网膜下腔出血的临床研究%Clinical research of 64-slice CT angiography in aneurysmal subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    陈立朝; 许民辉; 邹咏文; 杨东虹; 张云东; 徐伦山; 张溢华

    2011-01-01

    目的:评估CT血管造影(CTA)在动脉瘤性蛛网膜下腔出血(SAH)病人中选择治疗策略的作用.方法:对231例动脉瘤性SAH病人行64排CTA检查.选择临床治疗方案,并通过DSA或外科手术验证CTA检查的准确性.结果:CTA检查与DSA或术中探查一致228例,CTA信息不充分2例,CTA漏诊1例;CTA检查的敏感性98.7%,特异性100%.根据CTA检查确定治疗方案228例(98.7%),其中采用血管内栓塞治疗141例,夹闭术87例;根据DSA检查,采用血管内栓塞治疗3例.结论:64排CTA能准确检测颅内动脉瘤及其特征,有助于选择治疗策略.%Objective To evaluate the clinical application of CT angiography (CTA) in making therapeutic strategy for patients with aneurysmal subarachnoid hemorrhage (SAH). Methods The 64-slice CTA examination was performed in 231 patients with aneurysmal SAH to select appropriate treatment strategies. CTA findings should be confirmed by DSA or surgical exploration. Results CTA findings were coincident with the findings by DSA or surgical exploration in 228 cases, CTA findings were insufficient in 2 cases, and missed diagnosis by CTA in 1 case. The sensitivity of CTA examination was 98.7% and specificity was 100%. The therapeutic measures were decided based on CTA in 228 cases (98.7%), including endovascular treatment in 141 cases, clipping of aneurysm in 87. Endovascular treatment was adopted based on DSA in 3 cases. Conclusions The 64-slice CTA as an accurate tool for detecting intracranial aneurysms is useful to decide therapeutic strategy.

  20. Helical CT for emergency patients with cerebrovascular diseases. Diagnosis of cerebral aneurysms with subarachnoid hemorrhage (SAH) by three-dimensional CT angiography (3D-CTA)

    International Nuclear Information System (INIS)

    Recently, the usefulness of three-dimensional CT angiography (3D-CTA) using helical CT has been reported. Although 3D-CTA has been applied for neurosurgical diseases, especially for surgical planning, it has not done for emergency patients because of the long time required for image reconstruction and location of a helical CT scanner. We studied emergency patients with SAH, and compared the 3D-CTA with angiography and surgical findings, using TOSHIBA X vigor. Twenty-two patients with SAH were evaluated. The helical CT was performed for 55 seconds with a bolus injection of 90 ml non-ionic, iodinated contrast medium at a rate of 3 ml/sec with a delay of 20 sec. Angiography was carried out immediately after the helical CT. Eighteen of 22 cases were operated on urgently. We were able to create the 3D-CTA in about 7 minutes, and diagnose aneurysms by the 3D-CTA before angiography. The 3D-CTA was able to demonstrate 30 of 31 aneurysms including 9 unruptured aneurysms. An unruptured internal carotid-posterior communicating artery aneurysm 1.3 mm in diameter and associated with a ruptured aneurysm was not detected by either the 3D-CTA or angiography. On the other hand, an unruptured Acom aneurysm 0.8 mm in diameter and associated with a ruptured aneurysm could be detected by the: 3D-CTA, but not by angiography. The 3D-CTA gave us useful information concerning the anatomical relationship of the aneurysm, its neck and parent artery, and the surrounding branches. There were no complications or side effects associated with the helical CT scan. Although the 3D-CTA requires further development of visualization of small arteries less than 1 mm in diameter, such as perforating arteries, subtraction technique of bony structure, and a method for checking cervical arteries, it is useful for diagnosis of emergency patients with SAH and urgent operations. We believe that an operation might be performed by only the 3D-CTA without the angiography in the near future. (author)

  1. Endovascular parent artery occlusion in large-giant or fusiform distal posterior cerebral artery aneurysms

    International Nuclear Information System (INIS)

    Posterior cerebral artery aneurysms are amenable to deconstructive surgical treatment because of the rich collateral supply of the distal posterior cerebral artery. This report retrospectively analyses the outcome of endovascular parent artery occlusion for large or fusiform distal posterior cerebral artery aneurysms. Medical records and cerebral angiograms from two endovascular centres were analysed retrospectively. Eight patients with large or fusiform distal posterior cerebral artery (PCA) aneurysms were treated by endovascular occlusion of the segment of the PCA at the site of the aneurysm. Three of those were treated urgently after acute subarachnoid haemorrhage, the remainder had elective treatment. The clinical and angiographic outcomes in seven patients were assessed at 6 to 12 months. A single case of occipital infarction resulting in permanent homonymous hemianopia was the only permanent complication. Of the remaining patients, six made excellent recoveries and one was lost to follow-up. No recurrence or re-bleeding was noted. Endovascular parent artery occlusion may be an alternative to surgical parent artery occlusion in distal PCA aneurysms which are not convenient for selective endovascular treatment or surgical clipping. (orig.)

  2. Aneurysms of the posterior cerebral artery in children

    International Nuclear Information System (INIS)

    Two cases of aneurysms of the posterior cerebral artery, diagnosed by CT and confirmed angiographically, are reported. In the first case, the aneurysm was discovered fortuitously. The second began with intracerebral haemorrhage. A review of the literature is reported. (orig.)

  3. Comparison of MR angiography and conventional angiography in the investigation of intracranial arteriovenous malformations and aneurysms in children

    International Nuclear Information System (INIS)

    Magnetic resonance angiography (MRA) is an attractive alternative to conventional catheter angiography (CCA) in children, especially for the detection of intracranial arteriovenous malformations (AVMs) or aneurysms in the out-of-hours setting, because it has fewer risks and complications. To compare MRA with CCA for the detection of intracranial AVMs, aneurysms and arterial anatomy in children. Retrospective blinded review of MRAs and CCAs by two independent paediatric radiologists, in a group of 19 children already diagnosed with AVMs, aneurysms and subarachnoid haemorrhage (SAH) and who had undergone both imaging techniques. Abnormalities were identified on MRA in 15 of 19 patients and by CCA in 11 of 19 patients. MRA showed one aneurysm, nine AVMs, three haemorrhages and two indeterminate lesions. CCA showed nine AVMs and two indeterminate lesions. The two modalities showed excellent correlation in the detection of AVMs in nine patients. Vascular supply to the AVMs correlated well in four cases. There was complete disagreement in the determination of vessel supply in one case, and in two cases CCA showed additional vessel supply compared to MRA, while in two further cases MRA showed an additional vessel supply compared to CCA. CCA was superior to MRA in demonstrating arterial anatomy, except with regard to the anterior and posterior communicating arteries where MRA was superior. The high sensitivity of MRA in the detection of AVMs when compared to CCA and the low incidence of aneurysms support the use of MRA as the initial imaging modality when intracranial haemorrhage is diagnosed on CT, especially in the out-of-hours setting. (orig.)

  4. Intracerebral haemorrhage.

    Science.gov (United States)

    Qureshi, Adnan I; Mendelow, A David; Hanley, Daniel F

    2009-05-01

    Intracerebral haemorrhage is an important public health problem leading to high rates of death and disability in adults. Although the number of hospital admissions for intracerebral haemorrhage has increased worldwide in the past 10 years, mortality has not fallen. Results of clinical trials and observational studies suggest that coordinated primary and specialty care is associated with lower mortality than is typical community practice. Development of treatment goals for critical care, and new sequences of care and specialty practice can improve outcome after intracerebral haemorrhage. Specific treatment approaches include early diagnosis and haemostasis, aggressive management of blood pressure, open surgical and minimally invasive surgical techniques to remove clot, techniques to remove intraventricular blood, and management of intracranial pressure. These approaches improve clinical management of patients with intracerebral haemorrhage and promise to reduce mortality and increase functional survival. PMID:19427958

  5. Intracerebral haemorrhage

    OpenAIRE

    Qureshi, Adnan I.; Mendelow, A David; Hanley, Daniel F.

    2009-01-01

    Intracerebral haemorrhage is an important public health problem leading to high rates of death and disability in adults. Although the number of hospital admissions for intracerebral haemorrhage has increased worldwide in the past 10 years, mortality has not fallen. Results of clinical trials and observational studies suggest that coordinated primary and specialty care is associated with lower mortality than is typical community practice. Development of treatment goals for critical care, and n...

  6. CT Angiography May Be a More Useful Modality Than Digital Subtractional Angiography in the Diagnosis of Patients with Subarachnoid Hemorrhage Due to Cerebral Aneurysms

    OpenAIRE

    Masih Saboori; Ali Reza Hekmatnia; Navid Omidifar; Amirhossein Ghazavi; Farzaneh Hekmatnia

    2011-01-01

    Background/Objective: The preoperative diagnostic"nvalidity of two radiological modalities (computed"ntomographic angiography and digital subtractional"nangiography) in the diagnosis of brain aneurysms were"ncompared."nPatients and Methods: During 2 years of study,"nreferred patients with signs of SAH to the emergency"nward underwent routine CT scan and after SAH was"nfirmly diagnosed, CTA and DSA methods were done"nand patients with correct indica...

  7. The Early Clinical Value of Combined CT and CTA in Aneurysmal Subarachnoid Hemorrhage%CT和CTA联合检查在动脉瘤性蛛网膜下腔出血早期的临床价值

    Institute of Scientific and Technical Information of China (English)

    傅顺斌; 杨海丽; 勾振恒; 任阿红; 李莉; 宋英

    2014-01-01

    Objective To analyze the early diagnosis potentiality of CT and CTA in the aneurismal subarachnoid hemorrhage (ASAH).Methods 75 cases of aneurismal subarachnoid hemorrhage (SAH)patients underwent CT,computed tomographic angiography (CTA) and digital substraction angiography (DSA).Relationship of bleeding morphological characteristic and aneurysm site was retrospectively analyzed.The releance of symptomatic cerebral vasospasm(SCVS) and blood volume was determined.The dif erence between CTA and DSA were retrospectively analyzed.Results According to Fisher grading standards,class Ⅰ7 cases (9.33%), Ⅱgrade 17 cases (22.67%),Ⅲgrade 32 cases (42.67%), Ⅳgrade 19 cases (25.33%).There were significant dif erences between the bleeding morphological characteristic and aneurysm site (P﹤0.05). SCVS occurred in 19 cases(25.33%),the incidence of SCVS among dif erent Fisher grades were statistical y significantly dif erent(P0.05). Conclusion CT can indirectly speculate the position of aneurysm,help to diagnose the SCVS according Fisher grade prospectively.CTA has good consistency compared with DSA.CT combined CTA play an important role in diagnosing and guiding the treadment of ASAH and preventing complications.%目的:探讨CT联合CTA对动脉瘤性蛛网膜下腔出血(ASAH)的早期诊断价值。方法搜集75例动脉瘤性蛛网膜下腔出血患者,所有病例均有急性期 CT平扫、CTA和DSA检查。对出血分布和出血量与破裂动脉瘤部位、出血与症状性脑血管痉挛(SCVS)以及CTA进行回顾性分析。结果 SAH按改良Fisher分级,Ⅰ级7例(9.33%),Ⅱ级17例(22.67%),Ⅲ级32例(42.67%),Ⅳ级19例(25.33%)。 ASAH的分布与动脉瘤的位置有一定规律,差异有统计学意义(P﹤0.05)。其中19例(25.33%)出现SCVS,不同Fisher分级与SCVS发生率具有统计学差异(P<0.05)。在检出动脉瘤方面,DSA共发现87个,CTA共发现85个,P>0.05,两种检查方

  8. The analysis of cerebral hemodynamics in patients with aneurysmal subarachnoid hemorrhage%动脉瘤性蛛网膜下腔出血患者的脑血流动力学分析

    Institute of Scientific and Technical Information of China (English)

    颜燕红; 惠品晶; 王中; 张世明; 郭亮

    2012-01-01

    Objective To study the clinical value of hemodynamic changes in cerebral circulation detected by transcranial Doppler (TCD) in the patients with aneurysm subarachnoid hemorrhage(SAH). Methods SAH in 35 patients was confirmed by CTA and/or DSA, who were operated for aneurysm clipping and underwent periodic TCD monitoring. The changes of mean flow velocities in the middle cerebral artery (MCA Vm) were record and Lindegaard index (LI) was calculated The hemodynamic changes of cerebral circulation were analyzed and the onset of cerebral vasospasm(CVS) detected by TCD with CTA during 7-10 days after aneurysm SAH was compared. Results MCA Vm and LI usually increased during 3-6 days,peaked in 7-9 days and lasted until 13-16 days after aneurysm SAH. Taking MCA Vm> 120 cm/s and Ll>3 as the criteria for CVS. the incidence rate of CVS was 51.4%. The results of TCD were well accordant to those of CTA (Kappa= 0. 727). Conclusion TCD is a noninvasive method for detecting CVS after aneurysm SAH with an advantage of simple and repeated examination.%目的 探讨经颅多普勒(TCD)检测动脉瘤性蛛网膜下腔出血(SAH)患者脑血流动力学改变的临床意义.方法 35例CT检查为SAH患者,均行CTA和(或)DSA检查证实为动脉瘤并行动脉瘤夹闭术.于SAH后备时间段行TCD检测,动态检测大脑中动脉平均血流速度(MCA Vm)、阻力指数(RI)等血流动力学参数,计算同侧大脑中动脉与颅外段颈内动脉之比(LI)指数,分析血流频谱形态等脑血流动力学改变,并且与SAH后7-10 d CTA检测结果进行对比分析.结果 TCD检测显示,MCA Vm、LI指数于动脉瘤性SAH后3-6 d开始升高,7-9d达高峰,持续至13-16 d;以MCA Vm高于120 cm/s及LI指数>3作为判断脑血管痉挛(CVS)的标准,CVS发生率51.4% (18/35),且TCD与CTA检测结果有良好的一致性(Kappa=0.727).结论 TCD是判断动脉瘤性SAH后CVS的一项无创的检查手段,具有操作简便、可重复检测等优势.

  9. Management of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Nasr, Deena M; Brown, Robert D

    2016-09-01

    Unruptured intracranial aneurysms (UIA) occur in approximately 2-3 % of the population. Most of these lesions are incidentally found, asymptomatic and typically carry a benign course. Although the risk of aneurysmal subarachnoid hemorrhage is low, this complication can result in significant morbidity and mortality, making assessment of this risk the cornerstone of UIA management. This article reviews important factors to consider when managing unruptured intracranial aneurysms including patient demographics, comorbidities, family history, symptom status, and aneurysm characteristics. It also addresses screening, monitoring, medical management and current surgical and endovascular therapies. PMID:27443382

  10. A hypothesis on possible neurochemical mechanisms of action of cervical spinal cord stimulation in prevention and treatment of cerebral arterial vasospasm after aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Yin, D; Slavin, K V

    2015-09-01

    Subarachnoid hemorrhage (SAH) is associated with the high incidence of development of cerebral vasospasm that results in morbidity and mortality due to delayed cerebral ischemia. So far there are no consistently effective therapies for treatment of vasospasm in patients suffering from SAH. It is well known that cervical spinal cord stimulation (SCS) can induce vasodilatation and increase cerebral blood flow (CBF). Based on the experiments in animals and the studies in humans, we have proposed the possibility to use SCS as a therapeutic strategy for prevention and treatment of cerebral vasospasm after SAH. However, the physiological mechanisms of action of SCS in this regard are poorly understood. Better understanding of the pathophysiology of vasospasm after SAH may provide insight into the role of SCS in such conditions. We hypothesize that effect of SCS on vasodilatation may be related to modulation of activity of phosphodiesterases 5 (PDE-5) and nitric oxide synthase (eNOS), resulting in enhancement of nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) pathway, which may help prevent and/or treat vasospasm after SAH. Further investigations on the physiological mechanisms of action of SCS would be necessary to support this hypothesis. PMID:26141634

  11. Leptomeningeal transthyretin-type amyloidosis presenting as acute hydrocephalus and subarachnoid hemorrhage.

    Science.gov (United States)

    Bevers, Matthew B; McGuone, Declan; Jerath, Nivedita U; Musolino, Patricia L

    2016-07-01

    We present a report of a 47-year-old woman with developmental delay who presented with subarachnoid hemorrhage and acute hydrocephalus. She did not have an aneurysm, but there was symmetric calcification and gadolinium-enhancement of the meninges within the Sylvian fissure. Biopsy and genetic testing confirmed transthyretin-type amyloidosis. It is important to consider such rare causes in atypical presentations of non-aneurysmal subarachnoid hemorrhage. PMID:26896372

  12. A case of angiographically occult, distal small anterior inferior cerebellar artery aneurysm

    OpenAIRE

    Hisashi Kubota; Yasuhiro Sanada; Kazuhiro Nagatsuka; Amami Kato

    2015-01-01

    Background: A small aneurysm at an unusual location, such as a distal anterior inferior cerebellar artery (AICA) aneurysm, may conceal as a computed tomography angiography (CTA) and digital subtraction angiography (DSA)-occult aneurysm. Case Description: We herein present the case of a patient suffering from a subarachnoid hemorrhage (SAH) with two aneurysms in which the AICA aneurysm was negative by CTA and DSA. CTA demonstrated a right anterior choroidal artery aneurysm, which was revea...

  13. Aneurysm Complications

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  14. 动脉瘤性蛛网膜下腔出血诊治热点问题及展望%Guidelines for diagnosis and management of aneurysmal subarachnoid hemorrhage:top issues and prospective

    Institute of Scientific and Technical Information of China (English)

    张建民

    2015-01-01

    动脉瘤性蛛网膜下腔出血( aSAH)是一类致死率和致残率极高的出血性脑卒中。尽管aSAH临床术前诊断、术中治疗和术后重症监护等方面都获得了很大的进展,但aSAH患者的总体预后并无明显改善。2011年,美国神经危重症协会发布了aSAH患者重症医学处理的推荐意见;2012年,心脏病协会和美国卒中协会更新了2009年aSAH的诊治指南;2013年,欧洲卒中组织制定了欧洲颅内动脉瘤和aSAH诊疗指南2;014年,韩国神经介入学会发布了破裂和未破裂动脉瘤的治疗指南。2015年,中国医师协会神经外科专家委员会也发布了重症aSAH管理专家共识。可见,aSAH的诊治成为神经外科研究的重点和热点。本文总结上述指南中关于aSAH诊断和治疗方面的重点内容、新进展或更新,比较各种用于aSAH诊断的影像学检查的优缺点,探讨手术治疗和血管内治疗的适应证,以期提高aSAH诊治水平,改善患者的预后。%Objective: Aneurysmal subarachnoid hemorrhage (aSAH) is a kind of hemorrhagic stroke with high mortality and morbidity. Although the preoperative diagnosis, surgical clipping, endovascular treatment, and intensive care have progressed in recent years, the overall prognosis of aSAH patients remains poor.In 2011, the Neurocritical Care Society organized an international, multidisciplinary consensus conference addressed the critical care management of SAH.In 2012, the American Stroke Association ( AHA) updated the guidelines of diagnosis and treatment of aSAH published in 2009 .In 2013 , European Stroke Organization established the guideline for management of intracranial aneurysms and SAH.In 2014, the Korean Society of Interventional Neuroradiology ( KSIN ) published clinical practice guideline for the management of ruptured and unruptured aneurysms.The guideline for diagnosis and management of aSAH for Chinese patients has been drafted in this year

  15. Gender differences in cerebral aneurysm location

    OpenAIRE

    Ali Jourabchi Ghods; Demetrius eLopes; Michael eChen

    2012-01-01

    Background and Purpose: A limited number of studies consisting predominantly of ruptured aneurysms have looked at differences in anatomical distribution of aneurysms between male and females. Unlike all other causes of stroke, subarachnoid-hemorrhages (SAH) occur more often in women and are thought to be a result of both hormonal influences and variation in wall shear stress (WSS). This paper retrospectively looks at a cohort of largely unruptured intracranial aneurysms to determine if there ...

  16. Natural history of giant intracranial aneurysms

    International Nuclear Information System (INIS)

    The outcome of a consecutive series of 28 patients with giant aneurysm who had been followed without surgery from one month to 12 years after the diagnosis was made, are presented with reviewing their radiological and clinical features. Symptoms and signs were directly or indirectly attributable to the intracranial mass effect and nine patients (32 %) presented subarachnoid hemorrhage. Subarachnoid hemorrhage was frequently associated with intraventricular or intracerebral hemorrhage, a poor clinical grading at admission and a high mortality. Subarachnoid hemorrhage was most often recorded from the giant aneurysm at the supraclinoid portion of the internal carotid artery and the vertebro-basilar artery, but the rupture from the intracavernous giant aneurysm, completely thrombosed giant aneurysm and the fusiform type of giant aneurysm was rare. The mortality rate in 28 cases for the above follow up period was 46 % (13 in 28 cases) and major morbidity occured in 11 % (3 in 28 cases). The above outcome of non operated giant aneurysm cases may justify the surgical management of the giant aneurysm, but as the intracavernous giant aneurysm and thrombosed giant aneurysm are relatively harmless, surgical indication should be carefully decided, especially in the older patients. (author)

  17. Spontaneous subarachnoid hemorrhage in the emergency department

    Directory of Open Access Journals (Sweden)

    Diego Garbossa

    2012-07-01

    Full Text Available Subarachnoid hemorrhage (SAH is one of the major cause of mortality for stroke. The leading cause is the rupture of an intracrnial aneurym. Acute aneurysmal subarachnoid hemorrhage (SAH is a complex multifaceted disorder that plays out over days to weeks. The development of aneurysms is mainly due to a hemodynamic stress. Considerableadvances have been made in endovascular techniques, diagnostic methods, and surgical and perioperative management guidelines. Rebleeding remains the most imminent danger until the aneurysm is excluded from cerebral circulation. The only effective prevention of rebleeding is repair the aneurysm; choosing the right way with surgical or an endovascular approach. Outcome for patients with SAH remains poor, with population-based mortality rates as high as 45% and significant morbidity among survivors. In this work we analyzed the diagnostic-therapeutic course of patients presenting SAH. We analyzed the types and the occurrence of complications. We present two cases report to better demonstrate that treatments for specific patients need to be individualized.

  18. Distal posterior inferior cerebellar artery aneurysm in a child

    OpenAIRE

    J. FRANCISCO SALOMÃO; René D. Leibinger; Yara M. S. Lima Ciro de A. Cunha; Ilton G. Shinzato; Paulo de T. L. Dantas

    1992-01-01

    The case of a 7-year-old boy presenting with recurrent episodes of subarachnoid hemorrhage due to a distal posterior inferior cerebellar artery aneurysm (PICA), successfully operated, is reported.' The low incidence of intracranial aneurysms in the first decade of life and the rare occurrence of distal PICA aneurysms are unusual features of this case. The theories regarding the origin of intracranial berry aneurysms are discussed.

  19. Clinical Practice Guideline for the Management of Intracranial Aneurysms

    OpenAIRE

    Jeong, Hae Woong; Seo, Jung Hwa; Kim, Sung Tae; Jung, Cheol Kyu; Suh, Sang-il

    2014-01-01

    Purpose An intracranial aneurysm, with or without subarachnoid hemorrhage (SAH), is a relevant health problem. The rupture of an intracranial aneurysm is a critical concern for individual health; even an unruptured intracranial aneurysm is an anxious condition for the individual. The aim of this guideline is to present current and comprehensive recommendations for the management of intracranial aneurysms, with or without rupture. Materials and Methods We performed an extensive literature sear...

  20. Intracranial aneurysm and sildenafil.

    Science.gov (United States)

    Adiga, Avinash; Edriss, Hawa; Nugent, Kenneth

    2016-04-01

    Sildenafil is one of the most commonly used drugs for the treatment of erectile dysfunction. To date, we found five reported cases of intracerebral bleeding and two reported cases of subarachnoid hemorrhage related to sildenafil use. We report a 49-year-old hypertensive and diabetic patient who presented with acute pulmonary edema and loss of consciousness following ingestion of 100 mg of sildenafil prior to sexual intercourse. He was not previously aware of the presence of an aneurysm and had no family history of it. Computed tomography of his head revealed a subarachnoid hemorrhage due to rupture of a saccular aneurysm with subsequent repeat hemorrhage within a few hours of presentation. A sudden increase in blood pressure led to pulmonary edema. Studies have shown that sildenafil acts on phosphodiesterase-1, -2 and -5 receptors and leads to a secondary increase in intracerebral circulation and vasodilatory effects, leading to sympathetic overactivity which increases the risk for intracranial bleeding. PMID:27034561

  1. Spontaneous Anterior Cerebral Artery Dissection Presenting with Simultaneous Subarachnoid Hemorrhage and Cerebral Infarction in a Patient with Multiple Extracranial Arterial Dissections

    OpenAIRE

    Park, Yung Ki; Yi, Hyeong-Joong; Lee, Young Jun; Kim, Young-Seo

    2013-01-01

    Simultaneous subarachnoid hemorrhage and infarction is a quite rare presentation in a patient with a spontaneous dissecting aneurysm of the anterior cerebral artery. Identifying relevant radiographic features and serial angiographic surveillance as well as mode of clinical manifestation, either hemorrhage or infarction, could sufficiently determine appropriate treatment. Enlargement of ruptured aneurysm and progressing arterial stenosis around the aneurysm indicates impending risk of subseque...

  2. Endovascular treatment of an adolescent patient with ruptured intracranial aneurysm

    International Nuclear Information System (INIS)

    The occurrence of intracranial aneurysms in pediatric patients under 18 years of age is between 0,5-2% of all diagnosed aneurysms. We describe our experience with a patient of 10 years old with subarachnoid hemorrhage due to ruptured trilobular aneurysm on the top of the basilar artery, evidenced by CT angiography and DSA. Powered been consistently excluded from the bloodstream of two lobules of the aneurysm through coiling. Changed conditions of hemodynamics in aneurysmal sac fed to subsequent selftrombosing the third lobe of the aneurysm. Made control angiography after 10 months confirmed the good result of endovascular treatment and no neurological deficit. In conclusion it can be noted that in present conditions with a multidisciplinary approach endovascular treatment can be applied in this group of patients. (authors) Key words: SUBARACHNOID HEMORRHAGIA. CEREBRAL VESSEL ANEURYSM. BASILAR CEREBRAL ARTERY. COIL EMBOLIZATION

  3. Troponin elevation in subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Ioannis N Mavridis; Maria Meliou; Efstratios-Stylianos Pyrgelis

    2015-01-01

    Troponin (tr) elevation in aneurysmal subarachnoid hemorrhage (SAH) patients is often difficult to be appropriately assessed by clinicians, causing even disagreements regarding its management between neurosurgeons and cardiologists. The purpose of this article was to review the literature regarding the clinical interpretation of tr elevation in SAH. We searched for articles in PubMed using the key words:“troponin elevation”and“subarachnoid hemorrhage”. All of them, as well as relative neurosurgical books, were used for this review. Some type of cardiovascular abnormality develops in most SAH patients. Neurogenic stunned myocardium is a frequent SAH complication, due to catecholamine surge which induces cardiac injury, as evidenced by increased serum tr levels, electrocardiographic (ECG) changes and cardiac wall motion abnormalities. Tr elevation, usually modest, is an early and specific marker for cardiac involvement after SAH and its levels peak about two days after SAH. Cardiac tr elevation predictors include poor clinical grade, intraventricular hemorrhage, loss of consciousness at ictus, global cerebral edema, female sex, large body surface area, lower systolic blood pressure, higher heart rate and prolonged Q-Tc interval. Elevated tr levels are associated with disability and death (especially tr>1μg/L), worse neurological grade, systolic and diastolic cardiac dysfunction, pulmonary congestion, longer intensive care unit stay and incidence of vasospasm. Tr elevation is a common finding in SAH patients and constitutes a rightful cause of worry about the patients’ cardiac function and prognosis. It should be therefore early detected, carefully monitored and appropriately managed by clinicians.

  4. A rare anomaly of the anterior communicating artery complex hidden by a large broad-neck aneurysm and disclosed by three-dimensional rotational angiography

    International Nuclear Information System (INIS)

    Double fenestration of the anterior communicating artery (ACoA) complex associated with an aneurysm is a very rare finding and is usually caused by ACoA duplication and the presence of a median artery of the corpus callosum (MACC). We present a patient in whom double fenestration was not associated with ACoA duplication or even with MACC, representing therefore, a previously unreported anatomic variation. A 43 year old woman experienced sudden headache and the CT scans showed subarachnoid haemorrhage (SAH). On admission, her clinical condition was consistent with Hunt and Hess grade II. Conventional digital subtraction angiography (DSA) was performed and revealed multiple intracranial aneurysms arising from both middle cerebral arteries (MCA) and from the ACoA. Three-dimensional rotational angiography (3D-RA) disclosed a double fenestration of the ACoA complex which was missed by DSA. The patient underwent a classic pterional approach in order to achieve occlusion of both left MCA and ACoA aneurysms by surgical clipping. The post-operative period was uneventful. A rare anatomical variation characterised by a double fenestration not associated with ACoA duplication or MACC is described. The DSA images missed the double fenestration which was disclosed by 3D-RA, indicating the importance of 3D-RA in the diagnosis and surgical planning of intracranial aneurysms. (author)

  5. Exploration the application value of 320-slice three-dimensional CTA technique in aneurysmal spontaneity subarachnoid hemorrhage%320排3D-CTA在动脉瘤性自发性蛛网膜下腔出血中的应用价值探讨

    Institute of Scientific and Technical Information of China (English)

    吴遵富

    2015-01-01

    ObjectiveTo explore the application value of 320-slice three-dimensional CTA technique in aneurysmal spontaneity Subarachnoid Hemorrhage(SAH).Methods58 patients with SAH is chosen as the research object,all do 320-slice 3d-CTA examination,And according to the results of Digital Subtraction Angiography(DSA)and operation were retrospectively analyzed.Results58 patients with SAH were completed 320-slice 3d- CTA examination,Check out of 56 patients with intracranial aneurysm,were diagnosed by DSA and surgery. Single aneurysm 51 cases,There are 2 aneurysms in 5 cases. The other 2 cases of SAH patients with 3d-CTA and DSA are found no intracranial aneurysm.Conclusion320-slice 3d-CTA For diagnosing SAH cause very high accuracy、Safe noninvasive、Imaging fast and easy to operate,for clinicians to choose treatment and surgery to provide reliable basis,is bound to become a major means of Checking and excluding intracranial aneurysm.%目的:探讨320排螺旋CT三维血管造影(3D-CTA)在动脉瘤性自发性蛛网膜下腔出血(SAH)中的应用价值。方法选择SAH患者58例作为研究对象,均行320排3D-CTA检查,并根据数字减影血管造影(DSA)及手术结果进行回顾性分析。结果58例SAH患者检查出颅内动脉瘤56例,均经DSA及手术确诊,其中单发动脉瘤51例,存在2个动脉瘤的5例。另2例SAH患者3D-CTA及DSA均未发现颅内动脉瘤。结论320排3D-CTA用于诊断SAH病因准确率极高、安全无创、且操作简便成像快速,为临床医师选择治疗及手术方案提供了可靠的依据,势必会成为检查和排除颅内动脉瘤的主要手段。

  6. Clinical presentation of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Cianfoni, Alessandro [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Pravatà, Emanuele, E-mail: emanuele.pravata@gmail.com [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); De Blasi, Roberto [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Tschuor, Costa Silvia [Dipartimento di Radiologia, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Bonaldi, Giuseppe [U.O. Neuroradiologia, Ospedali Riuniti di Bergamo, Largo Barozzi, 1, 24128 Bergamo (Italy)

    2013-10-01

    Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture. Most unruptured intracranial aneurysms are thought to be asymptomatic, or present with vague or non-specific symptoms like headache or dizziness. Isolated oculomotor nerve palsies, however, may typically indicate the presence of a posterior circulation aneurysm. Ruptured intracranial aneurysms are by far the most common cause of non-traumatic subarachnoid hemorrhage and represent a neurological emergency with potentially devastating consequences. Subarachnoid hemorrhage may be easily suspected in the presence of sudden and severe headache, vomiting, meningism signs, and/or altered mental status. However, failure to recognize milder and more ambiguous clinical pictures may result in a delayed or missed diagnosis. In this paper we will describe the clinical spectrum of unruptured and ruptured intracranial aneurysms by discussing both typical and uncommon clinical features emerging from the literature review. We will additionally provide the reader with descriptions of the underlying pathophysiologic mechanisms, and main diagnostic pitfalls.

  7. Clinical presentation of cerebral aneurysms

    International Nuclear Information System (INIS)

    Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture. Most unruptured intracranial aneurysms are thought to be asymptomatic, or present with vague or non-specific symptoms like headache or dizziness. Isolated oculomotor nerve palsies, however, may typically indicate the presence of a posterior circulation aneurysm. Ruptured intracranial aneurysms are by far the most common cause of non-traumatic subarachnoid hemorrhage and represent a neurological emergency with potentially devastating consequences. Subarachnoid hemorrhage may be easily suspected in the presence of sudden and severe headache, vomiting, meningism signs, and/or altered mental status. However, failure to recognize milder and more ambiguous clinical pictures may result in a delayed or missed diagnosis. In this paper we will describe the clinical spectrum of unruptured and ruptured intracranial aneurysms by discussing both typical and uncommon clinical features emerging from the literature review. We will additionally provide the reader with descriptions of the underlying pathophysiologic mechanisms, and main diagnostic pitfalls

  8. Internal Carotid Artery Blister-Like Aneurysm Caused by Aspergillus – Case Report

    International Nuclear Information System (INIS)

    Blister-like aneurysm of the supraclinoid internal carotid artery (ICA) is a well-documented cause of subarachnoid hemorrhage. Generally, this type of aneurysm is associated with various conditions such as hypertension, arteriosclerosis, and ICA dissection. Although Aspergillus is the most common organism causing intracranial fungal aneurysmal formation, there is no report of a blister-like aneurysm caused by Aspergillus infection. An 83-year-old man received corticosteroid pulse therapy followed by oral steroid therapy for an inflammatory pseudotumor of the clivus. Two months later, the patient was transported to an emergency department due to the diffuse subarachnoid hemorrhage, classified as Fisher group 4. Subsequent 3D computed tomography angiogram revealed a blister-like aneurysm at the superior wall of the left ICA. Six days later, the patient died of subarachnoid hemorrhage caused by the left ICA aneurysm rerupture. Autopsy revealed proliferation of Aspergillus hyphae in the wall of the aneurysm. Notably, that change was present more densely in the inner membrane than in the outer one. Thus, it was considered that Aspergillus hyphae caused infectious aneurysm formation in the left ICA via hematogenous seeding rather than direct invasion. The blister-like aneurysm is a rare but important cause of subarachnoid hemorrhage. This case report documents another cause of blister-like aneurysms, that is an infectious aneurysm associated with Aspergillus infection

  9. Comprehensive Overview of Contemporary Management Strategies for Cerebral Aneurysms.

    Science.gov (United States)

    Manhas, Amitoz; Nimjee, Shahid M; Agrawal, Abhishek; Zhang, Jonathan; Diaz, Orlando; Zomorodi, Ali R; Smith, Tony; Powers, Ciarán J; Sauvageau, Eric; Klucznik, Richard P; Ferrell, Andrew; Golshani, Kiarash; Stieg, Philip E; Britz, Gavin W

    2015-10-01

    Aneurysmal subarachnoid hemorrhage (SAH) remains an important health issue in the United States. Despite recent improvements in the diagnosis and treatment of cerebral aneurysms, the mortality rate following aneurysm rupture. In those patients who survive, up to 50% are left severely disabled. The goal of preventing the hemorrhage or re-hemorrhage can only be achieved by successfully excluding the aneurysm from the circulation. This article is a comprehensive review by contemporary vascular neurosurgeons and interventional neuroradiolgists on the modern management of cerebral aneurysms. PMID:26072457

  10. Multiple Intracranial Aneurysms Associated with Behçet's Disease

    Science.gov (United States)

    Ha, Sangwoo; Kim, Jaeho; Kim, Chong-gue

    2016-01-01

    Behçet's disease is an inflammatory disorder involving multiple organs. Its cause is still unknown, but vasculitis is the major pathologic characteristic. The common vascular lesions associated with Behçet's disease are aneurysm formation, arterial or venous occlusive diseases, and varices. Arterial aneurysms mostly occur in large arteries. Intracranial aneurysms hardly occur with Behçet's disease. We would like to present a 41-year-old female patient with Behçet's disease who showed symptoms of severe headache due to subarachnoid hemorrhage. Brain computed tomography revealed multiple aneurysms. We also present a literature review of intracranial arterial aneurysms associated with Behçet's disease.

  11. Bleeding in the subarachnoid space: a possible complication during laser therapy for equine progressive ethmoid haematoma.

    Science.gov (United States)

    Vreman, S; Wiemer, P; Keesler, R I

    2013-10-01

    A 10-year-old KWPN (Royal Warmblood Studbook of the Netherlands) gelding was euthanized after developing severe neurological symptoms preceded by severe epistaxis during laser treatment for progressive ethmoid haematoma (PEH) in the right nasal cavity. Postmortem examination of the head revealed a large amount of clotted blood between the right ventral and dorsal conchae in the nasal cavity and acute haemorrhage in the right subarachnoid space. Histologically, there was moderate, acute polioencephalomalacia in the neuropil adjacent to the haemorrhage. The haemorrhages were most likely caused by the laser treatment and therefore should be considered a possible complication that could lead to severe peracute neurological symptoms. PMID:24199337

  12. Outcome after endovascular therapy of ruptured intracranial aneurysms: morbidity and impact of rebleeding

    International Nuclear Information System (INIS)

    We evaluated midterm functional outcome after endovascular occlusion of aneurysms in patients with subarachnoid haemorrhage (SAH) and determined the incidence of late rebleeding as an additional prognostic parameter. We treated 79 consecutive patients with SAH from an intracranial aneurysm admitted from a neurological intensive care unit by the endovascular route between 1993 and 1997 and 52 survivors were followed up in 1999-2000. The mean interval between SAH and follow-up was 41 months (range 13-74 months). Outcome was determined by the Glasgow outcome (GOS) and Rankin (RS) scales and by questions concerning neuropsychological disorders. The patients were analysed according to Hunt and Hess (H and H) grades I-III or IV-V on admission. We observed two episodes of rebleeding (3%) with impact on outcome at 907 and 2010 days after SAH, respectively. A complete recovery (GOS 5) was achieved in 53% of H and H grade I-III and 17% of grade IV-V patients; with death rates 19% and 50%, and morbidity according to the RS (5-2) 18% and 29%, respectively. Midterm morbidity after endovascular therapy is thus low. Rebleeding with an impact on outcome can be observed up to 2010 days after SAH, suggesting that long-term angiographic follow-up is indispensable. (orig.)

  13. Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm Sindrome da doença não tiroideana em pacientes com hemorragia subaracnoidea devida a aneurisma cerebral

    Directory of Open Access Journals (Sweden)

    Luiz Augusto Casulari

    2004-03-01

    Full Text Available We have previously reported that subarachnoid hemorrhage due to ruptured intracranial aneurysm (SH is associated with changes in the hormonal profile in the first 24 hours after the event. We proposed that the hormonal changes observed are due to the intense stress to which the patients are exposed. However, the thyroidal hormonal profile is indicative of the presence of a nonthyroidal illness syndrome (NTIS. In this paper, we examined whether the change in the thyroid hormone profile is compatible with a NTIS. Two groups of patients were included in the study: A 30 patients with SH (21 females and 9 males; 41.7±11.4 years and B a control group including 25 patients with benign diseases of the spine (BDS (lumbar disc hernia or stable spinal trauma (8 females and 17 males; 41.3±14.2 years. In a subgroup of eight patients of each group serum triiodothyronine (T3 and reverse T3 levels were measured. The blood samples were obtained between 8:00 and 9:00 AM. The following results were obtained: The SH group had smaller serum T3 and free T4 levels than the BDS group (pNós apresentamos previamente que a hemorragia subaracnoidea devido à ruptura de aneurisma intracraniano (SH está associada com alterações no perfil hormonal nas primeiras 24 horas após o evento. Nós propusemos que as alterações hormonais observadas são devidas ao intenso estresse ao qual os pacientes estão expostos. Contudo, o perfil hormonal tireoidiano é indicativo da presença da síndrome da doença não tireoidiana (NTIS. Neste trabalho, examinamos se as alterações no perfil dos hormônios tireoidianos são compatíveis com a NTIS. Dois grupos de pacientes foram incluídos no estudo: A 30 pacientes com SH (21 mulheres e 9 homens; 41,7±11,4 anos e B um grupo controle incluindo 25 pacientes com doenças benignas da coluna (BDS (hérnia de disco lombar ou estável trauma da coluna (8 mulheres e 17 homens; 41,3±14,2 anos. Em um subgrupo de oito pacientes de cada grupo

  14. Molecular alterations in the hippocampus after experimental subarachnoid hemorrhage

    OpenAIRE

    Han, Sang Myung; Wan, Hoyee; Kudo, Gen; Foltz, Warren D.; Vines, Douglass C; Green, David E.; Zoerle, Tommaso; Tariq, Asma; Brathwaite, Shakira; D'abbondanza, Josephine; Ai, Jinglu; Macdonald, R. Loch

    2013-01-01

    Patients with aneurysmal subarachnoid hemorrhage (SAH) frequently have deficits in learning and memory that may or may not be associated with detectable brain lesions. We examined mediators of long-term potentiation after SAH in rats to determine what processes might be involved. There was a reduction in synapses in the dendritic layer of the CA1 region on transmission electron microscopy as well as reduced colocalization of microtubule-associated protein 2 (MAP2) and synaptophysin. Immunohis...

  15. Low plasma arginine:asymmetric dimethyl arginine ratios predict mortality after intracranial aneurysm rupture

    DEFF Research Database (Denmark)

    Staalsø, Jonatan Myrup; Bergström, Anita; Edsen, Troels; Weikop, Pia; Romner, Bertil; Olsen, Niels Vidiendal

    2013-01-01

    Asymmetrical dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthases, predicts mortality in cardiovascular disease and has been linked to cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). In this prospective study, we assessed whether circulating ADMA, arginine...

  16. Familial aggregation of intracranial aneurysms in an Inuit patient population in Kalaallit Nunaat (Greenland)

    DEFF Research Database (Denmark)

    Lindgaard, Lars; Eskesen, Vagn; Gjerris, Flemming;

    2003-01-01

    The incidence of subarachnoid hemorrhage (SAH) and intracranial aneurysm (IA) has been reported to be higher in Greenlandic Inuits than in Caucasian Danes, but the rate of familial aggregation in Inuits is unknown....

  17. Retrospective analysis of the prevalence of asymptomatic cerebral aneurysm in 4518 patients undergoing magnetic resonance angiography. When does cerebral aneurysm develop?

    International Nuclear Information System (INIS)

    The natural history of cerebral aneurysms was investigated by measuring the prevalence of incidentally found unruptured aneurysms in the general population and evaluating the characteristics including risk factors. 'De novo' formation of aneurysm was also demographically estimated. The prevalence of incidental aneurysm was evaluated among 4518 patients who underwent magnetic resonance (MR) angiography for various reasons in a neurosurgical institute. Double the number of patients were randomly selected from the remaining patients without aneurysm as the Control group so that sex and age group were matched to the Aneurysm group. One hundred twenty seven patients (2.8%) had diagnoses of aneurysm. The prevalence of asymptomatic aneurysm among middle-aged and elderly patients were predominant in women and increased with age in both sexes. Patients with aneurysms had significantly more hypertension and family history of subarachnoid hemorrhage compared to the controls. The prevalence was markedly increased in the 8th decade in men and the 7th decade in women, and new aneurysms seemed to develop predominantly around these decades. Cerebral aneurysms become detectable on MR angiography in the middle or later decades, and women tend to develop aneurysm earlier than men. Hypertension and family history of subarachnoid hemorrhage are probably risk factors for the development of aneurysm. (author)

  18. Perimesencephalic subarachnoid hemorrhage: when to stop imaging?

    Science.gov (United States)

    Cruz, Juan Pablo; Sarma, Dipanka; Noel de Tilly, Lyne

    2011-06-01

    To evaluate the yield of digital subtraction angiography (DSA) and repeated follow-up imaging in patients with initial pattern of perimesencephalic subarachnoid hemorrhage (PSAH) and negative computed tomography angiography (CTA) in excluding an underlying aneurysm. We conducted a retrospective analysis of all nontraumatic SAH who underwent a DSA between January 2006 and January 2010 and selected those with a PSAH pattern on CT done within 72 h from ictus. All CTAs were performed with a 64-section multidetector row CT scanner, and findings were compared with DSA and to follow-up imaging. Forty-nine patients with initial PSAH pattern and negative CTA who underwent subsequent DSA were identified. Six patients were excluded because CTA was not available in hospitals or 72 h after ictus. Only one patient (2.4%) had a false negative CTA with a 1-mm left ICA aneurysm seen on DSA, considered not to be the source of hemorrhage. An average of 2.0 ± 1.2 follow-up exams per patient (range 0-5) revealed no source of bleeding. One patient had a procedure-related transient complication, but evolved with no sequels. In patients with PSAH, CTA is reliable for ruling out an underlying aneurysm. DSA and, especially, further follow-up imaging have no increased diagnostic yield compared to initial negative CTA. PMID:21360167

  19. Viral Haemorrhagic Septicaemia Virus

    DEFF Research Database (Denmark)

    Olesen, Niels Jørgen; Skall, Helle Frank

    This chapter covers the genetics (genotypes and serotypes), clinical signs, host species, transmission, prevalence, diagnosis, control and prevention of viral haemorrhagic septicaemia virus.......This chapter covers the genetics (genotypes and serotypes), clinical signs, host species, transmission, prevalence, diagnosis, control and prevention of viral haemorrhagic septicaemia virus....

  20. Viral Haemorrhagic Septicaemia Virus

    DEFF Research Database (Denmark)

    Olesen, Niels Jørgen; Skall, Helle Frank

    2013-01-01

    This chapter covers the genetics (genotypes and serotypes), clinical signs, host species, transmission, prevalence, diagnosis, control and prevention of viral haemorrhagic septicaemia virus.......This chapter covers the genetics (genotypes and serotypes), clinical signs, host species, transmission, prevalence, diagnosis, control and prevention of viral haemorrhagic septicaemia virus....

  1. The VASOGRADE: A Simple Grading Scale for Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

    NARCIS (Netherlands)

    Oliveira Manoel, A.L. de; Jaja, B.N.; Germans, M.R.; Yan, H.; Qian, W.; Kouzmina, E.; Marotta, T.R.; Turkel-Parrella, D.; Schweizer, T.A.; Macdonald, R.L.

    2015-01-01

    BACKGROUND AND PURPOSE: Patients are classically at risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage. We validated a grading scale-the VASOGRADE-for prediction of DCI. METHODS: We used data of 3 phase II randomized clinical trials and a single hospital series to asses

  2. Basilar Artery Aneurysm at a Persistent Trigeminal Artery Junction

    Science.gov (United States)

    Aguiar, G.B.; Conti, M.L.M.; Veiga, J.C.E.; Jory, M.; Souza, R.B.

    2011-01-01

    Summary The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature. PMID:22005697

  3. Spontaneous thrombosis of a recurrent clipped intracranial aneurysm.

    Science.gov (United States)

    Hassan, F; Taschner, C-A; Thines, L; Lejeune, J-P; Pruvo, J-P; Leclerc, X

    2009-06-01

    Spontaneous thrombosis of an intracranial aneurysm is a rare event. It is predominantly observed with aneurysms that are large and have relatively narrow necks. We report here a case of a 48-year-old woman presenting with subarachnoid hemorrhage (SAH) due to rupture of a 2-mm aneurysm of the anterior cerebral artery treated by microsurgical clipping. Six months after treatment of the aneurysm, the patient presented with severe headache. SAH was excluded, but computed tomographic angiography (CTA) revealed the recurrence of a large aneurysm (7 mm) that was confirmed by cerebral angiography (DSA). Endovascular treatment was scheduled for several days later, but DSA also revealed spontaneous occlusion of the recurrent aneurysm. On the control CTA performed one week later, the recurrent aneurysm had again reappeared, again confirmed by DSA, and was subsequently treated by coil embolization. PMID:19144409

  4. "Subarachnoid Hemorrhage; An An-giographic Evaluation in Iran "

    Directory of Open Access Journals (Sweden)

    K. Firouznia

    2004-06-01

    Full Text Available Background/Objectives: The evaluation of different aspects of subarachnoid hemorrhage (SAH can effectively improve the outcomes of this fatal disease. This article presents some information about angiographic and epidemiologic findings in 580 cases of SAH in Iran. Materials and Methods: We reviewed the records of 580 SAH patients in whom the disease was proved by brain CT scan and/or lumbar puncture. In all of the patients, a standard subtraction brain angiography was done. Results: Sixty percent of all patients were male and about sixty percent of patients were aged 30-60years. The angiogram showed: aneurysm in 23.4%, arteriovenous malformation in 14.1%, and miscellaneous problems in 6.3%. The angiogram was normal in the remained 56%. The mean age of aneurysm patients was 46 years, and 59% of them were male. 33.6% of aneurysms resided in A.C.A, 31% in I.C.A (14.1% of total aneurysms located in P.Comm.A, 24.8% in MCA and 10.7% of aneurysm were located in posterior circulation. Conclusion: The high prevalence of the disease in men could be due to the relatively high exposure of men to certain risk factors, such as smoking, or the ethnic factors may play a role. The lower mean age could be due to high percentage of men. Low prevalence of P.Comm.A aneurysms could be due to ethnic factors.

  5. Cerebral CT angiography in the diagnosis of acute subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Purpose: To evaluate the usefulness of CT angiography (CTA) in the detection of intracranial aneurysms in patients with acute subarachnoid hemorrhage (SAH). Material and Methods: In 53 patients with nontraumatic SAH a helical contrast-enhanced CTA was performed. CTA data were reconstructed with maximum intensity projection (MIP). Each patient underwent selective arteriography of the cerebral vessels (as the gold standard). CTA (axial images and MIP reconstructions) and arteriography were evaluated separately and their diagnostic information was compared. Results: In 14 of the 53 patients neither CTA nor angiography showed a vascular malformation. In the remaining 39 patients, angiography demonstrated a total of 51 aneurysms ranging in size from 3 mm to 16 mm. CTA missed one of these aneurysms, which was located at the internal carotid artery. 3-D CT reconstruction was slightly superior to arteriography in the demonstration of the neck, shape and direction of the aneurysms. Partial thrombosis of 3 aneurysms was demonstrated only by CTA. Conclusion: Although CTA cannot replace cerebral arteriography in the diagnostic work-up of acute SAH, it proved to be helpful in demonstrating the topographic anatomy of cerebral aneurysms and surrounding structures. (orig.)

  6. Endovascular treatment for pediatric intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Yang, Xinjian; Wu, Zhongxue [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, Hebei (China)

    2009-11-15

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged {<=}17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  7. Angiographic Findings In Patients With Cerebral Aneurysm

    Directory of Open Access Journals (Sweden)

    Miri S M

    2004-09-01

    Full Text Available Background: This investigation was conducted in order to study angiographic findings in patients with cerebral aneurysm. Materials and Methods: The study conducted on 136 cases of ruptured cerebral aneurysms between 1995-2000 confirmed by means of 4-vessel cerebral angiography to get an insight to racial, geographic and environmental factors predisposing to the occurrence of subarachnoid hemorrhage and aneurysm formation. Results: The data analysis revealed the following results: 58% of the population comprised of male and 42% female with a mean age of 46 years. 89% of the aneurysms were found in the anterior circulation and 11% occurred in the posterior cerebral circulation. The most common site in both the sexes was the anterior communicating artery. 9.6% of the patients displayed two separate aneurysms. 5.2% of the aneurysms were found to be giant aneurysms and 3% of the patients had fusiform aneurysms. Conclusion: The low average age, a predilection in male population and the prevalence of aneurysms at carotid and middle cerebral artery bifurcation and the distal branches of anterior cerebral artery and a higher incidence of anterior communicating artery in women were the findings observed in this study.

  8. Endovascular treatment for pediatric intracranial aneurysms

    International Nuclear Information System (INIS)

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged ≤17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  9. Surgical Craniotomy for Intracerebral Haemorrhage.

    Science.gov (United States)

    Mendelow, A David

    2015-01-01

    Craniotomy is probably indicated for patients with superficial spontaneous lobar supratentorial intracerebral haemorrhage (ICH) when the level of consciousness drops below 13 within the first 8 h of the onset of the haemorrhage. Once the level drops below 9, it is probably too late to consider craniotomy for these patients, so clinical vigilance is paramount. While this statement is only backed up by evidence that is moderately strong, meta-analysis of available data suggests that it is true in the rather limited number of patients with ICH. Meta-analyses like this can often predict the results of future prospective randomised controlled trials a decade or more before the trials are completed and published. Countless such examples exist in the literature, as is the case for thrombolysis in patients with myocardial infarction in the last millennium: meta-analysis determined the efficacy more than a decade BEFORE the last trial (ISIS-2) confirmed the benefit of thrombolysis for myocardial infarction. Careful examination of the meta-analysis' Forest plots in this chapter will demonstrate why this statement is made at the outset. Other meta-analyses of surgery for ICH have also indicated that minimal interventional techniques using topical thrombolysis or endoscopy via burrholes or even twist drill aspiration may be particularly successful for the treatment of supratentorial ICH, especially when the clot is deep seated. Ongoing clinical trials (CLEAR III and MISTIE III) should confirm this in the fullness of time. There are 2 exceptions to these generalisations. First, based on trial evidence, aneurysmal ICH is best treated with surgery. Second, cerebellar ICH represents a special case because of the development of hydrocephalus, which may require expeditious drainage as the intracranial pressure rises. The cerebellar clot will then require evacuation, usually via posterior fossa craniectomy, rather than craniotomy. Technical advances suggest that image-guided surgery

  10. Understanding the Role of Autoimmune Disorders on the Initial Presentation of Cardiovascular Disease

    Science.gov (United States)

    2015-04-20

    Myocardial Infarction; Ischemic Stroke; Stroke; Subarachnoid Haemorrhage; Venous Thrombosis; Transient Ischemic Attack; Stable Angina Pectoris; Unstable Angina; Heart Failure; Peripheral Arterial Disease; Abdominal Aortic Aneurysm

  11. Pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: A systematic review

    Directory of Open Access Journals (Sweden)

    Benjamin W. Y. Lo

    2015-01-01

    Conclusions: This systematic review synthesizes the most current evidence of underlying mechanisms of brain related associations with body systems in aneurysmal subarachnoid hemorrhage. Results gained from these studies are clinically useful and shed light on how ruptured brain aneurysms affect the cardiopulmonary system. Subsequent neuro-cardio-endocrine responses then interact with other body systems as part of the secondary responses to primary injury.

  12. Anaplastic Medullary Ependymoma Presenting as Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Nicolas Nicastro

    2013-01-01

    Full Text Available A-41-year old man presented with violent thunderclap headache and a bilateral proprioceptive sensibility deficit of the upper limbs. Cerebral CT scan and MRI were negative. Lumbar puncture confirmed subarachnoid hemorrhage (SAH, but cerebral angiography was negative. Three months later, the patient presented with paraparesis, and a thorough work-up revealed a diffuse, anaplastic extramedullary C7-D10 ependymoma with meningeal carcinomatosis considered the source of hemorrhage. The patient went through a D5-D8 laminectomy, temozolomide chemotherapy, and radiotherapy. The situation remained stable for a few months. In this paper, we would like to emphasize that spinal masses should be considered in cases of SAH with negative diagnostic findings for aneurysms or arteriovenous malformation.

  13. Unruptured Brain Aneurysms

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  14. Brain Aneurysm: Treatment Options

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  15. Lethal subarachnoid bleeding under immunosuppressive therapy due to mycotic arteritis

    Energy Technology Data Exchange (ETDEWEB)

    Weigel, S.; Kloska, S.; Freund, M. [Dept. of Clinical Radiology, Univ. Hospital of Muenster, Muenster (Germany); Kehl, H.G. [Dept. of Pediatric Cardiology, Univ. Hospital of Muenster, Muenster (Germany)

    2003-12-01

    A subarachnoid haemorrhage (SAH) occurred 67 days after cardiac transplantation in 10-year-old girl with consecutive immunocompromising therapy. Neither digital subtraction angiography (DSA) nor computed tomographic angiography showed signs of intracranial vascular malformations. One month before the lethal SAH occurred, she had developed arterial hypertension and attacks of severe headache with cerebrospinal fluid (CSF) pleocytosis while CT scans showed an infarct of the left thalamus. Pathologic findings established the rare diagnosis of SAH due to aspergillosis-related mycotic arteritis. Imaging characteristics are presented. (orig.)

  16. Marburg Haemorrhagic Fever

    Science.gov (United States)

    ... onset of symptoms. Many patients develop severe haemorrhagic manifestations between 5 and 7 days, and fatal cases ... RT-PCR) assay; and virus isolation by cell culture. Tests on clinical samples present an extreme biohazard ...

  17. From GWAS to the clinic: risk factors for intracranial aneurysms

    OpenAIRE

    Ruigrok, Ynte M.; Rinkel, Gabriel JE

    2010-01-01

    Subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm is a devastating subset of stroke, occurring in relatively young people (mean age around 50 years) of whom around a third die within the initial weeks after the bleed. Environmental and genetic risk factors both have a role in SAH. A recent genome-wide association study of intracranial aneurysms in Finnish, Dutch and Japanese cohorts totaling 5,891 cases and 14,181 controls identified three new loci strongly associated with i...

  18. The role of inflammation in cerebral aneurysms

    Directory of Open Access Journals (Sweden)

    Ali H Turkmani

    2015-06-01

    Full Text Available The natural history of unruptured intracranial aneurysms (IAs is poorly understood. At present, risk factors for aneurysm rupture are limited to demographics and rudimentary anatomic features of the aneurysm. The first sign of aneurysm destabilization and rupture may be subarachnoid hemorrhage, a potentially devastating brain injury with high morbidity and mortality. An emerging body of literature suggests a complex inflammatory cascade likely promotes aneurysm wall remodeling and progressive ballooning of the arterial wall, ultimately terminating in aneurysm rupture. These events likely begin with hemodynamic, flow-related endothelial injury; the injured endothelium stimulates inflammation, including the recruitment and transmigration of inflammatory cells, particularly macrophages. Various proteases are secreted by the inflammatory infiltrate, resulting in degradation of the extracellular matrix and the structural changes unique to IAs. Detailed understanding of these inflammatory processes may result in (1 early identification of patients at high risk for aneurysm rupture, perhaps via arterial wall imaging, and (2 targeted, noninvasive therapies to treat or even prevent cerebral aneurysms.

  19. Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling

    Energy Technology Data Exchange (ETDEWEB)

    Westerlaan, H.E.; Gravendeel, J.; Fiore, D.; Oudkerk, M. [University Medical Center Groningen, Department of Radiology, Post Box 30.001, Groningen (Netherlands); Metzemaekers, J.D.M.; Groen, R.J.M.; Mooij, J.J.A. [University Medical Center Groningen, Department of Neurosurgery, Post Box 30.001, Groningen (Netherlands)

    2007-12-15

    We sought to establish whether CT angiography (CTA) can be applied to the planning and performance of clipping or coiling in ruptured intracranial aneurysms without recourse to intraarterial digital subtraction angiography (IA-DSA). Over the period April 2003 to January 2006 in all patients presenting with a subarachnoid haemorrhage CTA was performed primarily. If CTA demonstrated an aneurysm, coiling or clipping was undertaken. IA-DSA was limited to patients with negative or inconclusive CTA findings. We compared CTA images with findings at surgery or coiling in patients with positive CTA findings and in patients with negative and inconclusive findings in whom IA-DSA had been performed. In this study, 224 consecutive patients (mean age 52.7 years, 135 women) were included. In 133 patients (59%) CTA demonstrated an aneurysm, and CTA was followed directly by neurosurgical (n = 55) or endovascular treatment (n = 78). In 31 patients (14%) CTA findings were categorized as inconclusive, and in 60 (27%) CTA findings were negative. One patient received surgical treatment on the basis of false-positive CTA findings. In 17 patients in whom CTA findings were inconclusive, IA-DSA provided further diagnostic information required for correct patient selection for any therapy. Five ruptured aneurysms in patients with a nonperimesencephalic SAH were negative on CTA, and four of these were also false-negative on IA-DSA. On a patient basis the positive predictive value, negative predictive value, sensitivity, specificity and accuracy of CTA for symptomatic aneurysms were 99%, 90%, 96%, 98% and 96%, respectively. CTA should be used as the first diagnostic modality in the selection of patients for surgical or endovascular treatment of ruptured intracranial aneurysms. If CTA renders inconclusive results, IA-DSA should be performed. With negative CTA results the complementary value of IA-DSA is marginal. IA-DSA is not needed in patients with negative CTA and classic perimesencephalic

  20. Time evolution and hemodynamics of cerebral aneurysms

    Science.gov (United States)

    Sforza, Daniel M.; Putman, Christopher; Tateshima, Satoshi; Viñuela, Fernando; Cebral, Juan

    2011-03-01

    Cerebral aneurysm rupture is a leading cause of hemorrhagic strokes. Because they are being more frequently diagnosed before rupture and the prognosis of subarachnoid hemorrhage is poor, clinicians are often required to judge which aneurysms are prone to progression and rupture. Unfortunately, the processes of aneurysm initiation, growth and rupture are not well understood. Multiple factors associated to these processes have been identified. Our goal is to investigate two of them, arterial hemodynamics (using computational fluid dynamics) and the peri-aneurysmal environment, by studying a group of growing cerebral aneurysms that are followed longitudinally in time. Six patients with unruptured untreated brain aneurysms which exhibited growth during the observation period were selected for the study. Vascular models of each aneurysm at each observation time were constructed from the corresponding computed tomography angiography (CTA) images. Subsequently, models were aligned, and geometrical differences quantified. Blood flow was modeled with the 3D unsteady incompressible Navier-Stokes equation for a Newtonian fluid, and wall shear stress distribution and flow patterns were calculated and visualized. Analysis of the simulations and changes in geometry revealed asymmetric growth patterns and suggests that areas subject to vigorous flows, i.e. relative high wall shear stress and concentrated streamlines patterns; correspond to regions of aneurysm growth. Furthermore, in some cases the geometrical evolution of aneurysms is clearly affected by contacts with bone structures and calcifications in the wall, and as a consequence the hemodynamics is greatly modified. Thus, in these cases the peri-aneurysmal environment must be considered when analyzing aneurysm evolution.

  1. Brain Aneurysm

    Science.gov (United States)

    A brain aneurysm is an abnormal bulge or "ballooning" in the wall of an artery in the brain. They are sometimes called berry aneurysms because they ... often the size of a small berry. Most brain aneurysms produce no symptoms until they become large, ...

  2. Anaesthesia in a patient with subarachanoidal haemorrhage and high oxygen affinity haemoglobinopathy (HB york: case report

    Directory of Open Access Journals (Sweden)

    Monaca Enrico

    2012-08-01

    Full Text Available Abstract Background Approximately 90 haemoglobinopathies have been identified that result in abnormally high oxygen affinity. One of these is haemoglobinopathy York (HbY, first described in 1976. HbY causes an extreme leftward shift of the oxygen dissociation curve with the P50 value changing to 12.5 - 15.5 mmHg (normal value 26.7 mmHg, indicating that approximately half of the haemoglobin is not available as oxygen carrier. Patients with haemoglobinopathies with increased oxygen affinity could suffer from the risk developing ischaemic complications due to a lack of functional oxygen carriers. This is, to best of our knowledge, the first case report on a patient with HbY published in connection with anesthesia. Case Presentation A 42-year-old female with a severe headache and Glasgow coma scale (GCS of 15 was admitted to the neurosurgical intensive care unit with a ruptured, right sided ICA aneurysm with consecutive subarachnoid haemorrhage [Fisher III, World Federation of Neurosurgical Societies (WFNS I]. The medical history of the patient included an erythrocytosis (Hb 17.5 g/dl on the base of a high-oxygen-affinity haemoglobinopathy, called Hb York (HbY. With no time available to take special preoperative precautions, rapid blood loss occurred during the first attempt to clip the aneurysm. General transfusion procedures, according to the guidelines based on haemoglobin and haematocrit values, could not be applied due to the uncertainty in the oxygen carrier reduction. To maintain tissue oxygen supply, clinical indicators of ischaemia were instead utilized to gauge the appropriate required blood products, crystalloids and colloids replacements. Despite this, the patient survived the neurosurgical intervention without any neurological deficit. Conclusions Family members of patients with HbY (and other haemoglobinopathies with increased oxygen affinity should undergo clinical assessment, particularly if they are polycythaemic. If the diagnosis

  3. CT angiography versus 3D rotational angiography in patients with subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Bechan, R.S.; Peluso, J.P.; Sluzewski, M.; Rooij, W.J. van [Sint Elisabeth Ziekenhuis Tilburg, Department of Radiology, Tilburg (Netherlands); Rooij, S.B. van [Medisch Centrum Alkmaar, Department of Radiology, Alkmaar (Netherlands); Sprengers, M.E.; Majoie, C.B. [Academisch Medisch Centrum, Department of Radiology, Amsterdam (Netherlands)

    2015-12-15

    CT angiography (CTA) is increasingly used as primary diagnostic tool to replace digital subtraction angiography (DSA) in patients with subarachnoid hemorrhage (SAH). However, 3D rotational angiography (3DRA) has substituted DSA as a reference standard. In this prospective observational study, we compare CTA with 3DRA of all cerebral vessels in a large cohort of patients with SAH. Of 179 consecutive patients with SAH admitted between March 2013 and July 2014, 139 underwent 64- to 256-detector row CTA followed by complete cerebral 3DRA within 24 h. In 86 patients (62 %), 3DRA was performed under general anesthesia. Two observers from outside hospitals reviewed CTA data. In 118 of 139 patients (85 %), 3DRA diagnosed the cause of hemorrhage: 113 ruptured aneurysms, three arterial dissections, one micro-arteriovenous malformation (AVM), and one reversible vasoconstriction syndrome. On CTA, both observers missed all five non-aneurysmal causes of SAH. Sensitivity of CTA in depicting ruptured aneurysms was 0.88-0.91, and accuracy was 0.88-0.92. Of 113 ruptured aneurysms, 28 were ≤3 mm (25 %) and of 95 additional aneurysms, 71 were ≤3 mm (75 %). Sensitivity of depicting aneurysms ≤3 mm was 0.28-0.43. Of 95 additional aneurysms, the two raters missed 65 (68 %) and 58 (61 %). Sensitivity in detection was lower in aneurysms of the internal carotid artery than in other locations. CTA had some limitations as primary diagnostic tool in patients with SAH. All non-aneurysmal causes for SAH and one in ten ruptured aneurysms were missed. Performance of CTA was poor in aneurysms ≤3 mm. The majority of additional aneurysms were not depicted on CTA. (orig.)

  4. CT angiography versus 3D rotational angiography in patients with subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    CT angiography (CTA) is increasingly used as primary diagnostic tool to replace digital subtraction angiography (DSA) in patients with subarachnoid hemorrhage (SAH). However, 3D rotational angiography (3DRA) has substituted DSA as a reference standard. In this prospective observational study, we compare CTA with 3DRA of all cerebral vessels in a large cohort of patients with SAH. Of 179 consecutive patients with SAH admitted between March 2013 and July 2014, 139 underwent 64- to 256-detector row CTA followed by complete cerebral 3DRA within 24 h. In 86 patients (62 %), 3DRA was performed under general anesthesia. Two observers from outside hospitals reviewed CTA data. In 118 of 139 patients (85 %), 3DRA diagnosed the cause of hemorrhage: 113 ruptured aneurysms, three arterial dissections, one micro-arteriovenous malformation (AVM), and one reversible vasoconstriction syndrome. On CTA, both observers missed all five non-aneurysmal causes of SAH. Sensitivity of CTA in depicting ruptured aneurysms was 0.88-0.91, and accuracy was 0.88-0.92. Of 113 ruptured aneurysms, 28 were ≤3 mm (25 %) and of 95 additional aneurysms, 71 were ≤3 mm (75 %). Sensitivity of depicting aneurysms ≤3 mm was 0.28-0.43. Of 95 additional aneurysms, the two raters missed 65 (68 %) and 58 (61 %). Sensitivity in detection was lower in aneurysms of the internal carotid artery than in other locations. CTA had some limitations as primary diagnostic tool in patients with SAH. All non-aneurysmal causes for SAH and one in ten ruptured aneurysms were missed. Performance of CTA was poor in aneurysms ≤3 mm. The majority of additional aneurysms were not depicted on CTA. (orig.)

  5. STUDY OF RENAL FUNCTION TESTS IN PATIEN TS OF ACUTE HAEMORRHAGIC STROKE

    Directory of Open Access Journals (Sweden)

    Aditya Vardhan

    2015-05-01

    Full Text Available OBJECTIVE: To study renal function tests in patients with acute haemorrhagic stroke and to find association of abnormal renal function with adverse outcome in patients with acute haemorrhagic stroke . MATERIAL AND METHODS: The study was conducted at Darbhanga Medical College & Hospital , Laheriasarai , Darbhanga during the period from January 2012 to September 2013 . This was an observational study . A total of 100 patients presenting with acute haemorrhagic stroke admitted to the hospital or reporting in OPD/Emergency for stroke were included in this study after having taken written informed consent . Cases were selected by random sampling . OBSERVATION: Out of 100 patients with acute haemorrhagic stroke 92 patients had intracerebral haemorrhage and 8 patie nts had subarachnoid haemorrhage . Patients were divided into two groups on the basis of estimated glomerular filtration rate ( eGFR . Group A ( eGFR > 60 ml/min/1 . 73 m 2 BSA comprised of 71% of total stroke patients and group B ( eGFR 98umol/L and 15 ( 68 . 60% patients had blood urea >6 . 8mmol/L . CONCLUSION: This study clearly indicated that renal dysfunction as evidenced by ( a eGFR 98umol/L & c Blood urea >6 . 8mmol/L , are not only an important risk factor for acute haemorrhagic stroke but are also an independent predictor of mortality within 30 days of presentation .

  6. Computerized tomographic and angiographic study of large and giant cerebral aneurysms

    International Nuclear Information System (INIS)

    A series of 109 patients with subarachnoid hemorrhage has been studied over a 3-year period. Of the total of 117 aneurysms discovered twelve (10.25 per cent) are with sizes exceeding 15 mm. Of the latter seven cases become manifest with subarachnoid hemorrhage (SAH), and the remainder five (giant aneurysms) present pseudo-tumor symptomatology. On CT hyperdense rounded zones with or without calcifications or edema are seen, and therefore they may be interpreted as tumors or intracerebral hematomas. Following iv contrast medium injection in some cases direct visualization of the aneurysms and their supplying vessels is possible. In large and giant aneurysms, eventually diagnosed as tumors by CT, only unilateral carotid angiography is capable to demonstrate dislocation of the cerebral vessels typical of a tumor-like process. Hence, pan-angiography should be mandatorily done to rule out or demonstrate aneurysms in Willis' circle (author)

  7. Viral Haemorrhagic Septicaemia

    OpenAIRE

    Institute, Marine

    2011-01-01

    This leaflet gives information on viral haemorrhagic septicaemia (VHS). VHS is caused by a single stranded RNA virus of the family Rhabdoviridae, genus Novirhabdoviridae. VHS is listed as a non-exotic disease under EU Directive 2006/88/EC, and is notifiable in Ireland, according to S.I. No. 261 of 2008.

  8. Are Isofurans and Neuroprostanes Increased After Subarachnoid Hemorrhage and Traumatic Brain Injury?

    OpenAIRE

    Corcoran, Tomas B; Mas, Emilie; Barden, Anne E.; Durand, Thierry; Galano, Jean-Marie; Roberts, L. Jackson; Phillips, Michael; Ho, Kwok M.; Mori, Trevor A.

    2011-01-01

    Current diagnostic tools to assess neurological injury after aneurysmal subarachnoid hemorrhage (aSAH) and traumatic brain injury (TBI) have poor discriminatory abilities. Free radicals are associated with the pathophysiology of secondary damage after brain trauma. We examined cerebrospinal fluid (CSF) lipid markers of oxidative stress, isofurans (IsoFs), F4-neuroprostanes (F4-NeuroPs), and F2-isoprostanes (F2-IsoPs), in two case-controlled studies in patients with aSAH or severe TBI. Patient...

  9. Secondary infarction in single or in multiple vascular territories: two different entities following subarachnoid hemorrhage?

    OpenAIRE

    de Rooij, N. K.; Frijns, C. J. M.; Velthuis, B.K.; Rinkel, G J E

    2011-01-01

    The pathogenesis of secondary infarctions (SI) after aneurysmal subarachnoid hemorrhage (SAH) is poorly understood. To assess whether SI in single (SSI) or multiple (MSI) vascular territories represent different disease entities, we compared clinical profiles of patients with these patterns of SI. CT/MRI-examinations of 448 patients were reviewed for new infarctions within 28 days after SAH, and categorized into SSI or MSI. Only patients with adequate follow-up imaging excluding any new infar...

  10. Electroencephalographic response to sodium nitrite may predict delayed cerebral ischemia after severe subarachnoid hemorrhage

    OpenAIRE

    Garry, Payashi S.; Rowland, Matthew J.; Ezra, Martyn; Herigstad, Mari; Hayen, Anja; Sleigh, Jamie W.; Westbrook, Jon; Warnaby, Catherine E; Pattinson, Kyle T.

    2016-01-01

    OBJECTIVES: Aneurysmal subarachnoid hemorrhage often leads to death and poor clinical outcome. Injury occurring during the first 72 hours is termed "early brain injury," with disruption of the nitric oxide pathway playing an important pathophysiologic role in its development. Quantitative electroencephalographic variables, such as α/δ frequency ratio, are surrogate markers of cerebral ischemia. This study assessed the quantitative electroencephalographic response to a cerebral nitric oxide...

  11. Basilar artery aneurysm at a persistent trigeminal artery junction. A case report and literature review.

    Science.gov (United States)

    Aguiar, G B; Conti, M L M; Veiga, J C E; Jory, M; Souza, R B

    2011-09-01

    The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature. PMID:22005697

  12. Haemorrhagic pituitary tumours

    International Nuclear Information System (INIS)

    In a group of 69 patients with pituitary tumours, 12 were found to have evidence of intratumoral haemorrhage on MRI, characterized by high signal intensity on short TR/TE sequences. This was verified in all but 1 patient. The majority of the bleedings occurred in macroadenomas. Five (42%) were prolactinomas and 4 (33%) were non-functioning adenomas. There were 2 GH- and 1 ACTH-secreting tumours. All 5 patients with prolactinomas were on bromocriptine medication. Two of the patients had a clinical picture of pituitary apoplexy. The haemorrhage was not large enough to prompt surgery in any of the patients. However, surgical verification of the diagnosis was obtained in 5 cases, while 6 patients were examined with follow-up MRI. (orig.)

  13. Expulsive choroidal haemorrhage

    Directory of Open Access Journals (Sweden)

    Srinivasan M

    1992-01-01

    Full Text Available Expulsive choroidal haemorrhage is a dramatic and serious complication of cataract surgery that occurred in five patients out of ten thousand consecutive cataract surgeries performed by the author during the year 1989 and 1990. Report about this dreaded complication after cataract surgery are scanty and as far as I can remember I have not seen any report in Indian ophthalmic literature recently. Since cataract surgery forms the major part of intra ocular surgeries performed in our country, I thought it would be appropriate to report about this rare complication which may occur to all of us. Out of five cases 3 were males and 2 were females in the age group ranging between 45-72 years. Two eyes regained vision up to 6/12 after intra operative expulsive haemorrhage. All the eyes were salvaged by doing anterior sclerotomy. Diabetes, hypertension, glaucoma and myopia are the commonest predisposing factors.

  14. Epidemiology and genetics of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Caranci, F., E-mail: ferdinandocaranci@libero.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Briganti, F., E-mail: frabriga@unina.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Cirillo, L.; Leonardi, M. [Neuroradiology service, Bellaria Hospital, Bologna (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service Cardarelli Hospital Naples (Italy)

    2013-10-01

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  15. Epidemiology and genetics of intracranial aneurysms

    International Nuclear Information System (INIS)

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  16. Clarithromycin-induced haemorrhagic colitis

    OpenAIRE

    Miyauchi, Ryosuke; Kinoshita, Kensuke; Tokuda, Yasuharu

    2013-01-01

    Haemorrhagic colitis by Klebsiella oxytoca has been described as an antibiotic-associated colitis, particularly with the use of ampicillin. Here we report a patient with haemorrhagic colitis caused by K oxytoca after the use of clarithromycin. A 67-year-old Japanese woman with diabetes presented with mucobloody diarrhoea and abdominal pain. Stool culture grew K oxytoca. Colonoscopy showed the appearance of haemorrhagic colitis. Further history taking revealed that she had received a course of...

  17. Management of subarachnoid hemorrhage classified grade V. Possibility of intravascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Uzura, Masahiko; Oshima, Kousuke; Morishima, Hiroyuki; Uchida, Kazuyoshi; Watanabe, Hiroyuki; Nakamura, Homare; Tanaka, Katsuyuki; Sekino, Hiroaki; Akashi, Katsuya [St. Marianna Univ., Kawasaki, Kanagawa (Japan). School of Medicine

    2001-10-01

    Management outcomes in poor-grade patients (World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale Grade V) with ruptured cerebral aneurysms have historically been unsatisfactory. In the present study, we examined the possibility of intravascular treatment for ruptured aneurysm detected by 3-Dimensional CT angiography (3D-CTA) in poor-grade SAH patients. From April 1997 to July 2000, 3D-CTA was performed on 54 of 73 patients admitted with Grade V subarachnoid hemorrhage (SAH). Excluding 3 patients who underwent emergency surgery for ruptured aneurysms and intracerebral hematomas, CT findings from the remaining 51 patients were analyzed. The study included 23 men and 28 women, ranging in age from 28 to 91 with an average age of 63.6. The patients' initial scores on the Glasgow Coma Scale upon admission were 3 in 36 patients (including 19 patients who had undergone cardio-pulmonary arrest), 4 in 11 patients, 5 in 2 patients, and 6 in 2 patients. Ruptured aneurysms responsible for SAH were clearly delineated in 41 aneurysms from 39 patients, with 32 aneurysms in the anterior circulation and 9 in the posterior circulation. Patients with Glasgow Coma Scale of 4 or higher whose score did not progressively decrease for 12 hours after symptom onset were considered for intravascular treatment. In our study, 4 of 39 patients (10.3%) met these criteria. Glasgow Outcome Scale results were good recovery in 1 case, moderate disability in 1 case, severe disability in 1 case, and death in the remaining 48 cases. These results suggest that the management course for poor-grade (WFNS Grade V) SAH patients who retain brain stem reflexes contain the following: identification of aneurysms by 3D-CTA, maintenance of adequate sedation and external drainage to treat acute hydrocephalus, continued minimum 12-hour observation, monitoring levels of consciousness where possible, and consideration of aggressive therapy including

  18. Management of subarachnoid hemorrhage classified grade V. Possibility of intravascular treatment

    International Nuclear Information System (INIS)

    Management outcomes in poor-grade patients (World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale Grade V) with ruptured cerebral aneurysms have historically been unsatisfactory. In the present study, we examined the possibility of intravascular treatment for ruptured aneurysm detected by 3-Dimensional CT angiography (3D-CTA) in poor-grade SAH patients. From April 1997 to July 2000, 3D-CTA was performed on 54 of 73 patients admitted with Grade V subarachnoid hemorrhage (SAH). Excluding 3 patients who underwent emergency surgery for ruptured aneurysms and intracerebral hematomas, CT findings from the remaining 51 patients were analyzed. The study included 23 men and 28 women, ranging in age from 28 to 91 with an average age of 63.6. The patients' initial scores on the Glasgow Coma Scale upon admission were 3 in 36 patients (including 19 patients who had undergone cardio-pulmonary arrest), 4 in 11 patients, 5 in 2 patients, and 6 in 2 patients. Ruptured aneurysms responsible for SAH were clearly delineated in 41 aneurysms from 39 patients, with 32 aneurysms in the anterior circulation and 9 in the posterior circulation. Patients with Glasgow Coma Scale of 4 or higher whose score did not progressively decrease for 12 hours after symptom onset were considered for intravascular treatment. In our study, 4 of 39 patients (10.3%) met these criteria. Glasgow Outcome Scale results were good recovery in 1 case, moderate disability in 1 case, severe disability in 1 case, and death in the remaining 48 cases. These results suggest that the management course for poor-grade (WFNS Grade V) SAH patients who retain brain stem reflexes contain the following: identification of aneurysms by 3D-CTA, maintenance of adequate sedation and external drainage to treat acute hydrocephalus, continued minimum 12-hour observation, monitoring levels of consciousness where possible, and consideration of aggressive therapy including intravascular

  19. Clarithromycin-induced haemorrhagic colitis.

    Science.gov (United States)

    Miyauchi, Ryosuke; Kinoshita, Kensuke; Tokuda, Yasuharu

    2013-01-01

    Haemorrhagic colitis by Klebsiella oxytoca has been described as an antibiotic-associated colitis, particularly with the use of ampicillin. Here we report a patient with haemorrhagic colitis caused by K oxytoca after the use of clarithromycin. A 67-year-old Japanese woman with diabetes presented with mucobloody diarrhoea and abdominal pain. Stool culture grew K oxytoca. Colonoscopy showed the appearance of haemorrhagic colitis. Further history taking revealed that she had received a course of oral clarithromycin for upper respiratory tract infection. She had recovered by conservative treatment. We should be careful about gastrointestinal symptoms in patients on clarithromycin, which can cause haemorrhagic colitis associated with K oxytoca. PMID:23964038

  20. Brain Aneurysm Statistics and Facts

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  1. Postpartum haemorrhage: prevention

    OpenAIRE

    Chelmow, David

    2011-01-01

    Loss of more than 500 mL of blood is usually caused by failure of the uterus to contract fully after delivery of the placenta, and occurs in over 10% of deliveries with a 1% mortality rate worldwide. Other causes of postpartum haemorrhage include retained placental tissue, lacerations to the genital tract and coagulation disorders.Uterine atony is more likely in women who have had a general anaesthetic or oxytocin, an over-distended uterus, a prolonged or precipitous labour, or who are of ...

  2. Foetal and neonatal intracranial haemorrhage in term newborn infants: Hacettepe University experience.

    Science.gov (United States)

    Tavil, Betül; Korkmaz, Ayşe; Bayhan, Turan; Aytaç, Selin; Unal, Sule; Kuskonmaz, Baris; Yigit, Sule; Cetin, Mualla; Yurdakök, Murat; Gumruk, Fatma

    2016-03-01

    In this study, we aimed to evaluate the incidence, risk factors, causes and clinical management of intracranial haemorrhage (ICH) diagnosed during foetal life or in the first month of life in term neonates with a discussion of the role of haematological risk factors. This study included term neonates (gestational age 37-42 weeks) with ICH diagnosed, treated and followed up in the Neonatal Intensive Care Unit of Hacettepe University, Ankara, Turkey, between January 1994 and January 2014. Medical follow-up was obtained retrospectively from hospital files and prospectively from telephonic interviews and/or clinical visits. During the study period, 16 term neonates were identified as having ICH in our hospital. In six (37.5%) neonates, ICH was diagnosed during foetal life by obstetric ultrasonography, and in 10 (62.5%) neonates, it has been diagnosed after birth. Haemorrhage types included intraventricular haemorrhage (IVH) in eight (50.0%), intraparenchymal haemorrhage in six (37.5%), subarachnoid haemorrhage in one (6.2%) and subdural haemorrhage in one (6.2%) neonate. IVH was the most common (n = 5/6, 83.3%) haemorrhage type among neonates diagnosed during foetal life. Overall, haemorrhage severity was determined as mild in three (18.7%) neonates, moderate in three (18.75%) neonates and severe in 10 (62.5%) neonates. During follow-up, one infant was diagnosed as afibrinogenemia, one diagnosed as infantile spasm, one cystic fibrosis, one orofaciodigital syndrome and the other diagnosed as Friedrich ataxia. Detailed haematological investigation and search for other underlying diseases are very important to identify the reason of ICH in term neonates. Furthermore, early diagnosis, close monitoring and prompt surgical interventions are significant factors to reduce disabilities. PMID:26829281

  3. Giant intracranial aneurysms: development, clinical presentation and treatment

    International Nuclear Information System (INIS)

    The natural history of giant intracranial aneurysms are grave. More than 50% of patients suffer from rupture of these aneurysms and mortality is >60% in 2 years. Modern technology and advancement of knowledge in neurosurgery and interventional neuroradiology have altered its natural course for the better. As many reports have shown, the majority of these aneurysms can be treated either by surgery or by endovascular approach, even though morbidity is higher than when treating smaller aneurysms. Certain aneurysms are more suitable to direct surgical clipping and others may have better chances of good clinical outcome by endovascular treatment. It is imperative to analyse the location, morphology, hemodynamics and circulation of normal brain of each aneurysm before the mode of treatment is decided. Needless to say, the individual patient's age, neurological and medical condition should be considered. For endovascular treatment, application of each technique, endosaccular occlusion or parent artery occlusion depends on the aneurysm location and geometry as well as its pathology. Several reports indicated that clinical outcome is better in patients treated by parent artery occlusion since it eliminates any blood flow to the aneurysm and it provides a more effective reduction of the mass effect. However, not all parent arteries can be sacrificed. In addition, endosaccular treatment is effective in preventing haemorrhage if the aneurysm is not re-canalised. It is also demonstrated that symptoms of mass effect can be reversed by endosaccular coiling. The patients who are treated this way should be closely monitored for re-canalisation

  4. Endovascular Treatment of a Ruptured Posterior Inferior Cerebellar Artery Aneurysm during Pregnancy

    OpenAIRE

    Kim, Ki Dae; Chang, Chul Hoon; Choi, Byung Yon; Jung, Young Jin

    2014-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) during pregnancy is quite rare, however it has a high maternal mortality rate. A pregnant woman in the 16th gestational week was admitted to our hospital with a drowsy level of consciousness. A brain magnetic resonance (MR) image showed hemorrhage on the prepontine cistern, and both sylvian fissures, and MR angiography and cerebral digital subtraction angiography demonstrated an aneurysm at the left posterior inferior cerebellar artery (PICA). We perfo...

  5. Treatment of ruptured intracranial aneurysms in children associated with arteriovenous malformation

    OpenAIRE

    Mrdak Milan; Repac Nikola R.; Nikolić Igor M.; Đorić Igor B.; Janićijević Aleksandar M.; Matić Siniša P.; Šćepanović Vuk D.; Janićijević Vladimir T.; Mihajlović Miljan H.; Tasić Goran M.

    2013-01-01

    Introduction. Intracranial aneurysms are very rare in the pediatric population . Very rarely they are accompanied by subarachnoid hemorrhage (SAH). As in the adults they are most often discovered after their rupture. Case report. We report the case of a child 14 months old at the time of rupture of the aneurysm , which led to intraventricular hemorrhage and accompanied by left side body weakness. After diagnosis - digital subtraction angiography (DSA) aneur...

  6. [Japanese Guidelines for the Management of Stroke 2015: overview of the chapter on Subarachnoid Hemorrhage].

    Science.gov (United States)

    Ishihara, Hideyuki; Suzuki, Michiyasu

    2016-04-01

    After an interval of 6 years, the Japanese Guidelines for the Management of Stroke were revised in 2015 in accordance with recent advances in clinical knowledge. The chapter on subarachnoid hemorrhage includes new and revised recommendations for diagnosis, treatment selection, and management of vasospasm. The chapter on diagnosis recommends re-examination of vascular images at regular intervals in cases in which cerebral aneurysm was not detected on the first examination. The section dealing with treatment selection for cerebral aneurysmal emphasizes that the method for aneurysm obliteration should be selected based on consultation with both surgical and endovascular specialists. The role of triple-H therapy(i.e., induced hypertension, hypervolemia, and hemodilution) has changed from a preventive measure to a treatment option for symptomatic cerebral vasospasm. PMID:27333759

  7. Aneurysms: thoracic aortic aneurysms.

    Science.gov (United States)

    Chun, Kevin C; Lee, Eugene S

    2015-04-01

    Thoracic aortic aneurysms (TAAs) have many possible etiologies, including congenital heart defects (eg, bicuspid aortic valves, coarctation of the aorta), inherited connective tissue disorders (eg, Marfan, Ehlers-Danlos, Loeys-Dietz syndromes), and degenerative conditions (eg, medial necrosis, atherosclerosis of the aortic wall). Symptoms of rupture include a severe tearing pain in the chest, back, or neck, sometimes associated with cardiovascular collapse. Before rupture, TAAs may exert pressure on other thoracic structures, leading to a variety of symptoms. However, most TAAs are asymptomatic and are found incidentally during imaging for other conditions. Diagnosis is confirmed with computed tomography scan or echocardiography. Asymptomatic TAAs should be monitored with imaging at specified intervals and patients referred for repair if the TAAs are enlarging rapidly (greater than 0.5 cm in diameter over 6 months for heritable etiologies; greater than 0.5 cm over 1 year for degenerative etiologies) or reach a critical aortic diameter threshold for elective surgery (5.5 cm for TAAs due to degenerative etiologies, 5.0 cm when associated with inherited syndromes). Open surgery is used most often to treat asymptomatic TAAs in the ascending aorta and aortic arch. Asymptomatic TAAs in the descending aorta often are treated medically with aggressive blood pressure control, though recent data suggest that endovascular procedures may result in better long-term survival rates. PMID:25860136

  8. Erythropoietin for the Treatment of Subarachnoid Hemorrhage: A Feasible Ingredient for a Successful Medical Recipe

    Science.gov (United States)

    Grasso, Giovanni; Tomasello, Giovanni; Noto, Marcello; Alafaci, Concetta; Cappello, Francesco

    2015-01-01

    Subarachnoid hemorrhage (SAH) following aneurysm bleeding accounts for 6% to 8% of all cerebrovascular accidents. Although an aneurysm can be effectively managed by surgery or endovascular therapy, delayed cerebral ischemia is diagnosed in a high percentage of patients resulting in significant morbidity and mortality. Cerebral vasospasm occurs in more than half of all patients after aneurysm rupture and is recognized as the leading cause of delayed cerebral ischemia after SAH. Hemodynamic strategies and endovascular procedures may be considered for the treatment of cerebral vasospasm. In recent years, the mechanisms contributing to the development of vasospasm, abnormal reactivity of cerebral arteries and cerebral ischemia following SAH, have been investigated intensively. A number of pathological processes have been identified in the pathogenesis of vasospasm, including endothelial injury, smooth muscle cell contraction from spasmogenic substances produced by the subarachnoid blood clots, changes in vascular responsiveness and inflammatory response of the vascular endothelium. To date, the current therapeutic interventions remain ineffective as they are limited to the manipulation of systemic blood pressure, variation of blood volume and viscosity and control of arterial carbon dioxide tension. In this scenario, the hormone erythropoietin (EPO) has been found to exert neuroprotective action during experimental SAH when its recombinant form (rHuEPO) is administered systemically. However, recent translation of experimental data into clinical trials has suggested an unclear role of recombinant human EPO in the setting of SAH. In this context, the aim of the current review is to present current evidence on the potential role of EPO in cerebrovascular dysfunction following aneurysmal subarachnoid hemorrhage. PMID:26581085

  9. Intraventricular and subarachnoid racemose cysticercosis

    OpenAIRE

    Mittal, Puneet; Mittal, Gaurav

    2011-01-01

    Cysticercosis is endemic in India. Neurocysticercosis most commonly affects the brain parenchyma, which presents as focal lesions with the surrounding edema which later calcify. Rarely, it may affect the ventricular system and subarachnoid spaces and this form is known as racemose cysticercosis. We present magnetic resonance findings in a case of racemose cysticercosis.

  10. Takotsubo cardiomyopathy following subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Takotsubo cardiomyopathy corresponds to a syndrome characterized by a transient myocardial dysfunction affecting the left ventricular apex that classically occurs after major physical or emotional stress (also called 'broken heart syndrome' or 'stress-induced cardiomyopathy'). The author describes the case of a patient with takotsubo cardiomyopathy induced by subarachnoid hemorrhage. (author)

  11. Bedside diagnosis of mitochondrial dysfunction in aneurysmal subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Jacobsen, A.; Nielsen, T. H.; Nilsson, O.; Schalen, W.; Nordstrom, C. H.

    2014-01-01

    patients with recirculated cerebral infarcts. Results - In 29 patients, the biochemical pattern indicated mitochondrial dysfunction while 10 patients showed a pattern of cerebral ischemia, six of which also exhibited periods of mitochondrial dysfunction. Mitochondrial dysfunction was observed during 5162 h...

  12. Evaluation of headache severity after aneurysmal subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Rachel Swope, PharmD, BCPS

    2014-12-01

    Conclusions: Headache after SAH is persistent and treatment refractory. There may be an association with development of vasospasm and worsening of headache. Novel treatment strategies to attenuate headache in this population are needed.

  13. Traumatic intracranial aneurysms in children

    International Nuclear Information System (INIS)

    To describe the imaging findings of traumatic intracranial aneurysms (TICA) in children. Five boys aged 3-15 (mean, 7) years with surgically confirmed TICA were included in this study. All had a history of nonpenetrating head trauma, and they underwent precontrast CT imaging immediately after the injury and follow-up CR or MRI. In all cases, angiography revealed the presence of aneurysms, which at surgery were shown to be pseudoaneurysms with sever adhesions. Angiography demonstrated that all aneurysms were located in the anterior cerebral artery (ACA) or its branches. The precise locations were the A2 segment of the ACA, the site of origin of the callosomarginal artery or its first branch, or of the anterior internal frontal artery, or between the first and second branch of the pericallosal artery. In all patients, precontrast CT performed immediately after trauma depicted subarachnoid hemorrhage (SAH) in the anterior interhemispheric fissure (AIHF). Follow-up precontrast CT showed nodular high density around the anterior falx in three, recurrent SAH in the AIHF in two, and intracerebral hemorrhage (ICH) with intraventricular hemorrhage in two. In two patients with a nodular high-density lesion, nodular enhancement was demonstrated at postcontrast CT, and in one, follow-up MRI revealed a nodular signal void around the anterior falx; nodular enhancement was seen at postcontrast imaging, and MR angiogram depicted a saccular aneurysm. In one patient, MRI demonstrated infarction in the caudate nucleus and ACA territory. If, after head injury, an area of nodular high density is revealed by CT, or a signal void by MRI, or is SAH or ICH is present around the anterior falx, the possibility of TICA should be considered

  14. Natural course of subarachnoid hemorrhage is worse in elderly patients

    Directory of Open Access Journals (Sweden)

    Felix Hendrik Pahl

    2014-11-01

    Full Text Available Aging is a major risk factor for poor outcome in patients with ruptured or unruptured intracranial aneurysms (IA submitted to treatment. It impairs several physiologic patterns related to cerebrovascular hemodynamics and homeostasis. Objective Evaluate clinical, radiological patterns and prognostic factors of subarachnoid hemorrhage (SAH patients according to age. Method Three hundred and eighty nine patients with aneurismal SAH from a Brazilian tertiary institution (Hospital do Servidor Público Estadual de São Paulo were consecutively evaluated from 2002 to 2012 according to Fisher and Hunt Hess classifications and Glasgow Outcome Scale. Results There was statistically significant association of age with impaired clinical, radiological presentation and outcomes in cases of SAH. Conclusion Natural course of SAH is worse in elderly patients and thus, proper recognition of the profile of such patients and their outcome is necessary to propose standard treatment.

  15. Monitoring cerebral perfusion after subarachnoid hemorrhage using CT

    International Nuclear Information System (INIS)

    The aim of this prospective study was to assess the feasibility and diagnostic relevance of repetitive dynamic (contrast-enhanced) CT measurements of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) in the first 3 weeks after aneurysmal subarachnoid hemorrhage (SAH). In 15 patients with SAH, 59 dynamic CT studies including 944 regions of interest (ROI) were analyzed. The results were correlated with the clinical course and time after the event and the occurrence of vasospasm. Values for the entire series were 33.8 ± 19.3 ml/100 g/min (CBF), 3.3 ± 1.3 ml/100 g (CBV), and 7.3 ± 3.9 s (MTT). Significant differences in CBF and CBV were found between ROI in grey and white matter, with time after the event, between patients with significant and absent or minor vasospasm, and between patients with and without a presumed vasospasm-related infarct. (orig.)

  16. Glioblastoma and intracranial aneurysms: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Rushna Ali

    2015-01-01

    Conclusion: Several theories stand to explain the coincidental occurrence of intracranial aneurysms and GBM. The treating physician should be aware of this association when patients with intraaxial tumors present with unusual manifestation such as an intratumoral hemorrhage or angiogram negative subarachnoid hemorrhage. No guidelines exist to assist in the management of such patients; therefore, authors have attempted to address this issue using a classification and treatment algorithm.

  17. Assessment of feasibility of endovascular treatment of ruptured intracranial aneurysms with 16-detector row CT angiography

    NARCIS (Netherlands)

    M. van der Jagt (Mathieu); H.Z. Flach (Zwenneke); H.L.J. Tanghe (Hervé); S.L.M. Bakker (Stef); M.G.M. Hunink (Myriam); P.J. Koudstaal (Peter Jan); A. van der Lugt (Aad)

    2008-01-01

    textabstractBackground: It is unclear whether 16-detector row CT angiography (CTA) can replace digital subtraction angiography (DSA) to assess the feasibility of endovascular treatment (EVT) in the acute phase after aneurysmal subarachnoid hemorrhage. Methods: We studied 80 consecutive patients with

  18. Intracerebral haemorrhage after carotid endarterectomy

    DEFF Research Database (Denmark)

    Schroeder, T; Sillesen, H; Boesen, J;

    1987-01-01

    Among 662 consecutive carotid endarterectomies eight cases of postoperative ipsilateral intracerebral haemorrhage were identified, occurring into brain areas which, preoperatively were without infarction. As blood pressures across the stenosis were routinely measured during surgery, the internal...

  19. Molecular alterations in the hippocampus after experimental subarachnoid hemorrhage.

    Science.gov (United States)

    Han, Sang Myung; Wan, Hoyee; Kudo, Gen; Foltz, Warren D; Vines, Douglass C; Green, David E; Zoerle, Tommaso; Tariq, Asma; Brathwaite, Shakira; D'Abbondanza, Josephine; Ai, Jinglu; Macdonald, R Loch

    2014-01-01

    Patients with aneurysmal subarachnoid hemorrhage (SAH) frequently have deficits in learning and memory that may or may not be associated with detectable brain lesions. We examined mediators of long-term potentiation after SAH in rats to determine what processes might be involved. There was a reduction in synapses in the dendritic layer of the CA1 region on transmission electron microscopy as well as reduced colocalization of microtubule-associated protein 2 (MAP2) and synaptophysin. Immunohistochemistry showed reduced staining for GluR1 and calmodulin kinase 2 and increased staining for GluR2. Myelin basic protein staining was decreased as well. There was no detectable neuronal injury by Fluoro-Jade B, TUNEL, or activated caspase-3 staining. Vasospasm of the large arteries of the circle of Willis was mild to moderate in severity. Nitric oxide was increased and superoxide anion radical was decreased in hippocampal tissue. Cerebral blood flow, measured by magnetic resonance imaging, and cerebral glucose metabolism, measured by positron emission tomography, were no different in SAH compared with control groups. The results suggest that the etiology of loss of LTP after SAH is not cerebral ischemia but may be mediated by effects of subarachnoid blood such as oxidative stress and inflammation. PMID:24064494

  20. Vitreous haemorrhage after cataract extraction.

    OpenAIRE

    Littlewood, K R; Constable, I J

    1985-01-01

    One hundred eyes undergoing intracapsular cataract extraction and 100 undergoing extracapsular extraction were examined prospectively within one week postoperatively and again at 6-10 weeks postoperatively. Indirect ophthalmoscopy showed vitreous haemorrhage in 36% of the intracapsular group and 13% of the extracapsular group. Vitreous haemorrhage was significantly related to the occurrence of operative hyphaema (p less than 0.01) but not to iridectomy (p greater than 0.05). In the intracapsu...

  1. Coil embolization of an aneurysm located at the trunk of the persistent primitive trigeminal artery.

    Science.gov (United States)

    Kai, Yutaka; Ohmori, Yuki; Watanabe, Masaki; Morioka, Motohiro; Hirano, Teruyuki; Kawano, Takayuki; Sakurama, Tomotaka; Miura, Akiko; Kuratsu, Jun-Ichi

    2011-01-01

    A 71-year-old woman presented with an aneurysm at the trunk of the persistent primitive trigeminal artery (PPTA) manifesting as subarachnoid hemorrhage. Angiography and three-dimensional computed tomography revealed a wide-necked saccular aneurysm at the trunk of the left PPTA. Coil embolization with the balloon-assist technique was successful and PPTA patency was preserved. Preoperative conventional angiography should be performed to check for cross-filling of the PPTA. This case demonstrates that an aneurysm of the trunk of the PPTA can be successfully treated by coil embolization using the balloon-assist technique. PMID:21613761

  2. Atorvastatin ameliorates cerebral vasospasm and early brain injury after subarachnoid hemorrhage and inhibits caspase-dependent apoptosis pathway

    OpenAIRE

    Shi-guang Zhao; Zhi-dan Sun; Wei Liu; Cheng Gao; Xiang-zhen Liu

    2009-01-01

    Abstract Backgroud Cerebral vasospasm (CVS) and early brain injury remain major causes of morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). Hydroxymethylglutaryl coenzyme A reductase inhibitors, also known as statins, has the neuroprotective effects and ameliorating CVS after SAH. This study was designed to explore apoptosis inhibiting effects of atorvastatin and its potential apoptotic signal pathway after SAH. Results Preserving blood-brain-barrier permeability, decrea...

  3. Hemorragia postparto Postpartum haemorrhage

    Directory of Open Access Journals (Sweden)

    H. Karlsson

    2009-01-01

    Full Text Available La hemorragia postparto es una de las complicaciones obstétricas más temidas y es una de las tres primeras causas de mortalidad materna en el mundo. Universalmente se define como la pérdida hemática superior a 500 ml tras un parto vaginal o a 1.000 ml tras una cesárea. La hemorragia postparto precoz (HPP es aquella que ocurre durante las primeras 24 horas tras el parto y es generalmente la más grave. Las causas de HPP incluyen atonía uterina, traumas/laceraciones, retención de productos de la concepción y alteraciones de la coagulación, siendo la más frecuente la atonía. El diagnóstico es clínico y el tratamiento ha de abarcar unas medidas generales de soporte vital y otras más específicas de carácter etiológico. Afortunadamente, es potencialmente evitable en la mayoría de los casos si se sigue una adecuada estrategia de prevención activa y sistemática en la fase de alumbramiento de todos los partos.Postpartum haemorrhage is one of the most dreaded obstetric complications and one of the three main causes of maternal mortality in the world. It is universally defined as haematic loss above 500 ml following a vaginal delivery or above 1,000 ml following a caesarean. An early postpartum haemorrhage (EPH is one that occurs during the first 24 hours following delivery and is generally the most serious. The causes of EPH include uterine atony, trauma/lacerations, retention of products of conception and alterations of coagulation, with atony being the most frequent. Diagnose is clinical and treatment must include general life support measures and other more specific measures of an etiological character. Fortunately, in the majority of cases it is potentially avoidable if an adequate strategy of active and systematic prevention is followed in the delivery phase of all labors.

  4. Usefulness of CT angiography for demonstrating cerebral aneurysm

    International Nuclear Information System (INIS)

    We report the usefulness of computed cerebral angiotomography (CT angiography) for demonstrating cerebral aneurysm and the clinical significance of CT angiography for ruptured cerebral aneurysm. Our modified method of CT angiography was easy and less time-consuming. Fifteen seconds after starting a single bolus injection, 1 ml/kg/25 seconds via cubital vein, of contrast medium (60 % urograffin), 5 serial 5 mm thick-CT slices were scanned in every 6.5 seconds including 2 seconds of interval, beginning from an axial level 20 mm above the orbitomeatal line and ending at a level 40 mm. A total of 103 patients were examined in this report, consisting of 70 unruptured asymptomatic, 8 unruptured symptomatic (oculomotor nerve palsy) and 25 subarachnoid hemorrhage (SAH). Seven unruptured aneurysms in 4 asymptomatic cases, 2 unruptured aneurysms in 2 symptomatic cases 27 aneurysms in 24 SAH cases were suspected by CT angiography. Of these 36 aneurysms suspected by CT angiography 32 aneurysms were confirmed by cerebral angiography. The detection rate of CT angiography in this report was 89 %, higher than those of previous reports. Thirteen aneurysms were located at internal carotidposterior communicating artery (ICPC) junction. 11 at anterior communicating artery (Acom), 7 at middle cerebral artery (MCA). CT angiography showed a false positive findings in 4 cases, which were all located at Acom. Four aneurysms were not detected in CT angiography, which were all located at MCA and were very small (2 - 3 mm) in diameter. There were no deteriorated cases during and after CT angiography. We suggest that CT angiography is a useful and safe method for predicting the location of not only unruptured but ruptured aneurysms. (author)

  5. Role of 3-D Conventional Angiography In Evaluation of Intra Carnial Aneurysms

    Directory of Open Access Journals (Sweden)

    Ahmed M Bassiouny*, Maher M Arafa*, Sameh M Abdelwahab*,

    2013-04-01

    Full Text Available Introduction: intracranial aneurysms are pathological enlargement of the brain arteries that are most commonly located in the circle of Willis. Intracranial aneurysms are relatively common with a prevalence of approximately 4%. The real danger of aneurysms is subarachnoid hemorrhage. 3D digital subtraction angiography has become a critical imaging tool in neuroradiology allowing for the visualization of detailed cerebral vasculature prior to any intervention. Aim of the work: The aim of this work is to evaluate the diagnostic performance of 3D conventional angiography in the evaluation of intracranial aneurysms compared with the conventional cerebral angiography. Methods: The studied group included 20 patients (5 men and 15 women with subarachnoid hemorrhage or known to have cerebral aneurysms. All patients were subjected to conventional cerebral angiography and 3D cerebral angiography, using C-arm (Toshiba rotational technique.Results: 3D digital subtraction angiography is superior to conventional digital subtraction angiography in 100% of the cases 3D imaging revealed the proper aneurysmal shape, size, precise assessment of its neck and relation to the surrounding vessels. Conclusion: Three-dimensional DSA improves the detection and delineation of intracranial aneurysms

  6. Ebolavirus and Haemorrhagic Syndrome

    Directory of Open Access Journals (Sweden)

    Gerald A. Matua

    2015-05-01

    Full Text Available The Ebola virus is a highly virulent, single-stranded ribonucleic acid virus which affects both humans and apes and has fast become one of the world’s most feared pathogens. The virus induces acute fever and death, with haemorrhagic syndrome occurring in up to 90% of patients. The known species within the genus Ebolavirus are Bundibugyo, Sudan, Zaïre, Reston and Taï Forest. Although endemic in Africa, Ebola has caused worldwide anxiety due to media hype and concerns about its international spread, including through bioterrorism. The high fatality rate is attributed to unavailability of a standard treatment regimen or vaccine. The disease is frightening since it is characterised by rapid immune suppression and systemic inflammatory response, causing multi-organ and system failure, shock and often death. Currently, disease management is largely supportive, with containment efforts geared towards mitigating the spread of the virus. This review describes the classification, morphology, infective process, natural ecology, transmission, epidemic patterns, diagnosis, clinical features and immunology of Ebola, including management and epidemic containment strategies.

  7. Pilocytic Astrocytoma with subarachnoidal spread

    International Nuclear Information System (INIS)

    Pilocytic Astrocytomas (WHO I) are histopathologically tumors of glial origin occuring predominantly in chlidhood and adolescence. Normally, they are characterized by a benign clinical course, with a long overall survival time and a high rate of complete remission. The rare case of pilocytic astrocytoma, primarily located in the third ventricular region, with generalized subarachnoidal spread is described. In the 10 years of followup, the histopathologic findings of the seedings remained those of a typical pilocytic astrocytoma; tumor progression did not occur. (orig.)

  8. Pathobiology of healing response after endovascular treatment of intracranial aneurysms - Paradigm shift from lumen to wall oriented therapy

    OpenAIRE

    Marbacher, Serge

    2014-01-01

    Background and Purpose: Subarachnoid hemorrhage attributable to saccular intracranial aneurysm (IA) rupture is a devastating disease leading to stroke, permanent neurological damage and death. Despite rapid advances in the development of endovascular treatment (EVT), complete and long lasting IA occlusion remains a challenge, especially in complexly shaped and large-sized aneurysms. Intraluminal thrombus induced by EVT may recanalize. The biological mechanisms predisposing IA to recanalize an...

  9. Abdominal Aortic Aneurysms: Treatments

    Science.gov (United States)

    ... access catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter ... Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists are vascular ...

  10. Pericallosal lipoma and middle cerebral artery aneurysm: a coincidence?

    Energy Technology Data Exchange (ETDEWEB)

    Sommet, Julie; Schiff, Manuel; Evrard, Philippe [Hopital Robert Debre, APHP, Department of Paediatric Neurology and Metabolic Diseases, Paris Cedex 19 (France); Blanc, Raphael [Fondation Rothschild, Department of Interventional Radiology, Paris (France); Elmaleh-Berges, Monique [Hopital Robert Debre, Department of Paediatric Radiology, Paris (France)

    2010-08-15

    Intracranial lipomas are rare congenital malformations that can often be seen in association with other brain malformations; agenesis or dysgenesis of the corpus callosum is the most frequently associated brain anomaly. They are usually pericallosal asymptomatic midline lesions. Intracranial lipomas associated with a non-contiguous cerebral aneurysm are extremely rare. We report an infant with partial agenesis of the corpus callosum and pericallosal lipoma associated with cerebral haemorrhage due to a distal middle cerebral artery aneurysm. Such an association is probably not fortuitous and could suggest a pathogenic relationship. (orig.)

  11. Pericallosal lipoma and middle cerebral artery aneurysm: a coincidence?

    International Nuclear Information System (INIS)

    Intracranial lipomas are rare congenital malformations that can often be seen in association with other brain malformations; agenesis or dysgenesis of the corpus callosum is the most frequently associated brain anomaly. They are usually pericallosal asymptomatic midline lesions. Intracranial lipomas associated with a non-contiguous cerebral aneurysm are extremely rare. We report an infant with partial agenesis of the corpus callosum and pericallosal lipoma associated with cerebral haemorrhage due to a distal middle cerebral artery aneurysm. Such an association is probably not fortuitous and could suggest a pathogenic relationship. (orig.)

  12. Sexual Activity as a Risk Factor for the Spontaneous Rupture of Cerebral Aneurysms.

    Science.gov (United States)

    Blanke-Roeser, Constantin; Matschke, Jakob; Püschel, Klaus

    2016-06-01

    Subarachnoid hemorrhages from ruptured cerebral aneurysms have a high clinical relevance and often lead to death. Approximately 2% to 5% of the people worldwide, even of younger age, are said to have aneurysms at cerebral arteries. In many cases, they remain clinically unapparent for decades. However, there are numerous risk factors for the rupture of an aneurysm, including temporary raises of the blood pressure. Such changes of the blood pressure can be induced even by several everyday behaviors. For example, any sort of sexual activities may cause extensive raises of the blood pressure because of several physical and psychological factors. The term "sexual activity" covers sexual intercourse as well as masturbation. In this article, the remarkable case of a 24-year-old woman with a ruptured cerebral aneurysm in the context of masturbation is presented. It is discussed with respect to the possible pathophysiological effects of sexual activity on cerebral aneurysms. PMID:27043460

  13. Pial arteriovenous fistulas associated with multiple aneurysms presenting as intracerebral hemorrhage: a case report.

    Science.gov (United States)

    Cai, Wu; Gong, Jianping; Cheng, Bochao; Qiao, Fang; Zhang, Wei; Zhu, Qing; Lan, Qing

    2014-01-01

    Intracranial pial arteriovenous fistulas (AVFs) associated with multiple aneurysms of the main feeding arteries are very rare cerebrovascular lesions. We report a unique case of pial AVFs associated with four aneurysms of the feeding anterior cerebral artery (ACA) which presented as intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH) and spontaneous subarachnoid hemorrhage (SAH). CT angiography (CTA) and digital subtraction angiography (DSA) images demonstrated clearly the direct connection without nidus between the first and second segment of right ACA accompanied by four irregular aneurysms and an abnormally dilated draining vein into the superior sagittal sinus (SSS). Owing to the superficial-seated fistulas, the morphology of feeding arteries and associated four aneurysms and intracranial hemorrhage, the lesions were surgically treated. Postoperative cerebral angiography certified closure of the fistulas and exclusion of the four aneurysms as well as disappearance of early venous drainage. However, subsequent precontrast brain CT showed hydrocephalus underwent left ventriculoperitoneal shunt placement. PMID:25269054

  14. Symptomatic regrowth of a small intracranial aneurysm that had ruptured and completely thrombosed: a case report

    Directory of Open Access Journals (Sweden)

    Hidetoshi Ooigawa

    2015-06-01

    Full Text Available We report a case of small internal carotid–posterior communication artery (IC–PC aneurysm that was completely thrombosed after initial bleeding, but subsequently became symptomatic, causing a mass effect. A 54-year-old woman initially presented with grade-five subarachnoid hemorrhage from a small right IC–PC aneurysm. The aneurysm was treated conservatively and completely thrombosed within 35 days. The patient slowly recovered and remained well until 4 years later, when she developed right oculomotor nerve palsy. Imaging revealed relapse of the aneurysm, and repair led to symptom resolution. This case offers a reminder that totally thrombosed aneurysms carry a risk of regrowth if left untreated.

  15. Endovascular Therapeutic Occlusion of the Posterior Cerebral Artery: An Option for Ruptured Giant Aneurysm in a Child.

    Science.gov (United States)

    Demartini, Zeferino; Matos, Luiz Afonso Dias; Dos Santos, Marcio Luis Tostes; Cardoso-Demartini, Adriane de Andre

    2016-01-01

    The incidence of intracranial aneurysms in the pediatric population is low, and surgical clipping remains a good long-term treatment option. However, posterior circulation aneurysms are even more complex to manage in children than in adults. We report a case of a giant aneurysm of the posterior cerebral artery in a 10-year-old boy presenting with subarachnoid hemorrhage. Endovascular treatment with platinum coils was performed with total occlusion of the aneurysm and the affected arterial segment without complications. The patient achieved good recovery, and a late control angiogram confirmed exclusion of the aneurysm. Occurrence of special features of cerebral aneurysm in children, in comparison to adults, is also described. Parent artery sacrifice is an effective therapeutic option, but long-term follow-up is necessary to avoid recurrence and rebleeding. PMID:26974558

  16. The Early Endocrine Stress Response in Experimental Subarachnoid Hemorrhage.

    Directory of Open Access Journals (Sweden)

    Christoffer Nyberg

    Full Text Available In patients with severe illness, such as aneurysmal subarachnoid hemorrhage (SAH, a physiologic stress response is triggered. This includes activation of the hypothalamic-pituitary-adrenal (HPA axis and the sympathetic nervous system. The aim of this study was to investigate the very early responses of these systems.A porcine animal model of aneurysmal SAH was used. In this model, blood is injected slowly to the basal cisterns above the anterior skull base until the cerebral perfusion pressure is 0 mm Hg. Sampling was done from blood and urine at -10, +15, +75 and +135 minutes from time of induction of SAH. Analyses of adrenocorticotropic hormone (ACTH, cortisol, aldosterone, catecholamines and chromogranin-A were performed.Plasma ACTH, serum cortisol and plasma aldosterone increased in the samples following induction of SAH, and started to decline after 75 minutes. Urine cortisol also increased after SAH. Urine catecholamines and their metabolites were found to increase after SAH. Many samples were however below detection level, not allowing for statistical analysis. Plasma chromogranin-A peaked at 15 minutes after SAH, and thereafter decreased.The endocrine stress response after aneurysmal SAH was found to start within 15 minutes in the HPA axis with early peak values of ACTH, cortisol and aldosterone. The fact that the concentrations of the HPA axis hormones decreased 135 minutes after SAH may suggest that a similar pattern exists in SAH patients, thus making it difficult to catch these early peak values. There were also indications of early activation of the sympathetic nervous system, but the small number of valid samples made interpretation difficult.

  17. Subarachnoid disseminative hemangiopericytoma of the spinal cord

    Institute of Scientific and Technical Information of China (English)

    LIN Guo-zhong; WANG Zhen-yu; LI Zhen-dong; ZHONG Yan-feng; WANG Lei-ming

    2010-01-01

    @@ Hemangiopericytomas (HPCs) originating from central nervous system were increasingly reported recently.1 Intravertebral HPCs are predominantly epidural. Primary intradural HPCs of spinal cord are rare.2-5 Little subarachnoid dissemination has been reported. We reported a HPC of the cervical spinal cord with subarachnoid dissemination.

  18. Simultaneous Endovascular Treatment of Ruptured Cerebral Aneurysms and Vasospasm

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    Cho, Young Dae; Han, Moon Hee; Kang, Hyun Seung; Kim, Jeong Eun [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Ahn, Jun Hyoung [Dept. of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of); Jung, Seung Chai [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Chang Hun [Dept. of Neurology, Stroke Center, Myongji Hospital, Goyang (Korea, Republic of); Lim, Jeong Wook [Dept. of Neurosurgery, Sun Hospital, Daejeon (Korea, Republic of)

    2015-02-15

    The management of patients with ruptured cerebral aneurysms and severe vasospasm is subject to considerable controversy. We intended to describe herein an endovascular technique for the simultaneous treatment of aneurysms and vasospasm. A series of 11 patients undergoing simultaneous endovascular treatment of ruptured aneurysms and vasospasm were reviewed. After placement of a guiding catheter within the proximal internal carotid artery for coil embolization, an infusion line of nimodipine was wired to one hub, and of a microcatheter was advanced through another hub (to select and deliver detachable coils). Nimodipine was then infused continuously during the coil embolization. This technique was applied to 11 ruptured aneurysms accompanied by vasospasm (anterior communicating artery, 6 patients; internal carotid artery, 2 patients; posterior communicating and middle cerebral arteries, 1 patient each). Aneurysmal occlusion by coils and nimodipine-induced angioplasty were simultaneously achieved, resulting in excellent outcomes for all patients, and there were no procedure-related complications. Eight patients required repeated nimodipine infusions. Our small series of patients suggests that the simultaneous endovascular management of ruptured cerebral aneurysms and vasospasm is a viable approach in patients presenting with subarachnoid hemorrhage and severe vasospasm.

  19. Inflammation and intracranial aneurysms: mechanisms of initiation, growth, and rupture

    Directory of Open Access Journals (Sweden)

    Peter S Amenta

    2015-06-01

    Full Text Available Outcomes following aneurysmal subarachnoid hemorrhage remain poor in many patients, despite advances in microsurgical and endovascular management. Consequently, considerable effort has been placed in determining the mechanisms of aneurysm formation, growth, and rupture. Various environmental and genetic factors are implicated as key components in the aneurysm pathogenesis. Currently, sufficient evidence exists to incriminate the inflammatory response as the common pathway leading to aneurysm generation and rupture. Central to this model is the interaction between the vessel wall and inflammatory cells. Dysfunction of the endothelium and vascular smooth muscle cells (VSMCs promotes a chronic pathological inflammatory response that progressively weakens the vessel wall. We review the literature pertaining to the cellular and chemical mechanisms of inflammation that contribute to aneurysm development. Hemodynamic stress and alterations in blood flow are discussed regarding their role in promoting chronic inflammation. Endothelial cell and VSMC dysfunction are examined concerning vascular remodeling. The contribution of inflammatory cytokines, especially tumor necrosis factor-α is illustrated. Inflammatory cell infiltration, particularly macrophage-mediated deterioration of vascular integrity, is reviewed. We discuss the inflammation as a means to determine aneurysms at greatest risk of rupture. Finally, future therapeutic implications of pharmacologic modulation of the inflammation are discussed.

  20. Multiple intracranial aneurysms following radiation therapy for pituitary adenoma

    International Nuclear Information System (INIS)

    A rare case is reported in which multiple cerebral aneurysm occurred after radiotherapy. A female aged 51 was hospitalized with a chief complaint of consciousness disorder. The patient was discharged from the hospital 1 year before, after undergoing subtotal extirpation of a tumor through the transsphenoidal sinus in a case of pituitary adenoma, and post-operative radiotherapy (topical 50 Gy). Mild hyperlipidemia associated with hypothyroidism was observed by blood biochemical test during hospitalization. Multiple cerebral infarction was observed by CT scanning and MR imaging. Conservative treatment including intensified endocrine-supplementing treatment was performed. Thyroid gland function and hyperlipidemia improved, but the consciousness disorder occurred suddenly 6 weeks after hospitalization. Subarachnoid hemorrhage and hydrocephalus were observed by CT scanning. Cerebral angiography detected a saccular aneurysm in the trifuraction of the right middle cerebral artery, 3 fusiform aneurysms in the periphery of the right middle cerebral artery, 2 fusiform aneurysms in the posterior cerebral artery. These findings were not observed at the initial hospitalization but were unexceptionally confined to all the irradiation fields. The patient died 8 weeks after hospitalization, and no autoptic findings was obtained. We presumed that radiation vasculopathy, caused by radiation therapy done one year previously, had led to the occurrence of multiple cerebral aneurysms. We think that hyperlipidemia may have acted as an exacerbating factor responsible for these aneurysms. (author)

  1. In vitro study of cerebrospinal fluid dynamics in a shaken basal cistern after experimental subarachnoid hemorrhage.

    Directory of Open Access Journals (Sweden)

    Ulrich Kertzscher

    Full Text Available BACKGROUND: Cerebral arterial vasospasm leads to delayed cerebral ischemia and constitutes the major delayed complication following aneurysmal subarachnoid hemorrhage. Cerebral vasospasm can be reduced by increased blood clearance from the subarachnoid space. Clinical pilot studies allow the hypothesis that the clearance of subarachnoid blood is facilitated by means of head shaking. A major obstacle for meaningful clinical studies is the lack of data on appropriate parameters of head shaking. Our in vitro study aims to provide these essential parameters. METHODOLOGY/PRINCIPAL FINDINGS: A model of the basal cerebral cistern was derived from human magnetic resonance imaging data. Subarachnoid hemorrhage was simulated by addition of dyed experimental blood to transparent experimental cerebrospinal fluid (CSF filling the model of the basal cerebral cistern. Effects of various head positions and head motion settings (shaking angle amplitudes and shaking frequencies on blood clearance were investigated using the quantitative dye washout method. Blood washout can be divided into two phases: Blood/CSF mixing and clearance. The major effect of shaking consists in better mixing of blood and CSF thereby increasing clearance rate. Without shaking, blood/CSF mixing and blood clearance in the basal cerebral cistern are hampered by differences in density and viscosity of blood and CSF. Blood clearance increases with decreased shaking frequency and with increased shaking angle amplitude. Head shaking facilitates clearance by varying the direction of gravitational force. CONCLUSIONS/SIGNIFICANCE: From this in vitro study can be inferred that patient or head shaking with large shaking angles at low frequency is a promising therapeutic strategy to increase blood clearance from the subarachnoid space.

  2. Traumatic subarachnoid-pleural fistula

    International Nuclear Information System (INIS)

    Traumatic subarachnoid-pleural fistulas are rare. The authors found nine cases reported since 1959. Seven have been secondary to trauma and two following thoracotomy. One patient's death is thought to be directly related to the fistula. The diagnosis should be suspected in patients with a pleural effusion and associated vertebral trauma. The diagnosis can usually be confirmed with contrast or radioisotopic myelography. Successful closure of the fistula will usually occur spontaneously with closed tube drainage and antibiotics; occasionally, thoracotomy is necessary to close the rent in the dura

  3. Selective treatment of an anterior spinal artery aneurysm with endosaccular coil therapy. Case report.

    Science.gov (United States)

    Lavoie, Pascale; Raymond, Jean; Roy, Daniel; Guilbert, François; Weill, Alain

    2007-05-01

    The authors report the case of a 12-year-old boy with spinal cord arteriovenous malformation (AVM) and an associated anterior spinal artery (ASA) aneurysm treated with selective coil placement in the context of subarachnoid hemorrhage (SAH). The patient presented with headache. Head computed tomography scanning revealed no abnormal findings. The cerebrospinal fluid was sampled and analyzed and a diagnosis of SAH was established. Investigation, including magnetic resonance imaging of the cord as well as cerebral and spinal angiography, revealed a conus medullaris AVM and a saccular aneurysm located on the ASA at the T-11 level. The aneurysm was thought to be responsible for the bleeding. Superselective ASA angiography showed that the aneurysm was at the bifurcation between a large coronal artery supplying the AVM and the ASA. The relation of the aneurysm's neck to the main spinal axis and the aneurysm's morphological features indicated that the lesion was suited for endosaccular coil therapy. The aneurysm was selectively occluded, using electrodetachable bare platinum coils. Follow-up angiography immediately after surgery and at 6 months thereafter demonstrated complete occlusion of the aneurysm and a perfectly patent anterior spinal axis. On clinical follow-up examination, the patient remained neurologically intact. When the morphological features of a spinal aneurysm and its relation with the anterior spinal axis are favorable, selective endosaccular coil placement can successfully be achieved. PMID:17542515

  4. Brain Aneurysm: Early Detection and Screening

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  5. Brain Aneurysm Warning Signs/Symptoms

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  6. Roller coaster-associated subarachnoid hemorrhage--report of 2 cases.

    Science.gov (United States)

    Rutsch, Sebastian; Niesen, Wolf-Dirk; Meckel, Stephan; Reinhard, Matthias

    2012-04-15

    The most common neurological injuries associated with roller coaster rides are subdural hematoma and cervical artery dissection. We report two cases of roller-coaster associated subarachnoid hemorrhage (SAH). A 40-year-old healthy man developed a strong, holocephalic headache during a roller coaster ride. SAH Hunt & Hess grade II and Fisher grade 3 was diagnosed. An underlying aneurysm of the anterior communicating artery was successfully treated with coil embolization. A 41-year-old female (smoker, otherwise healthy) experienced a sudden, strong headache and diplopia during a roller coaster ride. A perimesencephalic SAH (Hunt & Hess grade II, Fisher grade 3) was disclosed by a CT scan. No aneurysm was detected on angiography. Both patients were discharged without neurological disability. In conclusion, SAH is a rare but relevant differential diagnosis in cases of acute headache during roller coaster rides. Both aneurysmal and non-aneurysmal perimesencephalic SAH can occur. A combination of mechanical factors and excessive blood pressure rises in vulnerable persons is discussed. PMID:22177088

  7. New screening system for unruptured cerebral aneurysms

    International Nuclear Information System (INIS)

    We have designed a screening system to diagnose unruptured aneurysms, including the use of digital subtraction angiography (DSA). We surveyed 115 patients who had undergone clipping procedures after subarachnoid hemorrhage (SAH) and questioned them with regard to the subjective symptoms. Sixty-eight of 92 patients who returned the questionnaire reported, prior to rupture, headache,eye pain, and neck pain most frequently, and also impairment of extraocular movements, ptosis, visual field defects, and motor and sensory disturbances. Nineteen (47.5%) of 40 patients who had complete pain relief after surgery complained of headache from 1 week to 1 month before SAH. In addition, nine patients (22.5%) complained of headache for several years, and were also pain-free after surgery. For the indication of DSA, we employed an expert system based on fuzzy set theory. Seven groups of parameters are: Group 1, a basic questionnaire concerning age, sex, and past and family histories; Group 2, 15 warning signs selected on the basis of retrospective study; and Groups 3-7, detailed questions concerning each sign. Scoring weights assigned to each condition based on the results of the retrospective study, and threshold values were determined by several neurosurgeons. The certainty factors for intermediate hypotheses were calculated from these weights and threshold values and summed up, from which the conclusion was obtained. Twelve new cases of unruptured cerebral aneurysm were diagnosed using this screening system. This system may improve the ability to diagnose cerebral aneurysms before rupture. (author)

  8. Detecting subarachnoid hemorrhage: Comparison of combined FLAIR/SWI versus CT

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Rajeev Kumar, E-mail: rajeev.verma@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Kottke, Raimund, E-mail: raimund.kottke@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Andereggen, Lukas, E-mail: lukas.andereggen@insel.ch [Department of Neurosurgery, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Weisstanner, Christian, E-mail: christian.weisstanner@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Zubler, Christoph, E-mail: christoph.zubler@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Gralla, Jan, E-mail: jan.gralla@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Kiefer, Claus, E-mail: claus.kiefer@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Slotboom, Johannes, E-mail: johannes.slotboom@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); and others

    2013-09-15

    Objectives: Aim of this study was to compare the utility of susceptibility weighted imaging (SWI) with the established diagnostic techniques CT and fluid attenuated inversion recovery (FLAIR) in their detecting capacity of subarachnoid hemorrhage (SAH), and further to compare the combined SWI/FLAIR MRI data with CT to evaluate whether MRI is more accurate than CT. Methods: Twenty-five patients with acute SAH underwent CT and MRI within 6 days after symptom onset. Underlying pathology for SAH was head trauma (n = 9), ruptured aneurysm (n = 6), ruptured arteriovenous malformation (n = 2), and spontaneous bleeding (n = 8). SWI, FLAIR, and CT data were analyzed. The anatomical distribution of SAH was subdivided into 8 subarachnoid regions with three peripheral cisterns (frontal-parietal, temporal-occipital, sylvian), two central cisterns and spaces (interhemispheric, intraventricular), and the perimesencephalic, posterior fossa, superior cerebellar cisterns. Results: SAH was detected in a total of 146 subarachnoid regions. CT identified 110 (75.3%), FLAIR 127 (87%), and SWI 129 (88.4%) involved regions. Combined FLAIR and SWI identified all 146 detectable regions (100%). FLAIR was sensitive for frontal-parietal, temporal-occipital and Sylvian cistern SAH, while SWI was particularly sensitive for interhemispheric and intraventricular hemorrhage. Conclusions: By combining SWI and FLAIR, MRI yields a distinctly higher detection rate for SAH than CT alone, particularly due to their complementary detection characteristics in different anatomical regions. Detection strength of SWI is high in central areas, whereas FLAIR shows a better detection rate in peripheral areas.

  9. Subarachnoid cyst in a cat

    International Nuclear Information System (INIS)

    A five-year-old domestic longhair was presented with hind-limb ataxia and some degree of incontinence of two weeks' duration. An enlarged spinal canal from the twelfth thoracic (T-12) vertebra to the third lumbar (L(3)) vertebra was identified on survey radiographs. An intradural-extramedullary cavity at the twelfth (T-12) and thirteenth (T-13) thoracic vertebrae, filled with contrast material, was demonstrated on myelography. A left-sided hemilaminectomy was performed over this region, and a subarachnoid cavitation or cyst was found to be the cause of the severe spinal-cord compression. The cyst was drained. The cat showed improvement in the neurological signs during the first three weeks postoperatively. Six months later no neurological deficits were identified on follow-up examination

  10. GDC embolization of wide-necked cerebral aneurysms using balloon-assisted technique

    International Nuclear Information System (INIS)

    The main factor limiting endovascular treatment of intracranial aneurysms is the shape of the aneurysmal sac, especially the width of the neck. We describe an early experience and technical aspects of treating wide-necked cerebral aneurysm using a Guglielmi detachable coil (GDC) and simultaneous application of a temporary balloon. Four cases of unruptured wide-necked cerebral aneurysm were treated with GDC, with simultaneous application of a temporary balloon. Patients were aged between 29 and 49 years. On admission, clinical presentation was subarachnoid hemorrhage (SAH) in all cases. Hunt and Hess grade was 2 in two cases, 3 in one case, and traumatic SAH in one case. In all patients angiography revealed an asymptomatic aneurysm after rupture of another aneurysm or traumatic SAH. The aneurysms were occluded with GDC-10, and a Cirrus balloon occlusion system was used simultaneously. All procedures were performed under endotracheal general anesthesia and systemic heparinization. All cases were treated successfully, without parent artery compromise. The occlusion rate at the end of the procedure was total in three cases and subtotal in one. In one case a heparin-related hematoma occurred during post-procedural treatment and the patient eventually expired. One patient underwent follow-up angiography after 6 months, and the coil was not changed. An aneurysm may not be completely occluded, but with regard to coil compaction and parent artery preservation, the technique is an attractive alternative

  11. Ruptured cerebral aneurysm associated with a persistent primitive trigeminal artery variant

    Science.gov (United States)

    Yamamoto, Takahiro; Hasegawa, Yu; Ohmori, Yuki; Kawano, Takayuki; Kai, Yutaka; Morioka, Motohiro; Kuratsu, Jun-ichi

    2011-01-01

    Background: Primitive trigeminal artery variants (PTAVs) are one of the rare persistent fetal anastomoses between the carotid and vertebrobasilar circulations. They originate from the internal carotid artery and join one of the cerebellar arteries instead of the basilar artery. Case Description: We present an 82-year-old woman with subarachnoid hemorrhage due to a ruptured aneurysm originating at a PTAV. Three-dimensional computed tomography angiogram and cerebral angiography revealed bilateral PTAV and two aneurysms originating at the left PTAV. The proximal and distal aneurysms were saccular and fusiform, respectively. She underwent surgical treatment and her postoperative course was uneventful. Conclusion: Our case demonstrates that extremely rare cerebral aneurysms associated with PTAV can be addressed successfully by surgical intervention. PMID:22059121

  12. Recent advances in diagnostic approaches for sub-arachnoid hemorrhage.

    Science.gov (United States)

    Kumar, Ashish; Kato, Yoko; Hayakawa, Motoharu; Junpei, Oda; Watabe, Takeya; Imizu, Shuei; Oguri, Daikichi; Hirose, Yuichi

    2011-07-01

    Sub-arachnoid hemorrhage (SAH) has been easily one of the most debilitating neurosurgical entities as far as stroke related case mortality and morbidity rates are concerned. To date, it has case fatality rates ranging from 32-67%. Advances in the diagnostic accuracy of the available imaging methods have contributed significantly in reducing morbidity associated with this deadly disease. We currently have computed tomography angiography (CTA), magnetic resonance angiography (MRA) and the digital subtraction angiography (DSA) including three dimensional DSA as the mainstay diagnostic techniques. The non-invasive angiography in the form of CTA and MRA has evolved in the last decade as rapid, easily available, and economical means of diagnosing the cause of SAH. The role of three dimensional computed tomography angiography (3D-CTA) in management of aneurysms has been fairly acknowledged in the past. There have been numerous articles in the literature regarding its potential threat to the conventional "gold standard" DSA. The most recent addition has been the introduction of the fourth dimension to the established 3D-CT angiography (4D-CTA). At many centers, DSA is still treated as the first choice of investigation. Although, CT angiography still has some limitations, it can provide an unmatched multi-directional view of the aneurysmal morphology and its surroundings including relations with the skull base and blood vessels. We study the recent advances in the diagnostic approaches to SAH with special emphasis on 3D-CTA and 4D-CTA as the upcoming technologies. PMID:22347331

  13. Evaluation of results and radiologic follow-up in detachable balloon occlusion therapy of the internal carotid artery aneurysms

    International Nuclear Information System (INIS)

    The author has studied the clinical results of CT and MR findings of proximal carotid artery occlusion using detachable balloons in the treatement of unclippable internal carotid (IC) aneurysms. From 1987 to 1995, twenty-eight patients with IC aneurysms were treated by proximal artery occlusion with detachable balloons. Of these patients, 4 had aneurysms arising from the supraclinoid portion of the IC artery, 23 had aneuryms arising from cavernous portion of the IC artery, and one had aneurysm arising from cervical portion of the IC artery. Of the 28 patients, 7 patients without CT or MR examinations were excluded in this study. The mean follow-up period was 18.6 months. The causes of aneurysm formation were spontaneous in 17 cases and traumatic in 4 cases. Of 20 patients with aneurysms arising from supraclinoid and cavernous portion of the IC artery, 16 patients (80%) had cranial nerve symptoms by mass effect. Five patients had epistaxis (3 patient), carotid cavernous fistula (1 patient) or subarachnoid hemorrhage (1 patient) due to aneurysm rupture. Two patients, each with aneuryms arising from supraclinoid and cervical portion of carotid artery had 9th and 12th cranial nerve symptom. There were three instances of complication after permanent occlusion; two patients had subarachnoid and intracerebral hemorrhage by aneurysm rupture and expired. One patient had ischemia of posterior cerebral artery teritorry after one day. Delayed ischemic event did not occur during the follow-up period. All aneurysms of the carotid artery below the level of ophthalmic artery presented radiographic proof of complete thrombosis within two months. However, complete thrombosis of aneurysm was considerably delayed in two aneurysms arising from the supraclinoid portion of the carotid artery. In long-term follow-up study, completely thrombosed aneurysms decreased in size slowly. But incompletely thrombosed aneurysms did not decrease in size for a long time and began to contract after

  14. Supratentorial Intraparenchymal Haemorrhages during Spine Surgery

    OpenAIRE

    Leung, Gilberto Ka Kit; Chan, Johnny Ping Hon

    2014-01-01

    Intracranial haemorrhages are rare but potentially life-threatening complications of spine surgery. Most reported cases involved subdural or cerebellar haemorrhages; supratentorial parenchymal bleeding is very uncommon. We report a 28-year-old woman who underwent resection of a thoracic Ewing's sarcoma, and developed fatal haemorrhages around her cerebral metastases during surgery. The clinical presentations, possible pathogenesis and potential preventive measures are discussed. Patients with...

  15. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to become you to our live webcast. Today we’re going to repair an abdominal aortic aneurysm ... and together as a team of multidisciplinary physicians, we’re going to repair an abdominal aortic aneurysm ...

  16. Aortic Aneurysm Repair

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    Full Text Available ... for the past three years, and his aneurysm has now grown to 5.4 centimeters. And this ... that in this particular patient that the aneurysm has reached the size where risk of rupture when ...

  17. Cerebral Aneurysms Fact Sheet

    Science.gov (United States)

    ... cerebral aneurysm from forming. People with a diagnosed brain aneurysm should carefully control high blood pressure, stop smoking, and avoid cocaine use or other stimulant drugs. They should also ...

  18. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... is actually an important factor. Most aneurysms we treat conservatively and we’ll just watch them. But ... has to be, and we generally don’t treat aneurysms until they get to be 5 to ...

  19. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic aneurysms. Today’s patient is a ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  20. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... as atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic aneurysms. Today’s patient is ... be screened. In fact, patients who have a family history of aneurysm, men who are smoking over ...

  1. Aortic Aneurysm Statistics

    Science.gov (United States)

    ... connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, get thoracic aortic aneurysms. Signs and symptoms of thoracic aortic aneurysm can include Sharp, sudden pain in the chest or upper back. Shortness of ...

  2. A fusiform aneurysm of a persistent trigeminal artery variant: case report and literature review.

    Science.gov (United States)

    Yang, Zhigang; Liu, Jianmin; Zhao, Wenyuan; Xu, Yi; Hong, Bo; Huang, Qinghai; He, Shike

    2010-04-01

    A 48-year-old man suffered from spontaneous subarachnoid hemorrhage. Emergent right internal carotid angiography showed the presence of a persistent trigeminal artery (PTA) variant with a fusiform aneurysm on its proximal segment where it branched from the internal carotid artery. This artery supplied the territory of the anterior inferior cerebellar artery. After consideration of the adequacy of the cerebellar circulation without this anomalous artery, intraluminal occlusion of the aneurysm together with the PTA variant was performed using detachable coils. The patient recovered uneventfully without any neurologic deficits. PMID:19690795

  3. Cerebral aneurysms and inflammation

    Directory of Open Access Journals (Sweden)

    Toshihiro Yokoi

    2015-06-01

    Full Text Available Multiple inflammatory factors, playing a crucial role in cerebral aneurysm formation, have been identified. tumor necrosis factor-alpha (TNF-α has been revealed to have a close connection with several risk factors that affect aneurysm formation. Remarkable expression in aneurysm walls of mRNA for TNF-α has been observed in humans. Possible therapeutic interventions to reduce the formation of cerebral aneurysms may include the inhibition of mediators of inflammation.

  4. Paediatric intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    A A Wani

    2006-01-01

    Full Text Available Intracranial aneurysms in childhood account for 1-2% of intracranial aneurysms.[1],[2] These aneurysms have unique characteristics that make them different from those in adults. These differences are evident in their epidemiology, location, clinical spectrum, association with trauma and infection, complications and outcome.

  5. Diagnosis and Management of Subarachnoid Hemorrhage%蛛网膜下腔出血的诊断和处理

    Institute of Scientific and Technical Information of China (English)

    J. van Gijin

    2004-01-01

    The incidence of subarachnoid hemorrhage (SAH) is stable, at around 6 per 100 000 per annum, but higher in Japan and Finland. Any apparent decrease is attributable to a higher rate of computed tomography (CT) scanning, by which other haemorrhagic conditions are excluded. Most patients are below 60 years of age. Risk factors are similar to those for stroke in general; genetic factors operate in a minority. Case fatality is around 50% overall (including prehospital deaths); one third of survivors remain dependent. Sudden, explosive headache is a cardinal but non-specific feature in the diagnosis of SAH: in general practice the cause is innocuous in 9 out of 10 patients in whom this is the only symptom. CT scanning is mandatory in all, to be followed by (delayed) lumbar puncture if CT is negative. The cause of SAH is a ruptured aneurysm in 85%, non-aneurysmal perimesencephalic hemorrhage (with excellent prognosis) in 10%, and a variety of rare conditions in 5%. Catheter angiography for detecting aneurysms is gradually being replaced by CT or MR angiography. A poor clinical condition on admission may be caused by a remediable complication of the initial bleed or a recurrent hemorrhage: intracranial haematoma, acute hydrocephalus, or global brain ischemia. Occlusion of the aneurysm effectively prevents rebleeding, but there is a dearth of controlled trials assessing the relative benefits of early operation (within three days) versus late operation (day 10-12). Endovascular occlusion is now clearly preferable to operation if the location and structure of the aneurysm make this feasible. Antifibrinolytic drugs reduce the risk of rebleeding but do not improve overall outcome. The risk of delayed cerebral ischemia can be decreased by oral administration of nimodipine; other measures, with some support from observational studies,are a liberal supply of fluids and avoidance of antihypertensive drugs. Once ischemia has occurred treatment regimens such as a combination of

  6. Neutrophil depletion after subarachnoid hemorrhage improves memory via NMDA receptors.

    Science.gov (United States)

    Provencio, Jose Javier; Swank, Valerie; Lu, Haiyan; Brunet, Sylvain; Baltan, Selva; Khapre, Rohini V; Seerapu, Himabindu; Kokiko-Cochran, Olga N; Lamb, Bruce T; Ransohoff, Richard M

    2016-05-01

    Cognitive deficits after aneurysmal subarachnoid hemorrhage (SAH) are common and disabling. Patients who experience delayed deterioration associated with vasospasm are likely to have cognitive deficits, particularly problems with executive function, verbal and spatial memory. Here, we report neurophysiological and pathological mechanisms underlying behavioral deficits in a murine model of SAH. On tests of spatial memory, animals with SAH performed worse than sham animals in the first week and one month after SAH suggesting a prolonged injury. Between three and six days after experimental hemorrhage, mice demonstrated loss of late long-term potentiation (L-LTP) due to dysfunction of the NMDA receptor. Suppression of innate immune cell activation prevents delayed vasospasm after murine SAH. We therefore explored the role of neutrophil-mediated innate inflammation on memory deficits after SAH. Depletion of neutrophils three days after SAH mitigates tissue inflammation, reverses cerebral vasoconstriction in the middle cerebral artery, and rescues L-LTP dysfunction at day 6. Spatial memory deficits in both the short and long-term are improved and associated with a shift of NMDA receptor subunit composition toward a memory sparing phenotype. This work supports further investigating suppression of innate immunity after SAH as a target for preventative therapies in SAH. PMID:26872422

  7. Subarachnoid Hemorrhage, Spreading Depolarizations and Impaired Neurovascular Coupling

    Directory of Open Access Journals (Sweden)

    Masayo Koide

    2013-01-01

    Full Text Available Aneurysmal subarachnoid hemorrhage (SAH has devastating consequences on brain function including profound effects on communication between neurons and the vasculature leading to cerebral ischemia. Physiologically, neurovascular coupling represents a focal increase in cerebral blood flow to meet increased metabolic demand of neurons within active regions of the brain. Neurovascular coupling is an ongoing process involving coordinated activity of the neurovascular unit—neurons, astrocytes, and parenchymal arterioles. Neuronal activity can also influence cerebral blood flow on a larger scale. Spreading depolarizations (SD are self-propagating waves of neuronal depolarization and are observed during migraine, traumatic brain injury, and stroke. Typically, SD is associated with increased cerebral blood flow. Emerging evidence indicates that SAH causes inversion of neurovascular communication on both the local and global level. In contrast to other events causing SD, SAH-induced SD decreases rather than increases cerebral blood flow. Further, at the level of the neurovascular unit, SAH causes an inversion of neurovascular coupling from vasodilation to vasoconstriction. Global ischemia can also adversely affect the neurovascular response. Here, we summarize current knowledge regarding the impact of SAH and global ischemia on neurovascular communication. A mechanistic understanding of these events should provide novel strategies to treat these neurovascular disorders.

  8. Comparison of 16-row multislice CT angiography with conventional angiography for detection and evaluation of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Donmez, Halil; Serifov, Elman; Kahriman, Guven [University of Erciyes, School of Medicine, Department of Radiology, Kayseri (Turkey); Mavili, Ertugrul, E-mail: ertmavili@yahoo.com [University of Erciyes, School of Medicine, Department of Radiology, Kayseri (Turkey); Durak, Ahmet Candan [University of Erciyes, School of Medicine, Department of Radiology, Kayseri (Turkey); Menkue, Ahmet [University of Erciyes, School of Medicine, Department of Neurosurgery, Kayseri (Turkey)

    2011-11-15

    Purpose: The aim of this study is to compare the diagnostic performance of 16-row computed tomographic angiography (MDCTA) with digital subtraction angiography (DSA) for the detection and characterization of intracranial aneurysms in patients with nontraumatic subarachnoid hemorrhages (SAH). Materials and methods: One-hundred and twelve consecutive patients with suspected intracranial aneurysm underwent both 16-row MDCTA and DSA. The MDCT angiograms were interpreted in a blinded fashion by using combination with VRI, MIP and MPR techniques. Sensitivity specificity and accuracy were calculated for the CTA and DSA. The results were compared with each other. The DSA reader's interpretation was accepted as the reference standard. Results: A total of 164 aneurysms were detected at DSA in 112 patients, no aneurysms were detected by DSA and MDCTA in 16 patients. Eight aneurysms were missed by MDCTA. The overall sensitivity, specificity, and accuracy of MDCTA on a per-aneurysm basis were 95.1%, 94.1%, and 95%, respectively. According to the size of the aneurysm less than 3 mm; sensitivity, specificity and diagnostic accuracy of MDCTA were 86.1%, 94.1%, 88.6%, respectively. Conclusion: This study suggests that MDCTA is equally as sensitive as DSA in the detection of intracranial aneurysms of greater than 3 mm, and it also reveals 100% detection rate for ruptured aneurysms.

  9. Successful treatment of a ruptured flow-related aneurysm in a patient with hemangioblastoma: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Masanori Suzuki

    2014-01-01

    Full Text Available Background:  No cerebral aneurysms on the feeder associated with hemangioblastomas that ruptured before resection have been reported. We report a patient with a ruptured flow-related aneurysm associated with cerebellar hemangioblastoma and a tumor feeder treated simultaneously by a single procedure of embolization using N-butyl cyanoacrylate before tumor removal. Case Description: A 36-year-old female with a cerebellar tumor was admitted to our institute. Four days later, she suffered a massive subarachnoid hemorrhage mainly in the posterior fossa. Left vertebral angiograms showed an aneurysm on the feeding artery, posterior inferior cerebellar artery. Both the aneurysm and its main feeder were simultaneously treated by a single procedure of embolization using N-butyl cyanoacrylate. Their complete obliteration was confirmed angiographically. Four days after the procedure, we removed the tumor and the embolized aneurysm. The pathological diagnosis was hemangioblastoma and flow-related ruptured aneurysm. Conclusion: Cerebral angiography should be performed to rule out vascular abnormalities such as cerebral aneurysms adjacent to the tumor in patients with hemangioblastoma who present with intracranial hemorrhage. We emphasize the usefulness of embolization with N-butyl cyanoacrylate for hemangioblastoma with ruptured feeder aneurysm, by which the aneurysm and the feeder could be simultaneously embolized.

  10. The Value of Cerebral CT Angiography with Low Tube Voltage in Detection of Intracranial Aneurysms

    OpenAIRE

    Kun Tang; Rui Li; Jie Lin; Xiangwu Zheng; Ling Wang; Weiwei Yin

    2015-01-01

    Objective. The aim of this study is to investigate the value of cerebral CT angiography (CTA) with low tube voltage in detection of intracranial aneurysms. Materials and Methods. A total of 294 consecutive patients with spontaneous subarachnoid hemorrhage (SAH) were enrolled in this study and randomly assigned into conventional voltage CTA (C-CTA) group and low voltage CTA (L-CTA) group. The objective and subjective image qualities were analyzed and compared between C-CTA and L-CTA groups. W...

  11. Mouse model of intracerebellar haemorrhage.

    Science.gov (United States)

    Tijjani Salihu, Abubakar; Muthuraju, Sangu; Aziz Mohamed Yusoff, Abdul; Ahmad, Farizan; Zulkifli Mustafa, Mohd; Jaafar, Hasnan; Idris, Zamzuri; Rahman Izaini Ghani, Abdul; Malin Abdullah, Jafri

    2016-10-01

    The present study aimed to investigate the behavior and neuronal morphological changes in the perihaemorrhagic tissue of the mouse intracerebellar haemorrhage experimental model. Adult male Swiss albino mice were stereotactically infused with collagenase type VII (0.4U/μl of saline) unilaterally in to the cerebellum, following anaesthesia. Motor deficits were assessed using open field and composite score for evaluating the mouse model of cerebellar ataxia at 1, 3, 7, 14 and 21 days after collagenase infusion. The animals were sacrificed at the same time interval for evaluation of perihaematomal neuronal degeneration using haematoxylin and eosin staining and Annexin V-FITC/Propidium iodide assay. At the end of the study, it was found that infusion of 0.4U collagenase produces significant locomotor and ataxic deficit in the mice especially within the first week post surgery, and that this gradually improved within three weeks. Neuronal degeneration evident by cytoplasmic shrinkage and nuclear pyknosis was observed at the perihaematomal area after one day; especially at 3 and 7 days post haemorrhage. By 21 days, both the haematoma and degenerating neurons in the perihaematomal area were phagocytosed and the remaining neuronal cells around the scar tissue appeared normal. Moreover, Annexin-V/propidium iodide-positive cells were observed at the perihaematomal area at 3 and 7 days implying that the neurons likely die via apoptosis. It was concluded that a population of potentially salvageable neurons exist in the perihaematomal area after cerebellar haemorrhage throughout a wide time window that could be amenable to treatment. PMID:27327104

  12. Ultrasonically detectable cerebellar haemorrhage in preterm infants.

    LENUS (Irish Health Repository)

    McCarthy, Lisa Kenyon

    2011-07-01

    To determine the frequency and pattern of cerebellar haemorrhage (CBH) on routine cranial ultrasound (cUS) imaging in infants of ≤32 weeks gestation, and to investigate how extremely preterm infants with CBH differ from those with severe intraventricular haemorrhage (IVH).

  13. Bilateral spontaneous adrenal haemorrhage complicating acute pancreatitis

    International Nuclear Information System (INIS)

    Bilateral adrenal haemorrhage is an event that mandates prompt diagnosis and treatment to prevent primary adrenocortical insufficiency and potential death. Presentation can be non-specific and incidentally diagnosed with imaging alone, primarily CT. We present a case of acute pancreatitis with spontaneous bilateral adrenal haemorrhage and briefly discuss imaging and treatment implications

  14. Patterns and predictors of in-hospital aneurysmal rebleed: An institutional experience and review of literature

    Directory of Open Access Journals (Sweden)

    Menon Girish

    2007-01-01

    Full Text Available Background: Rebleeding is an important cause for mortality following aneurysmal subarachnoid hemorrhage. Early intervention is believed to reduce the risk of rebleeding. However, in developing countries such as India, early intervention is often difficult due to various reasons. The knowledge about the risks and predictors for rebleeding is essential to prioritize the management policy. Aims: To describe the frequency and impact of rebleeding in the modern era of aneurysm care, to study the clinical profile of patients with rebleed and to review the controversial aspects on aneurysmal rebleed. Materials and Methods: This observational study is based on the retrospective analysis of the case records of all patients admitted with aneurysmal subarachnoid hemorrhage (SAH since January 1999 in our institute. Twenty patients rebled after admission before surgical clipping, and these patients formed our study group. The findings were compared with all the major series on rebleeding published in literature. Results: Since January 1999, 952 patients underwent treatment for aneurysmal subarachnoid hemorrhage in our institute. Twenty patients rebled while awaiting surgery following the admission with an incidence of 2.14%. The study group included nine males and eleven females. The age of the patients ranged from 31 to 69 years, but the majority were in the sixth decade. Mean bleed to admission days was 7.9 days (range: 1-27 days, the mean admission to rebleed was 1.42 days (Range: 0-4 and the mean first bleed to rebleed was 9.26 days. The history of loss of consciousness at the time of bleeding was observed in 16 patients. Four patients bled before an angiogram could be performed. Two patients had giant aneurysms, while the rest had small aneurysms; two patients had multiple aneurysms. Angiographic spasm was observed in eight patients. In three patients, rebleeding was precipitated by angiogram. Twelve patients rebled while taking rest or in sleep, while

  15. Neurosarcoidosis-related intracranial haemorrhage: three new cases and a systematic review of the literature.

    LENUS (Irish Health Repository)

    O'Dwyer, J P

    2012-06-09

    BACKGROUND AND PURPOSE: Intracranial haemorrhage in neurosarcoidosis (NS-ICH) is rare, poorly understood and the diagnosis of NS may not be immediately apparent. METHODS: The clinical features of three new NS-ICH cases are described including new neuropathological findings and collated with cases from a systematic literature review. RESULTS: Cases: (i) A 41-year-old man with headaches, hypoandrogenism and encephalopathy developed a cerebellar haemorrhage. He had neuropathological confirmation of NS with biopsy-proven angiocentric granulomata and venous disruption. He responded to immunosuppressive therapy. (ii) A 41-year-old man with no history of hypertension was found unconscious. A subsequently fatal pontine haemorrhage was diagnosed. Liver biopsy revealed sarcoid granulomas. (iii) A 36-year-old man with raised intracranial pressure headaches presented with a seizure and a frontal haemorrhage. Hilar lymph node biopsy confirmed sarcoidosis, and he was treated successfully. Systematic Review: Twelve other published cases were identified and collated with our cases. Average age was 36 years and M:F = 2.3:1; 46% presented with neurological symptoms and 31% had CNS-isolated disease. Immediate symptoms of ICH were acute\\/worsening headache or seizures (60%). ICH was supratentorial (62%), infratentorial (31%) or subarachnoid (7%). 40% had definite NS, 53% probable NS and 7% possible NS (Zajicek criteria). Antigranulomatous\\/immunosuppressive therapy regimens varied and 31% died. CONCLUSIONS: This series expands our knowledge of the pathology of NS-ICH, which may be of arterial or venous origin. One-third have isolated NS. Clinicians should consider NS in young-onset ICH because early aggressive antigranulomatous therapy may improve outcome.

  16. Use of the pipeline embolization device to treat recently ruptured dissecting cerebral aneurysms.

    Science.gov (United States)

    Chan, Robert S K; Mak, Calvin H K; Wong, Alain K S; Chan, Kwong Yau; Leung, Kar Ming

    2014-01-01

    The Pipeline embolization device (PED) is one of the flow-diverting stents approved for the treatment of unruptured large or wide-necked cerebral aneurysms in 2011(1). Its use has now been extended to the treatment of recently ruptured dissecting cerebral aneurysm, carotid pseudoaneurysm from radiation injury, and blister aneurysms(2,3). We aimed to evaluate the effectiveness of utilizing the PED as a primary treatment for ruptured dissecting intracranial aneurysms. A single center retrospective review was conducted for all patients primarily treated with PED for acute subarachnoid hemorrhage (SAH) from ruptured dissecting cerebral aneurysms between December 2010 and February 2013. Patients were followed up with CT angiogram (CTA) or digital subtraction angiogram (DSA). Eight patients with a total of eight dissecting aneurysms were identified. The mean duration from SAH to treatment was 2.5 days. Six of the aneurysms arose from vertebral arteries and two from the basilar artery. Immediate check-DSA confirmed satisfactory contrast stasis in all eight cases, and complete aneurysmal obliteration was achieved at six months. There were two (25%) procedure-related complications, but no major procedure-related complications, such as thromboembolic events or rebleeding from aneurysm were encountered. The PED is a feasible treatment option for ruptured dissecting cerebral aneurysms in acute phase. According to our experience, using PED as flow-diverters in acute SAH does not significantly increase the complication risks or mortality rate if the antiplatelet regime is carefully monitored. Future studies shall evaluate the optimal antiplatelet regimen for using the PED in the acute phase. PMID:25207906

  17. Interventional therapy of huge aneurysm

    International Nuclear Information System (INIS)

    Objective: To evaluate the methods and the efficacy of interventional therapy for huge aneurysm. Methods: Seven patients with huge aneurysm including 2 with pulmonary aneurysm, 2 with renal aneurysm, 1 with humeral artery aneurysm, 1 with right common iliac artery aneurysm, 1 with right internal iliac artery aneurysm. Among these, 5 were true aneurysm, and 2 were pseudoaneurysms caused by congenital, trauma, arteriosclerosis. Three patients were treated with endovascular covered stent graft and 2 patients with embolization containing metallic coils. Two patients were treated with partial aneurysm and feeding artery trunk embolization with metallic coils. Results: All 7 patients were successful carried out the interventional therapy with successful rate of 100%. Six aneurysms were completely obstructed with disappearance of symptoms and signs. One died of aneurysm rupture. No other complication occurred. Conclusion: Interventional therapy for huge aneurysm is an effective method. (authors)

  18. Brain Aneurysm Statistics and Facts

    Science.gov (United States)

    ... Statistics and Facts A- A A+ Brain Aneurysm Statistics and Facts An estimated 6 million people in ... Understanding the Brain Warning Signs/ Symptoms Brain Aneurysm Statistics and Facts Seeking Medical Attention Risk Factors Aneurysm ...

  19. The utility of three dimensional DSA with bi-C-typed arms in the embolization of intracranial aneurysms

    International Nuclear Information System (INIS)

    Objective: To discuss the value of three dimensional DSA(3D-DSA) with bi-C-typed arms on the embolization of intracranial aneurysms. Methods: 3D-DSA was performed in eight patients (aged 43-73 years) with spontaneous subarachnoid hemorrhage (SAH) by frontal, lateral and various oblique projections including rotational angiography and three dimensional reconstruction. The perfect vision angle of aneurysms could be found on the 3D-workstation by the auto positioning function of 3D-DSA which could send the parameters to the main machine and make the bi-C-typed arms turning to the proper angle to have aneurysms embolized totally. Results: Eight SAH cases were found with aneurysms including one micro-aneurysm and four with bleb (6 blebs). Six cases were under-taken selective embolization with 5 of total occlusion showing no bleb in follow up angiography and the other one of partial occlusion. The patient with micro-aneurysm didn't receive embolization and another one received microneurosurgery operation. No blebs were found in the follow up angiography. Conclusions: 3D-DSA with bi-C-typed arms can facilitate in finding intracranial aneurysms, micro-aneurysms and blebs' and provide the best procedural angulation for embolization with more safe. (authors)

  20. Pediatric cerebral artery aneurysms

    OpenAIRE

    Koroknay-Pál, PÀivi

    2012-01-01

    Objectives. Intracranial aneurysms in children are rare and population-based long-term follow-up studies are limited. In this study, a large clinical and angiographic long-term follow-up was carried out. The special characteristics of the patients and their aneurysms were assessed together with factors affecting early and long-term morbidity and mortality. Materials and Methods. All pediatric (≀18 years) aneurysm patients treated at the Department of Neurosurgery in Helsinki during 193...

  1. Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to ''triage'' patients' treatment

    Energy Technology Data Exchange (ETDEWEB)

    Agid, R.; Lee, S.K.; Willinsky, R.A.; Farb, R.I.; TerBrugge, K.G. [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada)

    2006-11-15

    To evaluate the clinical role of CT angiography (CTA) in patients with acute subarachnoid hemorrhage (SAH) for treatment decision-making. Consecutive patients with acute SAH had CTA using a 64-slice scanner for initial clinical decision-making. Image processing included multiplanar volume reformatted (MPVR) maximum intensity projections (MIP) and 3D volume-rendered reconstructions. CTAs were used for (1) evaluating the cause of SAH, and (2) triaging aneurysm-bearing patients to the more appropriate management, either surgical clipping or endovascular coiling. CTA findings were confirmed by neurosurgical exploration or catheter angiography (digital subtraction angiography, DSA). Successful coiling provided evidence that triaging to endovascular treatment was correct. Included in the study were 73 patients. CTA findings were confirmed by DSA or neurosurgical operation in 65 patients, and of these 65, 47 had aneurysmal SAH, 3 had vasculitis, 1 had arterial dissection and 14 had no underlying arterial abnormality. The cause of SAH was detected with CTA in 62 out of the 65 patients (95.4%, sensitivity 94%, specificity 100%). CTA revealed the aneurysm in 46 of 47 patients (98%, sensitivity 98%, specificity 100%, positive predictive value 100%, negative predictive value 82.3%), 1 of 3 vasculitides and 1 of 1 dissection. Of the 46 patients with aneurysm, 44 (95.7%) were referred for treatment based on CTA. In 2 patients (2 of 46, 4.4%) CTA was not informative enough to choose treatment requiring DSA. Of the 44 patients, 27 (61.4%) were referred to endovascular treatment and successful coiling was achieved in 25 (25 of 27, 92.6%). CTA using a 64-slice scanner is an accurate tool for detecting and characterizing aneurysms in acute SAH. CTA is useful in the decision process whether to coil or clip an aneurysm. (orig.)

  2. The early etiological diagnosis and endovascular embolization therapy of Hunt-Hess IV-V grade subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Objective: To explore the methods of early etiological diagnosis and principles of endovascular embolization in Hunt-Hess IV-V grade subarachnoid hemorrhage (SAH), and to evaluate the therapeutic efficacy. Methods: Thirty-one patients underwent imaging examinations such as CT and DSA to make the early diagnosis of SAH. Meanwhile, Guglielmi detachable microcoil (GDC) was used to applying aneurysmal intracapsular embolization in the ruptured aneurysms, and efficient symptomatic treatment was adopted early postoperatively. The results were tested by χ2 test. Results: All 31 cases were diagnosed early and operated successfully. Among them, the aneurysm lumen was 100% occluded in 26 cases, 95% occluded in 3 cases; 90% occluded in 2 cases. There were 5 cases complicating with cerebral vasospasm. One case recurrent was cured with secondary complementary GDC embolization. Nine cases (29.0%) had permanent sequelae associated with SAH. According to the Glasgow prognosis score, the therapeutic efficacy was as following: 6 patients were in grade I, 9 in grade II, 4 in grade III, 2 in grade IV, and 10 in grade V; 10 patients died, and the morality rate was 32.3%. None of them exhibited re-bleeding with follow-up period of 3 to 68 months postoperatively. Morality rates were significantly different between the group with aneurysmal diameter of 11-25 mm and the group of 5-10 mm (χ2=6.60, P2=11.24, P2=6.35, P<0.05). Conclusions: CT and DSA can make the early etiological diagnosis of the Hunt-Hess IV-V grade aneurysmal SAH, and GDC can be used early to perform the aneurysmal intracapsular embolization. Dealing with hemorrhage and using efficient symptomatic treatment earlier postoperatively are important methods to improve the curative rate and reduce the mortality rate and mutilation rate. (authors)

  3. Risk factors for intracranial aneurysm in a Chinese ethnic population

    Institute of Scientific and Technical Information of China (English)

    GU Yu-xiang; CHEN Xian-cheng; SONG Dong-lei; LENG Bing; ZHAO Fan

    2006-01-01

    Background Intracranial aneurysm (IAN) is a protruding bubble or a sac on a brain artery that balloons out over time, which may lead to spontaneous subarachnoid hemorrhage (SAH), ultimately disability and mortality.Current research indicates that the disease is due to multiple causes, including environmental factors and various congenital abnormalities of blood vessels. Apart from congenital predisposition, various high-risk factors such as sex, age, hypertension, and atherosclerosis are involved in the formation of intracranial aneurysms. The aim of this study was to investigate the risk factors associated with the formation of sporadic intracranial aneurysms in Chinese Han ethnic patients.Methods A total of 251 patients with intracranial aneurysm and 338 patients with other cerebral diseases (control group) were enrolled in this study. Single factor and logistic regression model were used to analyze the association of intracranial aneurysms with age; sex; cigarette smoking; alcohol or cocaine consumption; history of hypertension, coronary artery disease, diabetes mellitus and inherited connective tissue disease; and the levels of fasting blood glucose and blood fat. The data expressed as mean ± standard deviation were processed with the statistical software SPSS13. Quantitative and qualitative data were analyzed by the independent-sample t test,and the chi-square test respectively. Logistic regression method was used to analyze the multiple factors.Results In the 251 patients, 163 (64.94%) were at age of 40 to 60 years. Sex (OR, 1.41; 95% CI, 1.01-1.96), cigarette smoking (OR, 1.81; 95% CI, 1.06-3.10), hypertension (OR, 2.32; 95% CI, 1.30-4.16) and fasting blood glucose were significantly associated with intracranial aneurysm (P<0.05). Intracranial aneurysm was correlated with alcohol consumption, coronary artery disease, and the level of blood lipids (P>0.05). Using logistic regression analysis, we identified female sex and advanced age as significant risk

  4. Diagnostic accuracy of early computed tomographic angiography for visualizing medium sized inferior and posterior projecting carotid system aneurysms

    International Nuclear Information System (INIS)

    Conventional angiography, generally referred to as intra-arterial digital subtraction angiography, still remains the gold standard reference method for the diagnosis of intracranial aneurysms, helical computed tomography angiography is a new non-invasive volumetric imaging method. Objectives: This study was conducted to screen patients presenting with subarachnoid-hemorrhage by computed tomography angiography before conventional digital subtraction angiography and subsequently comparing the results for various aneurysm projections. Patients and Methods: In a prospective study, 99 consecutive patients with an initial diagnosis of subarachnoid hemorrhage were screened for aneurysms with computed tomography angiography followed by conventional digital subtraction angiography. There were 17 cases with negative angiograms in whom repeat angiograms, three months later were negative for 15 cases, while two cases were found to bear aneurysm on the repeat examination. Eighty two patients had at least one proven aneurysm on initial digital subtraction angiography and two on the repeat angiogram. Out of 84 patients, five underwent endovascular treatment and 79 patients who underwent surgical clipping were considered for projection evaluation. Results: Sensitivity of computed tomography angiography was 98.78percent(95percentconfidence interval [CI], 93.4-99.7percent), while the specificity was 100percent(95percentCI,81.57-100percent) and the kappa coefficient of agreement between computed tomography angiography and digital subtraction angiography was 96.5percent. The most significant discrepancies with digital subtraction angiography findings were for visualizing the projection of inferior and posterior projecting proximal anterior circulation aneurysms. Conclusions: Helical computed tomography angiography was in good concordance with digital subtraction angiography for screening of cerebral aneurysms; however, for exact visualization of the aneurysm neck and its projection

  5. Cigarette Smoke and Inflammation: Role in Cerebral Aneurysm Formation and Rupture

    Directory of Open Access Journals (Sweden)

    Nohra Chalouhi

    2012-01-01

    Full Text Available Smoking is an established risk factor for subarachnoid hemorrhage yet the underlying mechanisms are largely unknown. Recent data has implicated a role of inflammation in the development of cerebral aneurysms. Inflammation accompanying cigarette smoke exposure may thus be a critical pathway underlying the development, progression, and rupture of cerebral aneurysms. Various constituents of the inflammatory response appear to be involved including adhesion molecules, cytokines, reactive oxygen species, leukocytes, matrix metalloproteinases, and vascular smooth muscle cells. Characterization of the molecular basis of the inflammatory response accompanying cigarette smoke exposure will provide a rational approach for future targeted therapy. In this paper, we review the current body of knowledge implicating cigarette smoke-induced inflammation in cerebral aneurysm formation/rupture and attempt to highlight important avenues for future investigation.

  6. Intraorbital ophthalmic artery aneurysm associated with basilar tip saccular aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Dehdashti, A.R.; Tribolet, N. de [Department of Neurosurgery, HUG, Geneva (Switzerland); Safran, A.B. [Department of Ophthalmology, HUG, Geneva (Switzerland); Martin, J.B.; Ruefenacht, D.A. [Division of Neuroradiology, HUG, Geneva (Switzerland)

    2002-07-01

    We present a rare case of intraorbital ophthalmic artery aneurysm found incidentally, together with a ruptured aneurysm of the tip of the basilar artery. The intraorbital aneurysm was asymptomatic, and no treatment was offered. Angiographic control was recommended to detect any progression. Treatment may be indicated for documented enlargement or significant mass effect of the aneurysm. (orig.)

  7. Intraorbital ophthalmic artery aneurysm associated with basilar tip saccular aneurysm

    International Nuclear Information System (INIS)

    We present a rare case of intraorbital ophthalmic artery aneurysm found incidentally, together with a ruptured aneurysm of the tip of the basilar artery. The intraorbital aneurysm was asymptomatic, and no treatment was offered. Angiographic control was recommended to detect any progression. Treatment may be indicated for documented enlargement or significant mass effect of the aneurysm. (orig.)

  8. Risk assessment after acute upper gastrointestinal haemorrhage.

    OpenAIRE

    Rockall, T A; Logan, R F; Devlin, H. B.; Northfield, T. C.

    1996-01-01

    The aim of this study was to establish the relative importance of risk factors for mortality after acute upper gastrointestinal haemorrhage, and to formulate a simple numerical scoring system that categorizes patients by risk. A prospective, unselected, multicentre, population based study was undertaken using standardised questionnaires in two phases one year apart. A total of 4185 cases of acute upper gastrointestinal haemorrhage over the age of 16 identified over a four month period in 1993...

  9. The Expanding Realm of Endovascular Neurosurgery: Flow Diversion for Cerebral Aneurysm Management

    Science.gov (United States)

    Krishna, Chandan; Sonig, Ashish; Natarajan, Sabareesh K.; Siddiqui, Adnan H.

    2014-01-01

    The worldwide prevalence of intracranial aneurysms is estimated to be between 5% and 10%, with some demographic variance. Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm results in devastating neurological outcomes, leaving the majority of victims dead or disabled. Surgical clipping of intracranial aneurysms remained the definitive mode of treatment until Guglielmi detachable coils were introduced in the 1990s. This revolutionary innovation led to the recognition of neurointervention/neuroendovascular surgery as a bona fide option for intracranial aneurysms. Constant evolution of endovascular devices and techniques supported by several prospective randomized trials has catapulted the endovascular treatment of intracranial aneurysms to its current status as the preferred treatment modality for most ruptured and unruptured intracranial aneurysms. We are slowly transitioning from the era of coils to the era of flow diverters. Flow-diversion technology and techniques have revolutionized the treatment of wide-necked, giant, and fusiform aneurysms, where the results of microsurgery or conventional neuroendovascular strategies have traditionally been dismal. Although the Pipeline™ Embolization Device (ev3-Covidien, Irvine, CA) is the only flow-diversion device approved by the Food and Drug Administration for use in the United States, others are commercially available in Europe and South America, including the Silk (Balt Extrusion, Montmorency, France), Flow-Redirection Endoluminal Device (FRED; MicroVention, Tustin, CA), Surpass (Stryker, Kalamazoo, MI), and p64 (Phenox, Bochum, Germany). Improvements in technology and operator experience and the encouraging results of clinical trials have led to broader acceptance for the use of these devices in cerebral aneurysm management. Continued innovation and refinement of endovascular devices and techniques will inevitably improve technical success rates, reduce procedure-related complications, and broaden

  10. Trials and tribulations: an evidence-based approach to aneurysm treatment.

    Science.gov (United States)

    Sorenson, Thomas; Lanzino, Giuseppe

    2016-03-01

    Since the introduction of embolic coils in the early 1990s, endovascular treatment has gained much traction for use when treating ruptured and unruptured intracranial aneurysms. Three prospective studies have been conducted comparing endovascular coil embolization versus clipping for ruptured intracranial aneurysms. The first study took place in Finland and was the first head-to-head look at treating ruptured aneurysms by either endovascular coiling or surgical clipping. Results from this study suggested better functional outcome after endovascular treatment than surgery at the expenses of higher rates of incomplete aneurysm occlusion. The second largest and only multicenter study was the International Subarachnoid Aneurysm Trial (ISAT). The ISAT took place across Europe and was the first large-scale comparison between endovascular and surgical treatments. The results from this study caused a major opinion shift across the world in regards to optimal treatment of ruptured aneurysms. Additionally, the quantity of data from this study allowed for many subgroup analyses to be made. However, to assess the generalizability of the ISAT study, the Barrow Neurological Institute investigators conducted a single-center study. The intent of this latter study was to remove any potential bias and preselection by enrolling every consenting patient that presented with the designated pathology without any exclusion. However, this enrollment strategy resulted in a high percentage of patients with aneurysms not suitable for endovascular therapy being assigned to the coil group which in turn resulted in a high rate of turn over from the endovascular to the surgical arm of the study. Despite, these limitations, this latter trial presented similar results as the Kuopio and ISAT. Although each of these trials was not methodologically flawless, the combined results from all three suggest that endovascular treatment of ruptured aneurysms suitable for this treatment strategy results in

  11. Giant, thrombosed, sellar-suprasellar internal carotid artery aneurysm with persistent, primitive trigeminal artery causing hypopituitarism.

    Science.gov (United States)

    Tungaria, Arun; Kumar, Vijendra; Garg, Pallav; Jaiswal, Awadhesh K; Behari, Sanjay

    2011-05-01

    A rare case of a giant, thrombosed, sellar-suprasellar paraclinoid internal carotid artery (ICA) aneurysm with persistent primitive trigeminal artery (PPTA) causing hypopituitarism that manifested as hypogonadism, hypothyroidism, and hypocortisolism is reported. There were no visual/neurological deficits, diabetes insipidus, or episodes of subarachnoid hemorrhage. The alteration in the flow dynamics of the circle of Willis due to the presence of PPTA may have been responsible for both the genesis of the giant aneurysm as well as for the induction of thrombogenesis within its lumen. As the digital subtraction angiogram showed complete thrombosis within the aneurysm and hormonal replacement therapy was effective in ensuring complete normalization of symptoms, the patient was unwilling to undergo surgical clipping of the aneurysm and removal of the suprasellar clot in an attempt to restore pituitary functions. Hypopituitarism recurred when the patient stopped her hormonal supplementation therapy after 7 years, and she again became symptom-free on restarting the therapy. To the best of the authors' knowledge, this represents the first reported case in the literature of hypopituitarism consequent to a giant, thrombosed, sellar-suprasellar ICA aneurysm with an associated PPTA on the side of the aneurysm. PMID:21234615

  12. Fusiform superior cerebellar artery aneurysm treated with STA-SCA bypass and trapping

    Directory of Open Access Journals (Sweden)

    Fabricio C Lamis

    2014-01-01

    Full Text Available Background: Fusiform aneurysms of cerebellar arteries are rare. Different surgical techniques to address these challenging lesions have been described, and their application depends on whether the goal is to maintain the flow in the parent vessel or to occlude it. Case Description: The authors reported a case of a fusiform aneurysm located in the lateral pontomesencephalic segment of the superior cerebellar artery (SCA in a 32-year-old man who presented with subarachnoid hemorrhage. The patient was subjected to aneurysm trapping followed by a bypass between the superficial temporal artery (STA and SCA and had an uneventful recovery. Conclusions: Although only a few cases of fusiform aneurysms in the supracerebellar artery have been reported in the literature, the treatment strategies adopted were diverse. In selected cases of patients in good neurological condition with ruptured fusiform aneurysms at the proximal segments of SCA and who have poor evidence of collateral supply, the possibility of a STA-SCA bypass with aneurysm trapping must be considered. A review of the current treatment modalities of this pathology is also presented.

  13. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the age of 55 should be screened for aneurysms. And the way to screen is with a simple ultrasound. But sometimes a ...

  14. Aortic Aneurysm Repair

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    Full Text Available Aortic Aneurysm Repair May 7, 2009 Good afternoon. Welcome to the Baptist Cardiac and Vascular Institute here in Miami. My name ... our live webcast. Today we’re going to repair an abdominal aortic aneurysm using a technology called ...

  15. A model of subarachnoid hemorrhage in rats

    Institute of Scientific and Technical Information of China (English)

    Liao-liaoLI; Xiao-liangWANG

    2004-01-01

    AIM: To build a simple and repeatable animal model of subarachnoid hemorrhage (SAH). METHODS: SAH was introduced by passing a nylon thread up through the right internal carotid artery and piercing a hone in the right anterior cerebral artery. At 12 and 24 h, the rats were evaluated with rotarod test and the behavior scale (5-point scale). RESULTS: The ratswere trained through rotarod test and then randomly divided into

  16. Astrocyte Ca2+ Signaling Drives Inversion of Neurovascular Coupling after Subarachnoid Hemorrhage.

    Science.gov (United States)

    Pappas, Anthony C; Koide, Masayo; Wellman, George C

    2015-09-30

    Physiologically, neurovascular coupling (NVC) matches focal increases in neuronal activity with local arteriolar dilation. Astrocytes participate in NVC by sensing increased neurotransmission and releasing vasoactive agents (e.g., K(+)) from perivascular endfeet surrounding parenchymal arterioles. Previously, we demonstrated an increase in the amplitude of spontaneous Ca(2+) events in astrocyte endfeet and inversion of NVC from vasodilation to vasoconstriction in brain slices obtained from subarachnoid hemorrhage (SAH) model rats. However, the role of spontaneous astrocyte Ca(2+) signaling in determining the polarity of the NVC response remains unclear. Here, we used two-photon imaging of Fluo-4-loaded rat brain slices to determine whether altered endfoot Ca(2+) signaling underlies SAH-induced inversion of NVC. We report a time-dependent emergence of endfoot high-amplitude Ca(2+) signals (eHACSs) after SAH that were not observed in endfeet from unoperated animals. Furthermore, the percentage of endfeet with eHACSs varied with time and paralleled the development of inversion of NVC. Endfeet with eHACSs were present only around arterioles exhibiting inversion of NVC. Importantly, depletion of intracellular Ca(2+) stores using cyclopiazonic acid abolished SAH-induced eHACSs and restored arteriolar dilation in SAH brain slices to two mediators of NVC (a rise in endfoot Ca(2+) and elevation of extracellular K(+)). These data indicate a causal link between SAH-induced eHACSs and inversion of NVC. Ultrastructural examination using transmission electron microscopy indicated that a similar proportion of endfeet exhibiting eHACSs also exhibited asymmetrical enlargement. Our results demonstrate that subarachnoid blood causes a delayed increase in the amplitude of spontaneous intracellular Ca(2+) release events leading to inversion of NVC. Significance statement: Aneurysmal subarachnoid hemorrhage (SAH)--strokes involving cerebral aneurysm rupture and release of blood onto the

  17. [Stent-Assisted Coil Embolization of a Dissecting Aneurysm of the Posterior Cerebral Artery: A Case Report].

    Science.gov (United States)

    Haruma, Jun; Sugiu, Kenji; Yukiue, Tadato; Sasaki, Tatsuya; Hattori, Yasuhiko; Kobayashi, Kazuki; Yoshida, Hideyuki; Muneda, Koji; Date, Isao

    2015-12-01

    Dissecting aneurysms of the posterior cerebral artery (PCA) are rare, especially those at the P1 segment. Here, we describe the case of a 57-year-old woman with a subarachnoid hemorrhage (SAH). Computed tomography angiography (CTA) and digital subtraction angiography (DSA) revealed a small (3 mm) dissecting aneurysm with the typical pearl-and-string sign at the right P1 segment. Fourteen days after onset, the patient developed aphasia. DSA revealed vasospasm of the right middle cerebral artery, and we performed endovascular treatment by the intra-arterial injection of 1-(5-isoquinolinesulfonyl) homopiperazine. After this treatment, the patient's symptoms recovered immediately. Vertebral angiography revealed enlargement of the dissecting aneurysm (up to 7 mm diameter). We started a loading dose of 300 mg aspirin and 400 mg clopidogrel after observing growth of the aneurysm. Fifteen days after onset, we performed a stent-assisted coil embolization, and obtained nearly complete obliteration of the aneurysm with preserved patency of the parent artery. Six-month follow-up DSA demonstrated complete occlusion of the aneurysm with good patency of the stented PCA; the patient was at modified Rankin Scale 1. In the treatment of ruptured dissecting aneurysms, parent vessel occlusion (PVO) with aneurysm is common. However, PVO may cause both cerebral infarction of the distal area and perforator occlusion of the occluded vessel. Stent-assisted coil embolization can preserve parent vessel flow and obliterate the aneurysm. Stents offer a therapeutic alternative for PCA dissecting aneurysms, especially when PVO cannot be tolerated. PMID:26646176

  18. Therapeutic approaches to cerebral vasospasm complicating ruptured aneurysm

    Directory of Open Access Journals (Sweden)

    Mohamed Barbarawi

    2009-10-01

    Full Text Available Cerebral vasospasm is a serious complication of ruptured aneurysm. In order to avoid short- and long-term effects of cerebral vasospasm, and as there is no single or optimal treatment modality employed, we have instituted a protocol for the prevention and treatment of vasospasm in patients suffering aneurysmal sub-arachnoid hemorrhage (SAH. We then reviewed the effectiveness of this protocol in reducing the mortality and morbidity rate in our institution. In this study we present a retrospective analysis of 52 cases. Between March 2004 and December 2008 52 patients were admitted to our service with aneurysmal SAH. All patients commenced nimodipine, magnesium sulphate (MgSO4 and triple H therapy. Patients with significant reduction in conscious level were intubated, ventilated and sedated. Intracranial pressure (ICP monitoring was used for intubated patients. Sodium thiopental coma was induced for patients with refractory high ICP; angiography was performed for diagnosis and treatment. Balloon angioplasty was performed if considered necessary. Using this protocol, only 13 patients (25% developed clinical vaso-spasm. Ten of them were given barbiturates to induce coma. Three patients underwent transluminal balloon angioplasty. Four out of 52 patients (7.7% died from severe vasospasm, 3 patients (5.8% became severely disabled, and 39 patients (75% were discharged in a condition considered as either normal or near to their pre-hemorrhage status. Our results confirm that the aforementioned protocol for treatment of cerebral vasospasm is effective and can be used safely.

  19. Emergency percutaneous transcatheter embolisation of acute arterial haemorrhage.

    LENUS (Irish Health Repository)

    Keeling, A N

    2010-09-01

    The purpose of this study was to review indications, source of haemorrhage, method of embolisation and clinical outcome in patients referred to Interventional Radiology for the emergency management of acute arterial haemorrhage.

  20. Intraventricular Haemorrhage Echoencephalography Diagnosis in Newborns

    International Nuclear Information System (INIS)

    A descriptive study of series of cases in 152 newborns was carried out at the maternity ward at V.I.Lenin hospital from January to March 2005, through fontanel echoencephalography and the health histories review, aimed at widening the radiologists' and neonatologists' general knowledge on intracranial haemorrhage.15.80 % of them had intraventricular haemorrhage, with predominant grade I, the diagnosis was done within the first 72 hours after birth,57.14 % were through instrumental labor and the most frequent ones were in the preterm labors. 64.29% of the newborns weighing between 1500 and 2500 grams had intraventricular haemorrhage. The authors recommended to do echoencephalographies to all newborns with risk factors within 72 hours after birth and a new strategy of follow up imaging intervention to the affected children was suggested

  1. Surgical Clipping versus Endovascular Intervention for the Treatment of Subarachnoid Hemorrhage Patients in New York State.

    Directory of Open Access Journals (Sweden)

    Kimon Bekelis

    Full Text Available Randomized trials have demonstrated a survival benefit for endovascular treatment of ruptured cerebral aneurysms. We investigated the association of surgical clipping and endovascular coiling with outcomes in subarachnoid hemorrhage (SAH patients in a real-world regional cohort.We performed a cohort study involving patients with ruptured cerebral aneurysms, who underwent surgical clipping, or endovascular coiling from 2009-2013 and were registered in the Statewide Planning and Research Cooperative System (SPARCS database. An instrumental variable analysis was used to investigate the association of treatment technique with outcomes.Of the 4,098 patients undergoing treatment, 2,585 (63.1% underwent coiling, and 1,513 (36.9% underwent clipping. Using an instrumental variable analysis, we did not identify a difference in inpatient mortality [marginal effect (ME, -0.56; 95% CI, -1.03 to 0.02], length of stay (LOS (ME, 1.72; 95% CI, -3.39 to 6.84, or the rate of 30-day readmissions (ME, -0.30; 95% CI, -0.82 to 0.22 between the two treatment techniques for patients with SAH. Clipping was associated with a higher rate of discharge to rehabilitation (ME, 0.63; 95% CI, 0.24 to 1.01. In sensitivity analysis, mixed effect regression, and propensity score adjusted regression models demonstrated identical results.Using a comprehensive all-payer cohort of patients in New York State presenting with aneurysmal SAH we did not identify an association of treatment method with mortality, LOS or 30-day readmission. Clipping was associated with a higher rate of discharge to rehabilitation.

  2. Recurrent oculomotor palsy due to haemorrhage in pituitary adenoma.

    OpenAIRE

    Mohanty, S.

    1980-01-01

    Haemorrhage in pituitary adenoma is an unusual cause of recurrent oculomotor palsy. Three episodes of right oculomotor palsy are reported from a patient having haemorrhage in pituitary adenoma. Early operation and decompression of haemorrhagic pituitary adenoma should be performed so that vision may be preserved and recovery of oculomotor palsy be assured.

  3. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... And one of the things that I’m learning from this movie as we looking at these ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  4. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... with such holes in the groin, this really offers the patient a tremendous advantage over having his ... a thousand aneurysms with this. So we can offer patients a very, very good integrated care with ...

  5. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... moving inside in the aneurysm sack with the spine projected in the background. So how long have ... have a much more rapid recovery than open surgery. What do you think about that, Ignacio, compared ...

  6. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... years, and his aneurysm has now grown to 5.4 centimeters. And this is actually an important ... balloon is trying to iron out the attachment. 5 So right now we have the first half ...

  7. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... been following in the institute for the past three years, and his aneurysm has now grown to ... may get for other reasons, but we use three-dimensional reconstruction and we can reconstruct all the ...

  8. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... the age of 65. It’s most common in males. There is an increasing number, due to the ... The risk factors for abdominal aortic aneurysms are males over 60, hardening of the arteries, which is ...

  9. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... wall will actually thin out. And the big risk here is that if this gets too big ... to the aging baby boomers. Next slide. The risk factors for abdominal aortic aneurysms are males over ...

  10. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... They carry oxygen and blood to various organs. These arteries have muscular walls, and when they get ... continue to expand, and they can rupture. And these aneurysms can occur in a lot of different ...

  11. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... this procedure. So let’s go back now and learn a little bit about abdominal aortic aneurysms. Great. ... And one of the things that I’m learning from this movie as we looking at these ...

  12. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... dye and also to do measurements using our computer techniques that are going on here. So what ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  13. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to do now is begin to do the process of putting an endograft in, and I’m ... that we saw, actually thrombosis. So in the process of thrombosing or clotting off the aneurysm sack, ...

  14. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to the aging baby boomers. Next slide. The risk factors for abdominal aortic aneurysms are males over 60, ... doing a good examination and also accessing for risk factors. So we have a very integrated team here, ...

  15. Popliteal vein aneurysm.

    Science.gov (United States)

    Falkowski, A; Poncyljusz, W; Zawierucha, D; Kuczmik, W

    2006-06-01

    The incidence of a popliteal vein aneurysm is extremely low. Two cases of this rare venous anomaly are described. The epidemiology, morphology, and diagnostic methods are discussed and the potentially dangerous complications and treatment methods are presented. PMID:16796307

  16. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... information is critical for us in terms of planning and guiding the procedure we’re going to ... be screened. In fact, patients who have a family history of aneurysm, men who are smoking over ...

  17. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... this is to prevent rupture and to prevent death from rupture. This area just underneath the renal ... Okay. Abdominal aortic aneurysms cause approximately 15,000 deaths in the United States each year. It affects ...

  18. Metrizamide demonstration of the subarachnoid space surrounding the Gasserian ganglion

    Energy Technology Data Exchange (ETDEWEB)

    Christmann, D.; Babin, E.

    1980-05-01

    The chance opacification of the subarachnoid space surrounding the Gasserian ganglion, observed during metrizamide basal cisternography, is reported. This is compared to similar demonstrations of the optic subarachnoid space. Such infrequently observed images should be known because they may be related to the occurrence of trigeminal neuralgia.

  19. Sensitivity and specifity of different imaging methods for the detection of cerebral aneurysms; Sensitivitaet und Spezifitaet bildgebender Verfahren fuer den Nachweis intrakranieller Aneurysmen

    Energy Technology Data Exchange (ETDEWEB)

    Ringelstein, Adrian; Forsting, Michael [Universitaetsklinikum Essen (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie und Neuroradiologie

    2015-09-15

    The prevalence or cerebral aneurysms is estimated at 2 %. Out of these aciniform aneurysm, 0,1 % rupture each year. The 30-day-mortality after a subarachnoid hemorrhage (SAH) is estimated at 45 %. Additionally, about 50 % of the patients suffer from severe persistent neurologic deficits. The most reliable way to prevent rupture is early detection and prophylactic therapy of an unruptured aneurysm. For this, knowledge of the different imaging methods currently available and their diagnostic potential is highly desirable. This review describes the potential of CT, MRI and catheter angiography in diagnosing cerebral aneurysms, as well as therapy planning and follow-up care of patients. Based on this, some recommendations are made for management of patients with SAH.

  20. Ruptured intracranial aneurysm during pregnancy with false-negative computed tomography angiography findings: a case report.

    Science.gov (United States)

    Goto, Yukihiro; Ebisu, Toshihiko; Mineura, Katsuyoshi

    2015-06-01

    A 34-year-old female was admitted at 34 weeks of gestation with sudden onset of a severe headache accompanied by vomiting. Neurological examination revealed neck rigidity, and computed tomography (CT) of the brain revealed a subarachnoid hemorrhage (SAH). Although the hemorrhage was located primarily in the left Sylvian fissure, computed tomography angiography (CTA) performed immediately after CT did not reveal any obvious vascular abnormalities such as an intracranial aneurysm. An emergency cesarean section was performed, and a healthy infant was delivered. Cerebral digital subtraction angiography (DSA) was performed the day following surgery, which revealed a saccular aneurysm measuring 4.3 mm × 2.4 mm in the left middle cerebral artery. Left craniotomy and clipping of the aneurysm were performed. The clot around the aneurysm was relatively solid. This case report is of significance given that initial CTA was negative for SAH during pregnancy, suggesting the requirement for immediate DSA or another CTA in such cases. There are many previous reports on false-negative CTA findings or disappearance and reappearance of aneurysms in SAH patients, and various biophysical and dynamic parameters are suggested to cause such phenomena. However, there are no reports on similar occurrences during pregnancy. Although the precise cause remains unclear, multiple factors associated with homeostasis during pregnancy were possibly associated with the transient disappearance in this patient. PMID:25732356

  1. [Large distal anterior cerebral artery aneurysm associated with azygos anterior cerebral artery: case report].

    Science.gov (United States)

    Suzuki, Y; Kawamata, T; Matsumoto, H; Kunii, N; Matsumoto, K

    1998-10-01

    A 51-year-old woman presented with a distal anterior cerebral artery aneurysm (DACAA) manifesting as severe headache and monoparesis of the left lower limb. Computed tomography revealed subarachnoid hemorrhage in the interhemispheric fissure, bilateral sylvian fissures, and basal cistern, and a hematoma in the supracallosal region. Angiography showed a large aneurysm (23 x 18 mm) located on the distal end of the azygos anterior cerebral artery (azygos ACA) at the supracallosal portion. T2-weighted magnetic resonance imaging demonstrated the hematoma as a mixed intensity mass, compressing the corpus callosum downward, and the aneurysm as a flow void anterior to the hematoma. Unilateral frontoparietal parasagittal craniotomy was performed with a horse-shoe shaped incision. The aneurysm was clipped via the interhemispheric approach, and the hematoma was aspirated. Postoperative angiography showed disappearance of the aneurysm and intact azygos ACA. The patient was discharged with mild monoparesis, paresthesia of the left lower limb and diagnostic dyspraxia. DACAA almost always arises at or near the genu of the corpus callosum and is often associated with vascular anomaly. In the literature, 22 of 26 cases of large and giant DACAA were located at or near the genu, but only 3 cases, including ours, in the supracallosal area. 11 cases were associated with azygos ACA. Therefore, hemodynamic stress caused by vascular anomaly may be involved in the formation of large or giant DACAA in contrast with cases of normal DACAA. PMID:9789300

  2. Arachnoid granulation affected by subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    R.P. Chopard

    1993-11-01

    Full Text Available The purpose of this study was to investigate using light microscopy the fibro-cellular components of arachnoid granulations affected by mild and severe subarachnoid hemorrage. The erythrocytes were in the channels delimitated by collagenous and elastic bundles and arachnoid cells, showing their tortuous and intercommunicating row from the pedicle to the fibrous capsule. The core portion of the pedicle and the center represented a principal route to the bulk outflow of cerebrospinal fluid and erythrocytes. In the severe hemorrhage, the fibrocellular components are desorganized, increasing the extracellular channels. We could see arachnoid granulations without erythrocytes, which cells showed big round nucleous suggesting their transformation into phagocytic cells.

  3. Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience

    International Nuclear Information System (INIS)

    We present the long-term clinical and angiographic follow-up results of 100 consecutive intracranial aneurysms treated with Onyx liquid embolic system (MTI, Irvine, Calif.), either alone or combined with an adjunctive stent, in a single center. A total of 100 aneurysms in 94 patients were treated with endosaccular Onyx packing. Intracranial stenting was used adjunctively in 25 aneurysms including 19 during initial treatment and 6 during retreatment. All aneurysms except two were located in the internal carotid artery. Of the 100 aneurysms, 35 were giant or large/wide-necked, and 65 were small. Follow-up angiography was performed in all 91 surviving patients (96 aneurysms) at 3 and/or 6 months. Follow-up angiography was performed at 1, 2, 3, 4 and 5 years in 90, 41, 26, 6 and 2 patients, respectively. Overall, aneurysm recanalization was observed in 12 of 96 aneurysms with follow-up angiography (12.5%). All 12 were large or giant aneurysms, resulting in a 36% recanalization rate in the large and giant aneurysm group. One aneurysm out of 25 treated with the combination of a stent and Onyx showed recanalization. There was also no recanalization in the follow-up of small internal carotid artery aneurysms treated with balloon assistance only. At final follow-up, procedure- or device-related permanent neurological morbidity was present in eight patients (8.3%). There were two procedure-related and one disease-related (subarachnoid hemorrhage) deaths (mortality 3.2%). Delayed spontaneous asymptomatic occlusion of the parent vessel occurred in two patients, detected on routine follow-up. Onyx provides durable aneurysm occlusion with parent artery reconstruction resulting in perfectly stable 1-year to 5-year follow-up angiography both in small aneurysms treated with balloon assistance only (0% recanalization rate) and large or giant aneurysms treated with stent and Onyx combination (4% recanalization rate). Endosaccular Onyx packing with balloon assistance may not be

  4. Rabbit haemorrhagic disease (RHD) and rabbit haemorrhagic disease virus (RHDV): a review.

    OpenAIRE

    Abrantes Joana; van der Loo Wessel; Le Pendu Jacques; Esteves Pedro J

    2012-01-01

    Abstract Rabbit haemorrhagic disease virus (RHDV) is a calicivirus of the genus Lagovirus that causes rabbit haemorrhagic disease (RHD) in adult European rabbits (Oryctolagus cuniculus). First described in China in 1984, the virus rapidly spread worldwide and is nowadays considered as endemic in several countries. In Australia and New Zealand where rabbits are pests, RHDV was purposely introduced for rabbit biocontrol. Factors that may have precipitated RHD emergence remain unclear, but non-p...

  5. European research priorities for intracerebral haemorrhage

    DEFF Research Database (Denmark)

    Steiner, Thorsten; Petersson, Jesper; Al-Shahi Salman, Rustam;

    2011-01-01

    Over 2 million people are affected by intracerebral haemorrhage (ICH) worldwide every year, one third of them dying within 1 month, and many survivors being left with permanent disability. Unlike most other stroke types, the incidence, morbidity and mortality of ICH have not declined over time. N...

  6. Sanitation of viral haemorrhagic septicaemia (VHS)

    DEFF Research Database (Denmark)

    Olesen, Niels Jørgen

    1998-01-01

    A sanitation programme for stamping-out viral haemorrhagic septicaemia (VHS) was implemented in Denmark in 1965. The programme has resulted in a dramatic reduction in the number of infected rainbow trout farms, from approximate to 400 to 26. The programme is carried out on a voluntary basis at the...

  7. Recurrent secondary postpartum haemorrhage due to endometritis: requires 18 units blood transfusion

    Directory of Open Access Journals (Sweden)

    Mamta Sharma

    2016-06-01

    Full Text Available Postpartum hemorrhage (PPH represents a serious problem for women and obstetricians. Because of its association with haemorrhagic shock and predisposition to disseminated coagulopathy, it is a leading cause of maternal deaths worldwide. Furthermore, the jeopardy of PPH is rising with the secondary form of PPH occurring between 24 hours and 6 weeks postpartum, when women are already discharged home. The causes of this pathology are severe inflammation (endometritis inherited coagulation disorders, consumptive coagulopathy, and retained products of conceptions. Others are of rare occurrence, such as vessel subinvolution (VSI of the placental implantation site, uterine artery pseudo aneurysm, or trauma. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 2058-2060

  8. Combined application of virtual imaging techniques and three-dimensional computed tomographic angiography in diagnosing intracranial aneurysms

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Background The diagnostic value of virtual imaging combined with three-dimensional computed tomographic angiography (3D-CTA) for intracranial aneurysms has not been fully elucidated yet. This study aimed to evaluate the value of combined application of virtual imaging techniques and 3D-CTA in diagnosing patients with aneurismal subarachnoid hemorrhage (SAH) at the acute stage. Methods Eighty patients with non-traumatic SAH received 3D-CTA examinations. The raw CT data of these patients were reconstructed and transferred into the 3D mode through the surgical plan system based on virtual reality (VR) image, and the 3D virtual images of skulls and brain blood vessels were acquired. The location, size and shape of aneurysms and their anatomic relationship with adjacent tissues were measured from many points of view. Results Seventy-three aneurysms were detected in 68 of the 80 patients, but 2 aneurysms were detected in 2 of the 5 patients who had been found free of aneurysms previously and had received 3D-CTA examinations for a second time one month later. The 3D virtual images produced by the virtual imaging system were clear and vivid, and they could reveal the location and size of the aneurysm and its relations to the parent artery and skull directly. Conclusions The imaging of 3D-CTA is convenient, reliable and fast in diagnosing intracranial aneurysms and can be regarded as the first choice for the diagnosis and treatment of ruptured intracranial aneurysms. Combined with the surgical plan system based on the VR image, 3D-CTA may obtain more imaging information about aneurysms.

  9. Direct clipping of a blister-like aneurysm in the supraclinoid segment of the internal carotid artery: a clinical analysis of nine cases

    OpenAIRE

    Yu, Jinlu; Xu, Baofeng; Guo, Yunbao; Xu, Kan

    2015-01-01

    To investigate the method and outcome from direct clipping of a blister-like aneurysm (BBA) of the internal carotid artery supraclinoid segment. This study featured nine BBA patients, including eight females and one male. The patients presented subarachnoid hemorrhage (SAH) as the initial symptom and were diagnosed with BBA in the supraclinoid segment through a vascular exam and imaging. During the exam, the internal carotid artery was pressed to block the blood flow, and a transcranial Doppl...

  10. Verminous aneurysm caused by filaria.

    Science.gov (United States)

    Toledo, F V; de Araújo, A P; da Cunha, A M; Sidow, J R; Pavão, S G; de Araújo, E D

    1983-06-01

    Aneurysms caused by atherosclerosis are relatively frequent, as a consequence of the high incidence of this degenerative disease of the arteries. Other types of aneurysm, for example, those of infectious etiology, are more uncommon. Bacterias and fungi are able to cause aneurysms in several parts of the arterial tree. Stengel et al (1943), in a review of world literature described 217 cases of mycotic aneurysms. The Stedman's Medical Dictionary refers to a special type of aneurysm observed in horses, caused by intra-vascular migration of a worm, the Strongylus vulgaris. It has been named verminous aneurysm and generally involves the mesenteric arteries. We haven't found in medical literature any similar observations refering to human cases. The purpose of this paper is to describe a case of aneurysm the etiology of which we have imputed to the filaria (Wuchereria bancrofti). This case was observed in Marcilio Dias Naval Hospital, Rio de Janeiro, Brazil. PMID:6346961

  11. European research priorities for intracerebral haemorrhage.

    Science.gov (United States)

    Steiner, Thorsten; Petersson, Jesper; Al-Shahi Salman, Rustam; Christensen, Hanne; Cordonnier, Charlotte; Csiba, Laszlo; Harnof, Sagi; Krieger, Derk; Mendelow, David; Molina, Carlos; Montaner, Joan; Overgaard, Karsten; Roine, Risto O; Schmutzhard, Erich; Tatlisumak, Turgut; Toni, Danilo; Stapf, Christian

    2011-01-01

    Over 2 million people are affected by intracerebral haemorrhage (ICH) worldwide every year, one third of them dying within 1 month, and many survivors being left with permanent disability. Unlike most other stroke types, the incidence, morbidity and mortality of ICH have not declined over time. No standardised diagnostic workup for the detection of the various underlying causes of ICH currently exists, and the evidence for medical or surgical therapeutic interventions remains limited. A dedicated European research programme for ICH is needed to identify ways to reduce the burden of ICH-related death and disability. The European Research Network on Intracerebral Haemorrhage EURONICH is a multidisciplinary academic research collaboration that has been established to define current research priorities and to conduct large clinical studies on all aspects of ICH. PMID:21986448

  12. Clinical utility and cost-effectiveness of CT-angiography in the diagnosis of nontraumatic subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Jabbarli, Ramazan; Shah, Mukesch; Hippchen, Beate; Velthoven, Vera van [University Hospital of Freiburg, Department of Neurosurgery, Freiburg/Breisgau (Germany); Taschner, Christian [University Hospital of Freiburg, Department of Neuroradiology, Freiburg (Germany); Kaier, Klaus [University Hospital of Freiburg, Institute for Medical Biometry and Medical Informatics, Freiburg (Germany)

    2014-10-15

    CT-angiography gains an increasing role in the initial diagnosis of patients with nontraumatic subarachnoid hemorrhage (SAH). However, the implementation of CT-angiography does not always exclude the necessity of conventional angiography. Our objective was to determine the practical utility and cost-effectiveness of CT-angiography. All patients with nontraumatic subarachnoid hemorrhage admitted to our university hospital after implementation of CT-angiography between June 1, 2011 and June 30, 2012 were retrospectively analyzed in regard to factors of treatment flow, radiation exposure, harms of contrast medium loading, and diagnostic costs. A control group of the same size was assembled from previously admitted SAH patients, who did not undergo pretreatment CT-angiography. Furthermore, cost-effectiveness analysis was performed. The final analysis consisted of 93 patients in each group. Of 93 patients with pretreatment CT-angiography, 74 had to undergo conventional angiography for diagnostic and/or therapeutic purposes. CT-angiography had significant impact on the reduction of collective effective radiation dose by 4.419 mSv per person (p = 0.0002) and was not associated with additional harms. Despite the significantly earlier detection of aneurysms with CT-angiography (p < 0.0001), there were no significant differences in the timing of aneurysm repair and duration of ICU and general hospital stay. There was an increase of diagnostic costs - the cost-effectiveness analysis showed, however, that benefits of CT-angiography in respect to radiation exposure and risk of conventional angiography-related complications justify the additional costs of CT-angiography. Although the implementation of CT-angiography in SAH diagnosis cannot completely replace conventional angiography, it can be approved in regard to radiation hygiene and cost-effectiveness. (orig.)

  13. European research priorities for intracerebral haemorrhage

    OpenAIRE

    Steiner, Thorsten; Petersson, Jesper; Al-Shahi Salman, Rustam; Christensen, Hanne; Cordonnier, Charlotte; Csiba, Laszlo; Harnof, Sagi; Krieger, Derk; Mendelow, David; Molina, Carlos; Montaner, Joan; Overgaard, Karsten; Roine, Risto O.; Schmutzhard, Erich; Tatlisumak, Turgut

    2011-01-01

    Over 2 million people are affected by intracerebral haemorrhage (ICH) worldwide every year, one third of them dying within 1 month, and many survivors being left with permanent disability. Unlike most other stroke types, the incidence, morbidity and mortality of ICH have not declined over time. No standardised diagnostic workup for the detection of the various underlying causes of ICH currently exists, and the evidence for medical or surgical therapeutic interventions remains limited. A dedic...

  14. European Research Priorities for Intracerebral Haemorrhage

    OpenAIRE

    Steiner, Thorsten; Petersson, Jesper; Al-Shahi Salman, Rustam; Christensen, Hanne; Cordonnier, Charlotte; Csiba, Laszlo; Harnof, Sagi; Krieger, Derk; Mendelow, David; Molina, Carlos; Montaner, Joan; Overgaard, Karsten; Roine, Risto O.; Schmutzhard, Erich; Tatlisumak, Turgut

    2011-01-01

    Over 2 million people are affected by intracerebral haemorrhage (ICH) worldwide every year, one third of them dying within 1 month, and many survivors being left with permanent disability. Unlike most other stroke types, the incidence, morbidity and mortality of ICH have not declined over time. No standardised diagnostic workup for the detection of the various underlying causes of ICH currently exists, and the evidence for medical or surgical therapeutic interventions remains limited. A dedic...

  15. European research priorities for intracerebral haemorrhage

    DEFF Research Database (Denmark)

    Steiner, Thorsten; Petersson, Jesper; Al-Shahi Salman, Rustam; Christensen, Hanne; Cordonnier, Charlotte; Csiba, Laszlo; Harnof, Sagi; Krieger, Derk; Mendelow, David; Molina, Carlos; Montaner, Joan; Roine, Risto O; Schmutzhard, Erich; Tatlisumak, Turgut; Toni, Danilo; Stapf, Christian; Overgaard, Karsten

    2011-01-01

    disability. The European Research Network on Intracerebral Haemorrhage EURONICH is a multidisciplinary academic research collaboration that has been established to define current research priorities and to conduct large clinical studies on all aspects of ICH....... standardised diagnostic workup for the detection of the various underlying causes of ICH currently exists, and the evidence for medical or surgical therapeutic interventions remains limited. A dedicated European research programme for ICH is needed to identify ways to reduce the burden of ICH-related death and...

  16. Morbidity and mortality of patients with endovascularly treated intracerebral aneurysms: does physician specialty matter?

    Science.gov (United States)

    Fennell, Vernard S; Martirosyan, Nikolay L; Palejwala, Sheri K; Lemole, G Michael; Dumont, Travis M

    2016-01-01

    OBJECT Endovascular treatment of cerebrovascular pathology, particularly aneurysms, is becoming more prevalent. There is a wide variety in clinical background and training of physicians who treat cerebrovascular pathology through endovascular means. The impact of clinical training background on patient outcomes is not well documented. METHODS The authors conducted a retrospective analysis of a large national database, the University HealthSystem Consortium, that was queried in the years 2009-2013. Cases of both unruptured cerebral aneurysms and subarachnoid hemorrhage treated by endovascular obliteration were studied. Outcome measures of morbidity and mortality were evaluated according to the specialty of the treating physician. RESULTS Elective embolization of an unruptured aneurysm was the procedure code and primary diagnosis, respectively, for 12,400 cases. Patients with at least 1 complication were reported in 799 cases (6.4%). Deaths were reported in 193 cases (1.6%). Complications and deaths were varied by specialty; the highest incidence of complications (11.1%) and deaths (3.0%) were reported by neurologists. The fewest complications were reported by neurosurgeons (5.4%; 1.4% deaths), with a higher incidence of complications reported in cases performed by neurologists (p < 0.0001 for both complications and deaths) and to a lesser degree interventional radiologists (p = 0.0093 for complications). Subarachnoid hemorrhage was the primary diagnosis and procedure for 8197 cases. At least 1 complication was reported in 2385 cases (29%) and deaths in 983 cases (12%). The number of complications and deaths varied among specialties. The highest incidence of complications (34%) and deaths (13.5%) in subarachnoid hemorrhage was in cases performed by neurologists. The fewest complications were in cases by neurosurgeons (27%), with a higher incidence of complications in cases performed by neurologists (34%, p < 0.0001), and a trend of increased complications with

  17. Natural history and surgical results in patients with unruptured intracranial aneurysms

    International Nuclear Information System (INIS)

    The management of patients with unruptured intracranial aneurysms (UIAs) is controversial. We aimed to assess the natural history of UIAs and evaluate the surgical results. We analyzed 154 patients (181 saccular UIAs) with no history of subarachnoid hemorrhage (SAH) from a different aneurysm. Aneurysms were detected by magnetic resonance angiography (MRA) or by 3-dimensional CT angiography. Although the most frequent reason for the diagnosis was routine brain examinations of healthy patients or a vague symptom such as headache or dizziness, 15 patients were symptomatic. The natural history in patients who did not have surgery (follow-up group: 76 cases, 95 aneurysms) was assessed, and the surgical outcome of UIAs (surgical group: 78 cases, 86 aneurysms) was evaluated. Among 76 patients in the follow-up group, 7 had SAH. The mean latency period to aneurysm rupture was 3.2 months. The aneurysms with subsequent bleeding ranged from 5 to 25 mm (19.3 mm on average), whereas those without ranged from 1 to 28 mm (4.5 mm on average). The rupture rates of UIAs in anterior and posterior circulation were 6.2% and 14.3%, respectively. All ruptured cases were females. Mortality and morbidity associated with UIAs in the follow-up group were 3.9% and 3.9%, respectively. In the surgical group, no mortality was noted. Permanent morbidity associated with prospective repair of UIAs was 5.1%, although the morbidity of the patients with preoperative Rankin scores of 0 or 1 was 1.3%. Transient morbidity was observed in 6 patients (7.7%) with the size of the aneurysm 19.8 mm on average. The natural history and surgical results in patients with UIAs are modified by several factors including aneurysm size and location, the patient's age and gender, the medical status and the patient's preoperative Rankin score. The present results indicated that these factors should be considered in deciding whether to treat UIAs, and that careful assessment of the surgical benefits might be essential

  18. Fronto-temporo-orbitozygomatic craniotomy and "half-and-half" approach for basilar apex aneurysms

    Directory of Open Access Journals (Sweden)

    Behari Sanjay

    2009-01-01

    Full Text Available Background: Basilar apex aneurysms (BAA are located in interpeduncular cistern surrounded by eloquent neurovascular structures. Surgical access is difficult due to narrow surgical corridors and requires traversing through a depth of 6-8 cm of subarachnoid space. Aim: Surgical management of BAAs clipped using frontotemporal craniotomy, orbitozygomatic osteotomy with combined subtemporal and transylvian (half and half approach is discussed. Setting and Design: Tertiary care referral institute; prospective study. Materials and Methods: Five patients with BAA rupture causing subarachnoid hemorrhage presented in modified Hunt and Hess (Hand H grades II (n=1, III (n=1 and IV (n=3, respectively. In 4 patients, the aneurysms were 0.8-1.2 cm in diameter, situated 7 mm-1 cm above dorsum sellae. Two of them had posteriorly projecting aneurysms. One patient had a giant, high BAA with a left parietooccipital arteriovenous malformation. Vasospasm of posterior cerebral/proximal basilar artery was seen in 2 patients. In one patient, internal carotid artery was mobilized by intradural anterior clinoid drilling with carotid collar division. Triple-H therapy was administered following surgery. Results: There was no intraoperative rupture or temporary clipping. Follow up angiography showed complete aneurysmal obliteration with preservation of posterior cerebral and superior cerebellar arteries. Follow up (mean: 8.7 ± 3.5 months H and H grades were II (n=2 and III (n=3, respectively. The morbidity include caudate and thalamic region infarct, transient III rd nerve palsy and cerebrospinal fluid otorrhoea (n=1, respectively. Conclusions: This simple approach provides a wide surgical corridor from 5 mm below to greater than 1 cm above dorsum sellae with adequate proximal control of basilar artery. It is an option to endovascular embolization especially with large and giant, or wide-necked BAA, vertebrobasilar tortuosity, coil compaction or postcoiling re-rupture and

  19. Functional analysis of Pro-inflammatory properties within the cerebrospinal fluid after subarachnoid hemorrhage in vivo and in vitro

    Directory of Open Access Journals (Sweden)

    Schneider Ulf C

    2012-02-01

    Full Text Available Abstract Background To functionally characterize pro-inflammatory and vasoconstrictive properties of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage (SAH in vivo and in vitro. Methods The cerebrospinal fluid (CSF of 10 patients suffering from SAH was applied to the transparent skinfold chamber model in male NMRI mice which allows for in vivo analysis of the microcirculatory response to a superfusat. Microvascular diameter changes were quantified and the numbers of rolling and sticking leukocytes were documented using intravital multifluorescence imaging techniques. Furthermore, the pro-inflammatory properties of CSF were assessed in vitro using a monocyte transendothelial migration assay. Results CSF superfusion started to induce significant vasoconstriction on days 4 and 6 after SAH. In parallel, CSF superfusion induced a microvascular leukocyte recruitment, with a significant number of leukocytes rolling (day 6 and sticking (days 2-4 to the endothelium. CSF of patients presenting with cerebral edema induced breakdown of blood vessel integrity in our assay as evidenced by fluorescent marker extravasation. In accordance with leukocyte activation in vivo, significantly higher in vitro monocyte migration rates were found after SAH. Conclusion We functionally characterized inflammatory and vasoactive properties of patients' CSF after SAH in vivo and in vitro. This pro-inflammatory milieu in the subarachnoid space might play a pivotal role in the pathophysiology of early and delayed brain injury as well as vasospasm development following SAH.

  20. MR imaging of subarachnoid spread of neoplasms

    International Nuclear Information System (INIS)

    One hundred nineteen MR examinations of 40 patients with cytologically proved subarachnoid dissemination of neoplasms were retrospectively reviewed. In the brain, 12 of 54 unenhanced (22.2%) and seven of 20 gadolinium-enhanced studies (35%) were positive for leptomeningeal metastases. Four of 29 (13.8%) unenhanced (13.8%) and six of 16 enhanced spine studies (37.5%) were positive. Patients with non-central nervous system primary tumors were most likely to show MR findings of leptomeningeal dissemination (31.4%). Hematologic malignancies were least likely (5.6%). The overall sensitivity of unenhanced (19.3%) and enhanced (36.1%) MR examinations in patients with cerebrospinal fluid positive for neoplastic seeding is low

  1. Magnesium sulfate administration in subarachnoid hemorrhage.

    Science.gov (United States)

    Suarez, Jose I

    2011-09-01

    Magnesium offers theoretic vascular and neuroprotective benefits for patients with subarachnoid hemorrhage. An electronic literature search was conducted to identify original research studies describing intravenous magnesium treatment in patients with SAH published in English between January 1990 and October 2010. Seventeen articles were identified and reviewed, including one phase III randomized-controlled clinical trial and six phase II randomized-controlled trials. Study quality was low for most of the included studies, with the phase III trial considered to be of moderate quality. Due to inconsistently reported benefits and the occurrence of side effects, phase II data suggested that intravenous magnesium for SAH provided either no overall net benefit or uncertain trade-offs. Benefit was likewise not supported in the single phase III clinical trial. PMID:21748496

  2. A rare cause of fatal intracranial haemorrhage.

    LENUS (Irish Health Repository)

    Neligan, A

    2012-01-31

    INTRODUCTION: We report the case of a 53-year-old farmer with a 5-day history of severe headache, photophobia and neck stiffness. Full blood count (platelets 173), coagulation screen were normal throughout. Liver function tests remained normal apart from an elevated gamma-GT (156). CT Brain was normal. CSF analysis showed a WCC of 454\\/mm(3) (60% lymphocytes), elevated CSF protein (1.42 g\\/l) and a normal CSF glucose. He was commenced on IV antibiotics and IV acyclivor and improved. On day 3 of admission, he complained of a sudden severe headache, became unresponsive (GCS 3\\/15). INVESTIGATIONS: CT Brain showed a massive left intraventricular haemorrhage. He died 4 days later. Subsequent serum serology for leptospirosis was positive. A repeat sample taken 4 days post-admission, showed a rising IgM indicating active leptospirosis. Detailed pathological examination confirmed intracerebral haemorrhage with normal cerebral vasculature. CONCLUSION: Leptospirosis is a rare cause of intracerebral haemorrhage even in the absence of coagulopathy.

  3. Extracerebral Organ Dysfunction and Sleep Disorders in Subarachnoid Hemorrhage

    NARCIS (Netherlands)

    Schuiling, Wouter Jan

    2006-01-01

    Cardiac and pulmonary complications are common in subarachnoid hemorrhage (SAH), but also other extracerebral complications are frequently observed. This thesis focuses on the occurrence of extracerebral organ dysfunction and the additional value of markers of these medical complications in prognost

  4. What You Should Know about Cerebral Aneurysms

    Science.gov (United States)

    ... T. Quiz 5 Things to Know About Stroke What You Should Know About Cerebral Aneurysms Updated:Jun ... Damage Treatments Click image to view an animation What is a cerebral aneurysm? An aneurysm is a ...

  5. Dengue haemorrhagic fever or dengue shock syndrome in children

    OpenAIRE

    Alejandria, Marissa M

    2009-01-01

    Infection with the dengue virus, transmitted by mosquito, ranges from asymptomatic or undifferentiated febrile illness to fatal haemorrhagic fever, and affects up to 100 million people a year worldwide. Dengue haemorrhagic fever is characterised by: a sudden onset of high fever; haemorrhages in the skin, gastrointestinal tract, and mucosa; and low platelet counts. Plasma leakage results in fluid in the abdomen and lungs. It typically occurs in children under 15 years.Severe dengue haemorrh...

  6. Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II) Protocol

    OpenAIRE

    Rowan Elise N; Murray Gordon D; Mitchell Patrick M; Gregson Barbara A; Mendelow A David; Gholkar Anil R

    2011-01-01

    Abstract Background Within the spectrum of spontaneous intracerebral haemorrhage there are some patients with large or space occupying haemorrhage who require surgery for neurological deterioration and others with small haematomas who should be managed conservatively. There is equipoise about the management of patients between these two extremes. In particular there is some evidence that patients with lobar haematomas and no intraventricular haemorrhage might benefit from haematoma evacuation...

  7. Surgical trial in lobar intracerebral haemorrhage (STICH II) protocol

    OpenAIRE

    Mendelow, A David; Gregson, Barbara A; Mitchell, Patrick M.; Murray, Gordon D.; Rowan, Elise N; Gholkar, Anil R; STICH II Investigators

    2011-01-01

    BACKGROUND: Within the spectrum of spontaneous intracerebral haemorrhage there are some patients with large or space occupying haemorrhage who require surgery for neurological deterioration and others with small haematomas who should be managed conservatively. There is equipoise about the management of patients between these two extremes. In particular there is some evidence that patients with lobar haematomas and no intraventricular haemorrhage might benefit from haematoma evacuation. The ST...

  8. Congo-Crimean haemorrhagic fever in Dubai: histopathological studies.

    OpenAIRE

    Baskerville, A; Satti, A; Murphy, F A; Simpson, D I

    1981-01-01

    Necropsies were carried out on two patients who died of Congo-Crimean haemorrhagic fever (C-CHF) in Dubai. The diagnosis was confirmed by isolation of C-CHF virus from the liver. Histopathological changes included extensive cellular necrosis and haemorrhage in the liver, necrosis and lymphoid depletion in the spleen, congestion and oedema formation in the lungs, and haemorrhage in a number of other organs.

  9. Successful vaginal delivery following spontaneous adrenal haemorrhage at term.

    Science.gov (United States)

    Street, Sally; Dekker Nitert, Marloes; Callaway, Leonie K

    2016-01-01

    Spontaneous adrenal haemorrhage (SAH) is a rare event in the general population, estimated to be around 0.3-1.8%. The exact incidence in pregnancy is unknown but rare. Most cases of SAH at or near term have presented with massive haemorrhage and haemodynamic instability, requiring emergency caesarean delivery or intrauterine fetal death. This is the first reported case of a successful vaginal delivery after acute, spontaneous, left adrenal haemorrhage at term. PMID:27190116

  10. Efficacy of b-lynch brace suture in postpartum haemorrhage

    International Nuclear Information System (INIS)

    Massive uncontrolled haemorrhage after childbirth is the leading cause of maternal death in developing countries. Postpartum haemorrhage is traditionally defined as blood loss of more than 500 ml after vaginal delivery and more than 1000 ml after caesarean section, but intraoperative estimation of blood loss is inaccurate. Uterine atony alone accounts for 75 - 90% of PPH. To estimate the effectiveness and safety of B-Lynch brace Suture in the management of primary postpartum haemorrhage (PPH). (author)

  11. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... past three years, and his aneurysm has now grown to 5.4 centimeters. And this is actually ... that looks like kind of railroad tracks going up and down, that’s the catheter that we’re ...

  12. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... for all of you listening, you can ask online. Just click the “Ask a question” button, and ... aneurysm. Please feel free to ask any questions online. Just click “Ask a question,” and they’ll ...

  13. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... racquet-like device whether or not there is flow in this sack after we replace in aneurysm. ... space age. That’s fine. Don’t go too high. Pull it down a little bit. Pull that ...

  14. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an interventional radiologist. That’s a specialty many people haven’t heard of, but that’s a specialty that ... in that patient’s abdominal sack. Now remember we haven’t treated his aneurysm. We’re sort of ...

  15. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to repair an abdominal aortic aneurysm using a technology called an “endograft,” which is sometimes called the “ ... separate area, and it’s because of this small technology that allows you to do this. Exactly. So ...

  16. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an aneurysm, it’s important that you ask your doctor about your options. As I said, about 80 percent of the patients we treat end up -- 80 or 90 percent these days, end up being good candidates for this type of therapy. We would encourage you to seek the least ...

  17. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an abdominal aortic aneurysm. Normally this procedure takes us about 45 minutes to an hour of doctor work time, which is, I think, a fairly quick procedure to replace a major life-threatening problem in the patient’s abdomen. So you can see ...

  18. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... microchip that acts a little bit like a cell phone technology. We’ll show you how that works. But this is the device that we’re going to put in that space between the endograft and the patient to the wall of the aneurysm. So in that space where ...

  19. Management of poor grade subarachnoid hemorrhage. Unsolved problems in the ultra-acute phase

    International Nuclear Information System (INIS)

    We evaluated the management of patients with subarachnoid hemorrhage (SAH) after arrival for surgical intervention in the ultra-acute stage. Immediately after brief neurological and systemic examination, patients were deeply sedated to prevent aneurysmal rerupture. Principally they were intubated with intensive control of systolic blood pressure below 120 mmHg by radial arterial monitoring. Buprenorphine, midazolam, and vecuronium were routinely intravenously administered; and propofol, barbiturate, nicardipine, or prostaglandin was added to lower blood pressure if necessary. A total of 163 consecutive patients with SAH (59 men and 104 women, mean age of 61.1 years) arrived between 2003 and 2005 were enrolled. The majority of patients were in poor grade: 26 with Grade IV, 54 with Grade V by grading scale of the World Federation of Neurological Society, and 32 with cardiopulmonary arrest. Eighty-seven patients (53%) arrived within 1 hour after onset of SAH and 127 patients (78%) arrived within 3 hours. Most of the poor-grade patients were intubated before initial brain CT scan. Mean systolic blood pressure was around 170 mmHg at the time of arrival, which was controlled around 120 mmHg or less during resuscitation and angiography. A total of 117 patients had DSA, 111 of them (68%) within 3 hours, and 111 patients underwent surgery, 81 of them (85%) within 6 hours. Despite intensive resuscitation, 36 episodes of rebleeding were detected in 32 patients, 24 before and 12 after arrival. Extravasation of contrast media was seen in 6 patients during cerebral angiography. Favorable outcome (good recovery and moderate disability) was obtained in 69% of Grade IV and 24% of the Grade V patients. The risk of ultra-early rebleeding is highest for patients with poor grades. Deep sedation and strict blood pressure control followed by urgent obliteration of the ruptured aneurysm have a strong rationale to prevent rerupture and to achieve better overall outcome. (author)

  20. The Value of Cerebral CT Angiography with Low Tube Voltage in Detection of Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    Kun Tang

    2015-01-01

    Full Text Available Objective. The aim of this study is to investigate the value of cerebral CT angiography (CTA with low tube voltage in detection of intracranial aneurysms. Materials and Methods. A total of 294 consecutive patients with spontaneous subarachnoid hemorrhage (SAH were enrolled in this study and randomly assigned into conventional voltage CTA (C-CTA group and low voltage CTA (L-CTA group. The objective and subjective image qualities were analyzed and compared between C-CTA and L-CTA groups. With the results of 3D-DSA as “gold standard,” the sensitivity, specificity, and accuracy of C-CTA and L-CTA in diagnosis of aneurysms were calculated and compared with each other. Results. Compared with group C-CTA, the CT dose index volume (CTDIvol of group L-CTA reduced by 35.65%. There were no significant differences between C-CTA and L-CTA groups regarding objective and subjective image qualities. The sensitivity, specificity, and accuracy of L-CTA in diagnosis of aneurysms were 95.16%, 99.72%, and 99.42%, respectively. There were no significant differences in sensitivity, specificity, and accuracy between the C-CTA and L-CTA groups. Conclusion. The value of cerebral CTA with 100 kV low tube voltage in detection of intracranial aneurysms is significant, and it should be recommended as a routine scan method.

  1. Hemodynamics, inflammation, vascular remodeling, and the development and rupture of intracranial aneurysms: a review

    Directory of Open Access Journals (Sweden)

    Francesco Signorelli

    2015-06-01

    Full Text Available The central nervous system is an immunologically active environment where several components of the immune and inflammatory response interact among them and with the constituents of nervous tissue and vasculature in a critically orchestrated manner, influencing physiologic and pathologic processes. In particular, inflammation takes a central role in the pathogenesis of intracranial aneurysms (IAs. The common pathway for aneurysm formation involves endothelial dysfunction and injury, a mounting inflammatory response, vascular smooth muscle cells (VSMCs phenotypic modulation, extracellular matrix remodeling, and subsequent cell death and vessel wall degeneration. We conducted a literature review (1980-2014 by Medline and EMBASE databases using the searching terms "IA" and "cerebral aneurysm" and further search was performed to link the search terms with the following key words: inflammation, hemodynamic(s, remodeling, macrophages, neutrophils, lymphocytes, complement, VSMCs, mast cells, cytokines, and inflammatory biomarkers. The aim of this review was to summarize the most recent and pertinent evidences regarding the articulated processes of aneurysms formation, growth, and rupture. Knowledge of these processes may guide the diagnosis and treatment of these vascular malformations, the most common cause of subarachnoid hemorrhage, which prognosis remains dismal.

  2. The effect of the results of the STICH trial on the management of spontaneous supratentorial intracerebral haemorrhage in Newcastle.

    Science.gov (United States)

    Kirkman, M A; Mahattanakul, W; Gregson, B A; Mendelow, A D

    2008-12-01

    Recently, the Surgical Trial in IntraCerebral Haemorrhage (STICH) was unable to show an overall benefit from 'early surgery' compared with a policy of 'initial conservative treatment'. Here, we evaluated the impact of the STICH results on the management of spontaneous supratentorial intracerebral haemorrhage (ICH) in the Newcastle upon Tyne Hospitals. The STICH results were released to the Neurosurgery Department at Newcastle General Hospital in November 2003; using ICD-10 data, we analysed ICH admissions before (2002) and after (2004, 2006, 2007) this. We assessed numbers of Neurosurgery and Stroke Unit admissions, numbers of clot evacuation procedures, and 30-day mortality rate (Neurosurgery vs. Stroke Unit admissions). Subarachnoid haemorrhage (SAH) admissions data were also collected to corroborate our findings. There were 478 spontaneous supratentorial ICH admissions in total; 156 in 2002, 120 in 2004, 106 in 2006 and 96 in 2007. SAH admissions remained remarkably constant over this period. Neurosurgery admissions decreased significantly across the four time periods, from 71% of total ICH admissions (n = 156) in 2002 to 55% (n = 96) in 2007, and Stroke Unit admissions increased significantly from 8% (n = 156) in 2002 to 30% (n = 96) in 2007 (chi(2) = 20.968, p < 0.001, df = 3). Clot evacuation procedures also decreased significantly from 32% (n = 111) of Neurosurgery admissions in 2002 to 17% (n = 53) in 2007 (chi(2) = 11.919, p = 0.008, df = 3). 30-day mortality increased in Neurosurgery from 14% of Neurosurgery admissions (n = 111) in 2002 to 26% (n = 53) in 2007, and decreased in the Stroke Unit, from 42% of Stroke Unit admissions (n = 12) in 2002 to 17% (n = 29) in 2007. The STICH results have significantly impacted ICH management in Newcastle, with a trend towards fewer Neurosurgery admissions and clot evacuations, and increased Stroke Unit admissions. The role of surgery for ICH remains controversial, and randomization continues in STICH II for patients

  3. CT features of mycotic aneurysms

    International Nuclear Information System (INIS)

    To describe CT features of mycotic aneurysms. We have retrospectively checked 10 patients diagnosed with mycotic aneurysm. Three revealed previously treated arteriosclerotic aneurysms, one was diabetic and had undergone a reno pancreatic transplant,and another presented advanced HIV infection. They al presented fever syndrome and eight exhibited leucocytosis. Mycotic aneurysm diagnosis was made by means of CT findings, clinical examination and positive hemo culture in all cases. Anatomopathological findings were available as confirmation for all four surgically treated patients. The CT scan was performed during arterial phase with spiral acquisition, without contrast and with endo venous administration of a contrast medium. Saccular aneurysms were found in seven patients (double aneurysms in the case of two), with seven of these being abdominal aneurysms (one retrocrural aortic,three infra renal aortic, and three iliac arteries) and two thoracic (aortic arch). In all three remaining patients, there was a pre-existing arteriosclerotic aneurysm (fusiform) and only incipient changes were observed in the adjacent fat. Perianeurysmatic soft-tissue was was noted in eight cases. Only two patients presented signs of tear (peri aneurysm hematoma and/or with contrast extravasation). In three cases, the calcium ring was disrupted. In two patients, absences were observed in other locations. In none of the cases was there gas in the aneurysm wall. Mycotic aneurysm is a rate entity, but must be considered in the evaluation of septic patients since it demands early diagnosis and treatment. In such patients, a CT finding of saccular aneurysm with adjacent soft-tissue mass, and associated with a positive hemo culture, is highly suggestive of this pathology. (Author) 9 refs

  4. Severe Crimean-Congo haemorrhagic fever presented with massive retroperitoneal haemorrhage that recovered without antiviral treatment

    DEFF Research Database (Denmark)

    Gharabaghi, Mehrnaz Asadi; Chinikar, Sadegh; Ghiasi, Seyyed Mojtaba;

    2011-01-01

    Crimean-Congo haemorrhagic fever (CCHF) is a tickborne viral zoonosis with up to 50% mortality in humans caused by CCHF virus belonging to the genus Nairovirus, family Bunyaviridae. The geographical distribution of CCHF cases corresponds closely with the distribution of principle tick vectors that...

  5. Subarachnoid hemorrhage with transient ischemic attack: Another masquerader in cerebral venous thrombosis

    Directory of Open Access Journals (Sweden)

    Bhawna Sharma

    2010-01-01

    Full Text Available Cerebral venous thrombosis has a wide spectrum of clinical manifestations that may mimic many other neurological disorders and lead to frequent misdiagnoses or delay in diagnosis. The most frequent symptoms and signs are headache, seizures, focal deficits, and papilledema. A number of rare atypical manifestations have been described. Cerebral venous thrombosis may present with an isolated intracranial hypertension type picture, thunderclap headache, attacks of migraine with aura, isolated psychiatric disturbances, pulsatile tinnitus, isolated or multiple cranial nerve involvement, and occasionally as subarachnoid hemorrhage (SAH or transient ischemic attack. Our patient presented with thunderclap headache and transient ischemic attack like episode with obvious SAH on CT scan. Acute SAH suggests the presence of a vascular lesion, such as ruptured aneurysm, and CVT is not generally considered in the diagnostic workup of SAH. The case emphasizes the importance of cerebral venous study in nonaneurysmal cases of SAH. It is important to have a high index of suspicion in such atypical cases to avoid delay in diagnosis.

  6. CT angiography and perfusion imaging in patients with subarachnoid hemorrhage: correlation of vasospasm to perfusion abnormality

    International Nuclear Information System (INIS)

    We retrospectively evaluated computed tomography angiography (CTA) and perfusion imaging (CTP) of patients with aneurysmal subarachnoid hemorrhage (SAH) for any correlation between degree of vasospasm and perfusion deficit. Sequentially performed CTP and CTA of 41 patients at least at the third day of postbleeding were reviewed for vasospasm and perfusion deficit throughout the anterior and middle cerebral arteries and corresponding territories. Vasospasm was noted comparing the contralateral normal ones or extradural components of the vessel itself and graded to negative, mild, moderate, and severe as luminal narrowing none, <25%, between 25% and 50%, and ≥50%, respectively. CTP abnormality was noted using cerebral blood flow and volume and mean transit time maps. Of 41 patients, 20 had no vasospasm; 15 had mild to moderate and six had severe vasospasm. Three of 20 patients with no vasospasm (15%), four of 15 patients with mild to moderate vasospasm (26%), and five of six patients with severe vasospasm (83%) had perfusion abnormality. Perfusion abnormalities noted were ischemia, infarction, and hyperperfusion. Perfusion abnormality without vasospasm was observed in the watershed areas and adjacent to sulcal clots. In SAH patients, if there is a macrovascular vasospasm with luminal narrowing ≥50%, there is a high likelihood (83%) of perfusion abnormality in the territory of the vasospastic vessel. There may also be perfusion abnormality without macrovascular vasospasm in the watershed areas or in the vicinity of sulcal clots. (orig.)

  7. Angio negative spontaneous subarachnoid hemorrhage: Is repeat angiogram required in all cases?

    Directory of Open Access Journals (Sweden)

    Rajan Kumar

    2014-01-01

    Full Text Available Background: In some cases of spontaneous subarachnoid hemorrhage (SAH, the cause of bleed remains obscure on initial evaluation. These patients may harbor structural lesions. We aim to determine the utility of repeat angiogram in these subsets of patients. Methods: In this prospective study, patients with SAH with a negative computed tomographic angiogram (CTA and digital subtraction angiogram (DSA were included. A repeat angiogram was done after 6 weeks of initial angiogram. Patients were divided into perimesencephalic SAH (PM-SAH and diffuse classic SAH (Classic-SAH groups. Outcome was determined by modified Rankin score (mRS. Results: A total of 22% (39/178 of all SAH were angio-negative. A total of 90% (n = 35 of these were in Hunt and Hess grade 1-3. A total of 22 patients had PM-SAH and 17 had a Classic-SAH. Repeat angiogram did not reveal any pathology in the PM-SAH group, whereas two patients with Classic-SAH were found to have aneurysms. At 6 months follow-up, 95% patients of PM-SAH and 83.3% of Classic-SAH had mRS of 0. Conclusion: Repeat angiogram is probably not necessary in patients of PM-SAH and they tend to have better outcome. Classic-SAH pattern of bleed is associated with fair chances of an underlying pathology and a repeat angiogram is recommended and these cases and they have poorer outcome.

  8. High dose Erythropoietin increases Brain Tissue Oxygen Tension in Severe Vasospasm after Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Helbok Raimund

    2012-06-01

    Full Text Available Abstract Background Vasospasm-related delayed cerebral ischemia (DCI significantly impacts on outcome after aneurysmal subarachnoid hemorrhage (SAH. Erythropoietin (EPO may reduce the severity of cerebral vasospasm and improve outcome, however, underlying mechanisms are incompletely understood. In this study, the authors aimed to investigate the effect of EPO on cerebral metabolism and brain tissue oxygen tension (PbtO2. Methods Seven consecutive poor grade SAH patients with multimodal neuromonitoring (MM received systemic EPO therapy (30.000 IU per day for 3 consecutive days for severe cerebral vasospasm. Cerebral perfusion pressure (CPP, mean arterial blood pressure (MAP, intracranial pressure (ICP, PbtO2 and brain metabolic changes were analyzed during the next 24 hours after each dose given. Statistical analysis was performed with a mixed effects model. Results A total of 22 interventions were analyzed. Median age was 47 years (32–68 and 86 % were female. Three patients (38 % developed DCI. MAP decreased 2 hours after intervention (P btO2 significantly increased over time (P  Conclusions EPO increases PbtO2 in poor grade SAH patients with severe cerebral vasospasm. The effect on outcome needs further investigation.

  9. fMRI of Working Memory Impairment after Recovery from Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Timothy Michael Ellmore

    2013-11-01

    Full Text Available Recovery from aneurysmal subarachnoid hemorrhage (SAH is often incomplete and accompanied by subtle but persistent cognitive deficits. Previous neuropsychological reports indicate these deficits include most prominently memory impairment, with working memory particularly affected. The neural basis of these memory deficits remains unknown and unexplored by functional magnetic resonance imaging (fMRI. In the present study, patients who experienced (SAH underwent fMRI during the performance of a verbal working memory paradigm. Behavioral results indicated a subtle but statistically significant impairment relative to healthy subjects in working memory performance accuracy, which was accompanied by relatively increased blood oxygen level dependent signal in widespread left and right hemisphere cortical areas during periods of encoding, maintenance, and retrieval. Activity increases remained after factoring out inter-individual differences in age and task performance, and included most notably left hemisphere regions associated with the phonological loop processing, bilateral sensorimotor regions, and right hemisphere dorsolateral prefrontal cortex. We conclude that deficits in verbal working memory following recovery from (SAH are accompanied by widespread differences in hemodynamic correlates of neural activity. These differences are discussed with respect to the immediate and delayed focal and global brain damage that can occur following (SAH, and the possibility that this damage induces subcortical disconnection and subsequent decreased efficiency in neural processing.

  10. The analysis of diagnostic value about clinical, laboratory, CT, MRA, DSA in primary subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Objective: To investigate the value of various diagnostic methods used in subarachnoid hemorrhage (SAH) for providing the best choice of method at different periods and for different etiology. Methods: The clinical information and results of lumbar puncture, CT, MRA, DSA were analyzed retrospectively in 122 patients suffering from SAH at different periods in order to investigate the sensitivity of positive findings and analyze the cause of negative findings. Results: Acute headache, vomit, meningeal irritation sign, the change of eyeground were the useful early clinical manifestation. The positive rate of lumbar puncture was 100% and the positive rate of CT was 92% within 72 hours after onset. The positive findings of MRI, MRA were 45.55% in etiological diagnosis, while those of DSA were 70.83% (including 28 cases of aneurysm, 30 of arteriovenous malformation AVM, 5 of dural arteriovenous fistula, 2 of vasculitis, 1 of lateral sinus thrombus). MRI detected vascular malformation of spinal cord in 2 cases. Conclusion: Specific symptom and lumbar puncture are the methods of choice for confirmation diagnosis in patients suffering from SAH within the acute period. Negative result in CT can't rule out SAH. DSA is better than MRA in etiological diagnosis. The actual result etiology could be revealed by MR or spinal cord angiography when all results of CT, MRA , and DSA are normal. (authors)

  11. A clinical study of cerebral vaso paralysis during a period of cerebral vasospasm after subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    We employ the 123I-infinitum (Imp) single photon emission computed tomography (SPECT) dual table autoradiography (Arg) method and stereotactic extraction estimation (SEE) analysis 7 or 8 days after subarachnoid hemorrhage (SAH) onset to predict cerebral vasospasm. We report new findings of cerebral vasoparalysis during a period of cerebral vasospasm after SAH. From January 1, 2005 to April 30, 2008, we encountered 330 cases of aneurysmal SAH, and treated 285 cases. Of these, 65 were excluded as unsuitable for this study, for reasons such as lack of SPECT data, external decompression, admission over 7 days from SAH onset. We studied 220 cases treated by microsurgical clipping (n=178) or endovascular coil embolization (n=42). Vasoparalysis was defined as a rise in resting cerebral blood flow (CBF) and a loss of vascular reserve on SEE analysis of CBF-SPECT. Vasoparalysis occurred in 15 cases (6.8%). Of these, 9 cases (60.0%) had cerebral hematoma, temporary clips had been used in the operation for 8 cases (53.3%), 9 cases (60.0%) experienced postoperative cerebral infarction, and 3 cases (20.0%) had postoperative convulsions. Vasoparalysis occurs in relation to perioperative cerebral damage. In terms of the loss of vascular reserve following SAH, vasoparalysis resembles hemodynamic cerebral ischemia, although the conditions are quite different. Differentiating between these 2 conditions is important, as different forms of management are required. Dual table ARG and SEE analysis are very useful for the evaluating these 2 conditions. (author)

  12. Dengue Haemorrhagic Fever presenting as Acute Abdomen

    OpenAIRE

    Al-Araimi, Hanaa; Al-Jabri, Amal; Mehmoud, Arshad; Al-Abri, Seif

    2011-01-01

    We describe a case of a 38 year-old Sri Lankan female who was referred to the surgeon on call with a picture of acute abdomen. She presented with a three-day history of fever, headache, abdominal pain and diarrhoea; however, the physical examination was not consistent with acute abdomen. Her platelet count was 22 ×109/L. A diagnosis of dengue haemorrhagic fever (DHF) was made and dengue serology was positive. Dengue epidemics have been associated with a variety of gastrointestinal symptoms an...

  13. Late onset retinoblastoma presenting with vitreous haemorrhage

    DEFF Research Database (Denmark)

    Bagger, Mette; Prause, Jan Ulrik; Heegaard, Steffen;

    2012-01-01

    in the retina. A vascularized gelatinous mass was revealed after vitrectomy. Later the patient developed white cysts in the anterior chamber and histological findings were indicative of a retinoblastoma. The patient was enucleated and the diagnosis of retinoblastoma was confirmed. Intraocular surgery...... in young people with unknown retinoblastoma enhances the risk of metastasis development, orbital recurrence and death. Unexplained vitreous haemorrhage can obscure the view of a tumour but ultrasonic findings of a retinal mass calls for further imaging e.g. through MRI. The case illustrates the...

  14. Subconjunctival haemorrhage from bronchoscopy: A case report

    Directory of Open Access Journals (Sweden)

    Huey Ying Lim

    2015-01-01

    Full Text Available Flexible bronchoscopy has been available for almost five decades. It has evolved as one of the most commonly used invasive diagnostic and therapeutic procedure in pulmonology, and its scope of applications is progressively expanding with the addition of new adjunct technologies such as endobronchial ultrasound, bronchial Thermoplasty, and navigational bronchoscopy. It is a safe procedure with complications ranging from fever, infiltrates, hypoxemia, bleeding, pneumothoraces and death, with most significant complications being bleeding and pneumothorax. We report a case of subconjuctival haemorrhage as an immediate complication of bronchoscopy. To our knowledge this is the first report documenting this rare complication.

  15. Treatment strategy, management and clinical outcome of patients with poor-grade subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    The medical charts of 801 consecutive patients transferred to our critical care center over a 14-year interval (1994-2007) in poor neurological condition (World Federation of Neurological Surgeons; WFNS grade IV or V) after subarachnoid hemorrhage (SAH) were retrospectively analyzed. All patients were treated following a strict protocol. After initial neurological evaluation, patients were sedated, paralyzed, and underwent strict blood pressure control. For patients with WFNS grade IV and selected patients with grade V, aggressive ultra-early repair (mainly clipping for anterior circulation aneurysm, coiling for posterior circulation aneurysm) was initiated. In grade V patients with poor brainstem function or destruction of vital brain areas on CT, only comfort measures were offered. Compared to the former period (1994-2000), coiling was more frequently indicated in elderly patients and bypass surgery was more often applied in complex aneurysm cases in the latter period (2001-2007). Compared to the former period, the number of aggressively treated patients significantly increased (37.6% versus 28.8%) in the latter period. Outcome assessments performed at 3 months revealed a significant increase of favorable outcomes (Glasgow Outcome Scale; good recovery (GR) or moderately disabled (MD)) and a decreased mortality rate in those patients (34% versus 28%, and 43% versus 47%; respectively). The ratio of favorable outcome and morbidity in all admitted patients were also improved (12% versus 8%, and 79% versus 85%; respectively). Outcome was largely determined by the initial hemorrhage and subsequent development of intractable intracranial hypertension or cerebral infraction. Age was also found to be significantly correlated with outcome. There was no significant difference in outcomes by treatment modality (clip or coil). In the latter period, aneurismal location was not the predictor, but delayed ischemic neurological deficit (DIND) remained an important factor. In

  16. Ultrasound and necropsy study of periventricular haemorrhage in preterm infants.

    Science.gov (United States)

    Szymonowicz, W; Schafler, K; Cussen, L J; Yu, V Y

    1984-07-01

    The diagnostic accuracy of cerebral ultrasound for periventricular haemorrhage was determined by comparing this with necropsy findings in 30 preterm neonates of 30 weeks' gestation or less and birthweight under 1500 g. Ultrasound gave an accurate diagnosis of 85% in infants with germinal layer haemorrhage, 92% in intraventricular haemorrhage, and 97% in intracerebral haemorrhage. False positive errors were caused by vascular congestion; false negative errors occurred when the maximum dimension of haemorrhage was less than 3 mm. Cerebral ultrasound gave a diagnostic accuracy of 63% for periventricular leucomalacia. False negative errors occurred when periventricular leucomalacia was microscopic or when it was out of range of the scanner. The maximum width of the germinal layer was measured in 77 neonates of gestational age 23 to 36 weeks who died and had no periventricular haemorrhage at necropsy. The progressive involution of the germinal layer with increasing gestational age paralleled the steady decrease in incidence of periventricular haemorrhage diagnosed over the same gestational age range. Neonates of the youngest gestational age who had the most extensive germinal layers also had the highest risk for periventricular haemorrhage. PMID:6465933

  17. Cerebral abscesses among Danish patients with hereditary haemorrhagic telangiectasia

    DEFF Research Database (Denmark)

    Kjeldsen, A D; Tørring, P M; Nissen, H;

    2013-01-01

    Hereditary haemorrhagic telangiectasia (HHT) is a dominantly inherited disease characterized by a wide variety of clinical manifestations, including pulmonary arteriovenous malformations (PAVMs), which due to paradoxical embolization may cause cerebral abscess.......Hereditary haemorrhagic telangiectasia (HHT) is a dominantly inherited disease characterized by a wide variety of clinical manifestations, including pulmonary arteriovenous malformations (PAVMs), which due to paradoxical embolization may cause cerebral abscess....

  18. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B; Olsen, P S; Perko, M J; Agerskov, Kim; Røder, O; Lorentzen, Jørgen Ewald

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 55......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems.......The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553...

  19. Post-traumatic subarachnoid hemorrhage: A review.

    Science.gov (United States)

    Modi, Nikhilkumar J; Agrawal, Manish; Sinha, Virendra Deo

    2016-01-01

    Head injury has been the leading cause of death and disability in people younger than 40 years and the incidence is rising continuously. Anticipation of the pathological consequences of post-traumatic subarachnoid hemorrhage (tSAH) and an outcome-oriented management are very important in these cases. To encounter the complications pertaining to traumatic brain injury (TBI) and tSAH, various classifications have been proposed and goal-oriented screening strategies have been offered. The role of serial computed tomography (CT) scans, perfusion studies, transcranial Doppler, magnetic resonance imaging (MRI), and angiographic studies as diagnostic tools, has been described. Recently, MRI fluid-attenuated inversion recovery (FLAIR), gradient reversal echo (GRE), and susceptibility weighted imaging (SWI) have emerged as excellent complimentary MRI sequences, and the authors of this article have evaluated their role in the diagnosis and prognostication of patients with tSAH. Numerous studies have been conducted on the various complications associated with tSAH such as vasospasm, hydrocephalus, and electrolyte disturbances and their management. This article discusses these aspects of tSAH and their management nuances. PMID:26954974

  20. ABDOMINAL AORTIC ANEURYSM (AAA

    Directory of Open Access Journals (Sweden)

    Rajesh G

    2011-11-01

    Full Text Available AAA is defined as a distension of the infrarenal aorta by more than 50% (or 1.5 times compared with a corresponding healthy, aged and gender matched population. AAA afflicts 1 to 6 % of the general population aged more than 60 years and the incidence rises by approximately 0.15% annually. When the definition of a maximum external diameter ≥3 cm is used, the prevalence of AAA is upto 6 times greater in men than in women. AAAs are much more common than thoracic aortic aneurysms. Most common cause of AAA is atherosclerosis (95%. Less common causes include infectious or inflammatory origin or those associated with connective tissue disorders. Process of AAA formation is multifactorial. Other than the general risk factors for atherosclerosis, genetic predispo s iti on, aut o immunity and hemodynamic factors all play roles in its formation. AAA is 1.5 times more frequent in hypert ensive patients. Smokers have 8 times risk for developing AAA. The existence of familial aggre gation of AAA implicates genetic factors in the etiology of AAA. Women with AAA are more likely to have a positive family history of this disorder. Those with a family history of AAA have an increased risk of 30%, and their aneurysms tend to occur at a younger age and carry a greater risk of rupture than do sporadic aneurysms.

  1. CHARACTERIZATION OF PATIENTS WITH ENDOVASCULAR TREATMENT OF DISSECTING ANEURYSMS OF POSTERIOR CEREBRAL CIRCULATION IN CARTAGENA DE INDIAS

    Directory of Open Access Journals (Sweden)

    Rueda-Tamayo Leidy

    2015-12-01

    Full Text Available Introduction: the intracraneal aneurysms are local and permanent dilations in the artery. Objective: to describe the clinical, imagenologic and effectiveness of endovascular treatment in terms of its independence and mortality in patients with dissecting aneurysms of posterior cerebral circulation in Cartagena. Methods: a descriptive study was carried out with patients 18 years or older with a diagnosis of dissecting aneurysms of posterior cerebral circulation who received endovascular treatment in the period between January 2007 and December 2014 in the medical center Neurodinamia. The variables related to personal medical history, diagnosis and characteristics of the aneurysm, devices used for treatment, time clinical and imagenologic follow-up and complications were measured. Descriptive statistical analysis was performed according to the nature of the variables. Results: nineteen patients were analyzed to receive endovascular treatments. The average of age was 55 years. The subarachnoid hemorrhage was the most frequent clinical case; this was diagnosed with CT in 89.5%. The location in the PICA and vertebral artery were 36.8% and 31.6%, respectively. The devices used were coils in 36.8%, followed by coils and stent with 31.6%, and Onyx with 21.0%. At the end of VTE this was classified as favorable outcome in 18 patients (94.7%; however, there was one death during hospital care (5.3%. The Rankin scale showed improvement in 84.2% (16 patients. Conclusions: the endovascular treatment of dissecting aneurysms posterior cerebral circulation and the aneurysm occlusion showed high success rates 94.7%, patients (84.2% showed positive results after 30 days of treatment. Rev.cienc.biomed. 2015;6(2:298-308 KEY WORDS Aneurysm; Neurosurgery; Radiology interventional.

  2. Dengue and dengue haemorrhagic fever: Indian perspective

    Indian Academy of Sciences (India)

    U C Chaturvedi; Rachna Nagar

    2008-11-01

    The relationship of this country with dengue has been long and intense. The first recorded epidemic of clinically dengue-like illness occurred at Madras in 1780 and the dengue virus was isolated for the first time almost simultaneously in Japan and Calcutta in 1943–1944. After the first virologically proved epidemic of dengue fever along the East Coast of India in 1963–1964, it spread to allover the country. The first full-blown epidemic of the severe form of the illness, the dengue haemorrhagic fever/dengue shock syndrome occurred in North India in 1996. Aedes aegypti is the vector for transmission of the disease. Vaccines or antiviral drugs are not available for dengue viruses; the only effective way to prevent epidemic degure fever/dengue haemorrhagic fever (DF/DHF) is to control the mosquito vector, Aedes aegypti and prevent its bite. This country has few virus laboratories and some of them have done excellent work in the area of molecular epidemiology, immunopathology and vaccine development. Selected work done in this country on the problems of dengue is presented here.

  3. Giant superior mesenteric artery aneurysm

    OpenAIRE

    Temiz, Ahmet; Bostan, Mehmet; Şatıroğlu, Ömer; Çetin, Mustafa; Bozkurt, Engin

    2011-01-01

    Aneurysm of the superior mesenteric artery (SMA) is a rare condition and most of them are symptomatic. Gradu­ally increasing abdominal pain, intestinal ischemic symp­toms and rupture are the most common symptoms. We herein report a giant SMA aneurysm detected in a patient with complaint of abdominal discomfort.

  4. True aneurysm of brachial artery.

    Science.gov (United States)

    Hudorović, Narcis; Lovričević, Ivo; Franjić, Dario Bjorn; Brkić, Petar; Tomas, Davor

    2010-10-01

    True upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Following computer-tomography angiographic (CT-a) imaging examination, true saccular aneurysm, originating from the left brachial artery was diagnosed in the 77-year-old female without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by interposition of a part of great saphenous vein harvested from the left groin and creation of two end-to-end anastomoses between interposition graft and previously resected part of brachial artery. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay. Factors combined with minimal morbidity associated with repair suggest that surgical repair should be performed routinely for true upper extremity arterial aneurysms. PMID:20865459

  5. Diffuse infiltrating retinoblastoma invading subarachnoid space

    Directory of Open Access Journals (Sweden)

    Kase S

    2011-06-01

    .Keywords: diffuse infiltrating retinoblastoma, subarachnoid space, optic nerve

  6. Spiral CT angiography and surgical correlations in the evaluation of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Preda, L.; Di Maggio, E.M.; La Fianza, A.; Dore, R.; Fulle, I.; Solcia, M.; Campani, R. [Istituto di Radiologia, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia (Italy); Gaetani, P.; Rodriguez y Baena, R. [Neurosurgery, Istituto Clinico ``Humanitas``, I-20089 Rozzano (Midway Islands) (Italy); Cecchini, A. [Servizio di Radiodiagnostica, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia (Italy); Infuso, L. [Neurochirurgia, Dipartimento di Chirurgia, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia (Italy)

    1998-06-02

    We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 {+-} 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3-0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 {+-} 0.12 cm vs 1.09 {+-} 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients

  7. Hyperbaric oxygen treatment for haemorrhagic radiation cystitis

    Energy Technology Data Exchange (ETDEWEB)

    Bevers, R.F.M.; Kurth, K.H. [Amsterdam Univ. (Netherlands). Academic Medical Center; Bakker, D.J. [Amsterdam Univ. (Netherlands). Depts. of Urology and Surgery

    1995-09-23

    Radiation-induced severe haemorrhagic cystitis is difficult to treat. Conventional treatments may decrease haematuria but do not affect the radiocystitis itself. Hyperbaric oxygen treatment has been reported to do both. We report the results of a prospective study of hyperbaric oxygen (20 sessions of 100% oxygen inhalation at 3 bar for 90 min in a multiplace hyperbaric chamber) to 40 patients with biopsy-proven radiation cystitis and severe haematuria. Haematuria disappeared completely or improved in 37 patients after treatment. Mean follow-up was 23.1 months (range 1-74); and the recurrence rate was 0.12/year. There were no adverse effects. Hyperbaric oxygen treatment should be considered for patients with severe radiation-induced haematuria. (author).

  8. Pulmonary hypertension in hereditary haemorrhagic telangiectasia

    Institute of Scientific and Technical Information of China (English)

    Veronique; MM; Vorselaars; Sebastiaan; Velthuis; Repke; J; Snijder; Jan; Albert; Vos; Johannes; J; Mager; Martijn; C; Post

    2015-01-01

    Hereditary haemorrhagic telangiectasia(HHT) is an autosomal dominant inherited disorder characterised by vascular malformations in predominantly the brain,liverand lungs.Pulmonary hypertension(PH) is increasingly recognised as a severe complication of HHT.PH may be categorised into two distinct types in patients with HHT.Post-capillary PH most often results from a high pulmonary blood flow that accompanies the high cardiac output state associated with liver arteriovenous malformations.Less frequently,the HHT-related gene mutations in ENG or ACVRL1 appear to predispose patients with HHT to develop pre-capillary pulmonary arterial hypertension.Differentiation between both forms of PH by right heart catheterisation is essential,since both entities are associated with severe morbidity and mortality with different treatment options.Therefore all HHT patients should be referred to an HHT centre.

  9. Doctors' Knowledge of Viral Haemorrhagic Fevers.

    Science.gov (United States)

    Lisk, Clifford; Snell, Luke; Haji-Coll, Michael; Ellis, Jayne; Sufi, Saaidullah; Raj, Rohit; Sharma, A; Smith, C

    2015-01-01

    Viral Haemorrhagic Fevers (VHF) such as Ebola Virus Disease (EVD) are of increasing concern to clinicians and public heath bodies across Europe and America due to the on-going epidemic in West Africa. We conducted an online study to assess clinicians' knowledge of VHF across six hospital sites in London. This showed suboptimal knowledge of Public Health England guidance, EVD epidemiology and the risk factors for acquiring VHF. Knowledge about VHF was dependent on seniority of grade with the most junior grade of doctors performing worse in several areas of the survey. Poor knowledge raises concerns that those at risk of VHF will be inappropriately risk stratified and managed. Education of doctors and other healthcare professionals about VHF is necessary to address these knowledge gaps. PMID:26305080

  10. Viral haemorrhagic fevers in South Africa.

    Science.gov (United States)

    Richards, Guy A; Weyer, Jacqueline; Blumberg, Lucille H

    2015-09-01

    Viral haemorrhagic fevers (VHFs) include a diverse array of diseases caused by a broad range of viruses transmitted from various animal hosts and originating from almost all the continents in the world. These are potentially fatal and highly transmissible diseases without specific treatments or prophylactic vaccines. As has been demonstrated during the Ebola virus disease outbreak in West Africa, the consequences of VHFs are not limited to specific countries - they may become epidemic, and may have considerable economic impact and disrupt local public health and social service structures. Intensive public health intervention is necessary to contain these diseases. Here we provide a concise overview of the VHFs that are of current public health importance to South Africa. PMID:26428973

  11. Operative strategy of complex internal carotid artery-posterior communicating artery aneurysms Defensive effect on perioperative nerve injury

    Institute of Scientific and Technical Information of China (English)

    Xinmin Wang; Wende Xiong; Xuqin Li

    2007-01-01

    BACKGROUND: The two problems in treating intracranial aneurysm are the vascular reconstruction and brain protection, especially for complex internal carotid artery-posterior communicating artery (ICA-PComA)aneurysms.OBJECTIVE: To analyze the anatomic features and operative technique of complex ICA-PComA aneurysms, and investigate how to better protect the brain tissue.DESIGN: A retrospective case analysis.SETTING: Department ofNeurosurgery, Dalian Central Hospital.PARTICIPANTS: Totally 154 inpatients with ICA-PComA aneurysms were selected from the Department of Neurosurgery, Dalian Central Hospital from January 1998 to December 2006, including 19 cases (12.3%)of complex ICA-PComA aneurysms, 8 males and 11 females, 38 - 67 years of age. Informed contents for surgery and observation were obtained from all the patients or their relatives.METHODS: The clinical manifestations, including initial symptoms and Hunt&Hess grading, were observed. Corresponding strategies were selected for different types of ICA-PComA aneurysms. The patients were followed up at 3 months postoperatively. According to the results of Glasgow scoring, the curative effects were classified as good (4 - 5 points), bad (2 - 3 points) and dead (1 point). The results at discharge were taken as early results, whereas the follow-up results as late results.MAIN OUTCOME MEASURES: Clinical manifestations and curative effects of the patients.RESULTS: All the 19 patients with ICA-PComA were involved in the analysis of results. For clinical manifestations, the initial symptoms were subarachnoid hemorrhage (n =15), paralysis of oculomotor nerve (n =3), and occasional attack (n =1); The Hunt&Hess grading was grade Ⅰ in 4 cases, grade Ⅱ in 6 cases,grade Ⅲ in 6 cases, grade Ⅳ in 2 cases, and grade Ⅴ in 1 case. The curative effects were that aneurysm breakage and bleeding occurred in 6 cases perioperatively, uncomplete clipping of aneurysm in 2 cases and constriction of parent artery in 1 case. The

  12. Filoviral haemorrhagic fevers: A threat to Zambia?

    Directory of Open Access Journals (Sweden)

    Katendi Changula

    2012-06-01

    Full Text Available Filoviral haemorrhagic fevers (FVHF are caused by agents belonging to Filoviridae family, Ebola and Marburg viruses. They are amongst the most lethal pathogens known to infect humans. Incidence of FVHF outbreaks are increasing, with affected number of patients on the rise. Whilst there has been no report yet of FVHF in Zambia, its proximity to Angola and Democratic Republic of Congo, which have recorded major outbreaks, as well as the open borders, increased trade and annual migration of bats between these countries, puts Zambia at present and increased risk. Previous studies have indicated bats as potential reservoir hosts for filoviruses. An increasing population with an increasing demand for resources has forced incursion into previously uninhabited land, potentially bringing them into contact with unknown pathogens, reservoir hosts and/or amplifying hosts. The recent discovery of a novel arenavirus, Lujo, highlights the potential that every region, including Zambia, has for being the epicentre or primary focus for emerging and re-emerging infections. It is therefore imperative that surveillance for potential emerging infections, such as viral haemorrhagic fevers be instituted. In order to accomplish this surveillance, rapid detection, identification and monitoring of agents in patients and potential reservoirs is needed. International co-operation is the strategy of choice for the surveillance and fight against emerging infections. Due to the extensive area in which filoviral infections can occur, a regional approach to surveillance activities is required, with regional referral centres. There is a need to adopt shared policies for the prevention and control of infectious diseases. There is also need for optimisation of currently available tests and development of new diagnostic tests, in order to have robust, highly sensitive and specific diagnostic tests that can be used even where there are inadequate laboratories and diagnostic services.

  13. Chronic hydrocephalus after experimental subarachnoid hemorrhage.

    Directory of Open Access Journals (Sweden)

    Peter Lackner

    Full Text Available Chronic communicating hydrocephalus is a significant health problem affecting up to 20% of survivors of spontaneous subarachnoid hemorrhage (SAH. The development of new treatment strategies is hampered by the lack of well characterized disease models. This study investigated the incidence of chronic hydrocephalus by evaluating the temporal profile of intracranial pressure (ICP elevation after SAH, induced by endovascular perforation in rats. Twenty-five adult male Sprague-Dawley rats (260-320 g were subjected to either endovascular perforation or sham surgery. Five animals died after SAH induction. At 7, 14 and 21 days after surgery ICP was measured by stereotaxic puncture of the cisterna magna in SAH (n=10 and SHAM (n=10 animals. On day 21 T-maze test was performed and the number of alterations and latency to decision was recorded. On day 23, samples were processed for histological analyses. The relative ventricle area was evaluated in coronal Nissl stained sections. On day 7 after surgery all animals showed normal ICP. The absolute ICP values were significantly higher in SAH compared to SHAM animals on day 21 (8.26±4.53 mmHg versus 4.38±0.95 mmHg but not on day 14. Observing an ICP of 10 mmHg as cut-off, 3 animals showed elevated ICP on day 14 and another animal on day 21. The overall incidence of ICP elevation was 40% in SAH animals. On day 21, results of T-maze testing were significantly correlated with ICP values, i.e. animals with elevated ICP showed a lower number of alterations and a delayed decision. Histology yielded a significantly higher (3.59 fold increased relative ventricle area in SAH animals with ICP elevation compared to SAH animals without ICP elevation. In conclusion, the current study shows that experimental SAH leads to chronic hydrocephalus, which is associated with ICP elevation, behavioral alterations and ventricular dilation in about 40% of SAH animals.

  14. MRI demonstration of subarachnoid neurocysticercosis simulating metastatic disease

    Energy Technology Data Exchange (ETDEWEB)

    Lau, K.Y.; Roebuck, D.J.; Metreweli, C. [Dept. of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Shatin NT (Hong Kong); Mok, V.; Kay, R. [Dept. of Neurology, Prince of Wales Hospital, Shatin, NT (Hong Kong); Ng, H.K.; Teo, J.G.C. [Dept. of Anatomical and Cellular Pathology, Prince of Wales Hospital, Shatin, NT (Hong Kong); Lam, J.; Poon, W. [Dept. of Neurosurgery, Prince of Wales Hospital, Shatin, NT (Hong Kong)

    1998-11-01

    We present a patient with neurocysticercosis with spinal subarachnoid spread who presented with lower back pain and progressive numbness and weakness of the left leg. MRI of the spine simulated metastasis. MRI of the brain demonstrated a ``bunch of grapes`` appearance in the basal cisterns, characteristic of cysticercosis. (orig.) With 2 figs., 17 refs.

  15. Intracerebral haemorrhage and vasculitis secondary to amphetamine use.

    OpenAIRE

    Salanova, V.; Taubner, R.

    1984-01-01

    We report a case of amphetamine-related intracranial haemorrhage and vasculitis, responding to immunosuppressants. Angiograms obtained before and after therapy are shown; the importance of immunosuppressive therapy is discussed.

  16. Neonatal bilateral diaphragmatic paralysis caused by brain stem haemorrhage.

    OpenAIRE

    Blazer, S; Hemli, J A; Sujov, P O; Braun, J

    1989-01-01

    We describe a neonate with severe bilateral diaphragmatic paralysis caused by haemorrhage in the lower brain stem. To our knowledge this association has not been previously reported in the English medical literature.

  17. Albinism with haemorrhagic diathesis: Hermansky-Pudlak syndrome.

    OpenAIRE

    Kinnear, P E; Tuddenham, E G

    1985-01-01

    Four cases of albinism with haemorrhagic diathesis (Hermansky-Pudlak syndrome) are presented. The cases displayed wide phenotypic variation. Electroretinography was performed on all four patients and was found to be normal. One patient developed a cutaneous malignant melanoma.

  18. Haemorrhagic Lumbar Juxtafacet Cyst with Ligamentum Flavum Involvement

    OpenAIRE

    Finn Ghent; Trent Davidson; Ralph Jasper Mobbs

    2014-01-01

    Juxtafacet cysts are an uncommon cause of radiculopathy. They occur most frequently in the lumbar region, and their distribution across the spine correlates with mobility. Haemorrhagic complications are rare and may occur in the absence of any provocation, although there is some association with anticoagulation and trauma. We present a case of acute radiculopathy due to an L5/S1 juxtafacet cyst with unprovoked haemorrhage which was found to extend into ligamentum flavum. The patient underwent...

  19. Acute Lower Gastrointestinal Haemorrhage Secondary to Small Bowel Ascariasis

    OpenAIRE

    Daphne Dewi, Stephen; Sze Li, Siow

    2012-01-01

    Acute lower gastrointestinal haemorrhage secondary to small bowel ascariasis is extremely rare. A high level of suspicion should be maintained when dealing with acute gastrointestinal haemorrhage in migrants and travellers. Small bowel examination is warranted when carefully repeated upper and lower endoscopies have failed to elicit the source of bleeding. Appropriate test selection is determined by the availability of local expertise. We present a case of acute lower gastrointestinal haemorr...

  20. Haemorrhage in a scrotal lymphangioma in a child: A rarity

    Directory of Open Access Journals (Sweden)

    Rattan Kamal

    2009-01-01

    Full Text Available We report here a case of cystic lymphangioma of scrotum presenting as acute scrotum due to haemorrhage. The diagnosis was confirmed on ultrasonography and magnetic resonance imaging and managed successfully by surgical excision. There was past history of bilateral congenital cataract for which the patient had undergone surgery with complete visual recovery. Scrotal cystic lymphangioma complicated by haemorrhage is rare; hence, the case is being reported with a review of literature.

  1. Endovascular treatment of PICA aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Mukonoweshuro, W.; Laitt, R.D.; Hughes, D.G. [Radiology Dept., Greater Manchester Neurosciences Unit, Hope Hospital, Salford, Manchester (United Kingdom)

    2003-03-01

    Endovascular treatment of aneurysms of the posterior inferior cerebellar artery (PICA) avoids manipulation of the brainstem or lower cranial nerves and should therefore carry a lower risk of neurological morbidity than surgical clipping. We reviewed our experience of 23 patients with PICA aneurysms treated by endovascular occlusion with Guglielmi detachable coils and documented their long-term outcome on follow-up. We observed a 28 day procedure-related neurological morbidity of 13% (3/23 patients). One patient suffered permanent neurological complications. There were no procedure-related deaths. None of our patients suffered a re-bleed from their treated aneurysms. Our series shows endovascular treatment of ruptured PICA aneurysms to be safe and effective. (orig.)

  2. Thoracic aortic aneurysm and dissection.

    Science.gov (United States)

    Goldfinger, Judith Z; Halperin, Jonathan L; Marin, Michael L; Stewart, Allan S; Eagle, Kim A; Fuster, Valentin

    2014-10-21

    Aortic dissection is the most devastating complication of thoracic aortic disease. In the more than 250 years since thoracic aortic dissection was first described, much has been learned about diseases of the thoracic aorta. In this review, we describe normal thoracic aortic size; risk factors for dissection, including genetic and inflammatory conditions; the underpinnings of genetic diseases associated with aneurysm and dissection, including Marfan syndrome and the role of transforming growth factor beta signaling; data on the role for medical therapies in aneurysmal disease, including beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors; prophylactic surgery for aneurysm; surgical techniques for the aortic root; and surgical and endovascular management of aneurysm and dissection for different aortic segments. PMID:25323262

  3. Tobacco smoking and aortic aneurysm

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Nordestgaard, Børge G; Grønbæk, Morten;

    2012-01-01

    from the Copenhagen City Heart Study followed for up to 34years and in 56,211 individuals from the Copenhagen General Population Study followed for up to 7years. RESULTS: During follow-up, 335 and 169 individuals developed aortic aneurysm outcomes in the Copenhagen City Heart Study and Copenhagen...... General Population Study, respectively. According to the magnitude of the hazard ratios, tobacco consumption was the most important risk factor for hospitalization and death from aortic aneurysm, followed by male sex and hypertension in both cohorts. The population attributable risk of aortic aneurysm...... outcomes due to tobacco consumption was 64% and 47% in the Copenhagen City Heart Study and Copenhagen General Population Study, respectively, and ranked highest among population attributable risks of aortic aneurysm in both cohorts. The absolute 10-year risk for hospitalization or death from aortic...

  4. Postpartum haemorrhage: a preventable cause of maternal mortality

    International Nuclear Information System (INIS)

    To assess the preventable predictors of severe postpartum haemorrhage and the adverse outcome associated with it. All the admitted patients who developed severe postpartum haemorrhage (>1500 ml) were included in the study. Clinical and sociodemographic data was obtained along with results of investigations to categorize the complications encountered. Odds ratio (OR) and 95% confidence intervals were determined. During the study period, 75 out of 4683 obstetrical admissions, developed severe postpartum haemorrhage (1.6 %). About 65% of the patients were admitted with some other complications including obstructed labour, antepartum haemorrhage and eclampsia. The risk factors were grand multiparity (OR=3.4), pre-eclampsia (OR=2.75), antepartum haemorrhage (OR=13.35), active labour of more than 10 hours (OR=46.92), twin delivery (OR=3.25), instrumental delivery (OR=8.62) and caesarean section (OR=9.74). Maternal mortality in these cases was 2.66% and residual morbidity being 40%. Birth attendant other than doctor and delivery outside the study unit were significantly associated with the adverse outcome in these patients. Maternal outcome associated with postpartum haemorrhage is a function of care given during labour and postnatal period with early diagnosis and management of the complication and its risk factors, being the key of good maternal outcome. (author)

  5. The TEAM trial: Safety and efficacy of endovascular treatment of unruptured intracranial aneurysms in the prevention of aneurysmal hemorrhages: A randomized comparison with indefinite deferral of treatment in 2002 patients followed for 10 years

    Directory of Open Access Journals (Sweden)

    Collet Jean-Paul

    2008-07-01

    Full Text Available Abstract The management of patients with unruptured aneurysms remains controversial. Patients with unruptured aneurysms may suffer intracranial haemorrhage, but the incidence of this event is still debated; endovascular treatment may prevent rupture, but involves immediate risks. Hence, the balance of risks and benefits of endovascular treatment is uncertain. Here, we report the design of the TEAM trial, the first international, randomized, controlled trial comparing conservative management with endovascular treatment. Primary endpoint is mortality and morbidity (modified Rankin Score ≥ 3 from intracranial haemorrhage or treatment. Secondary endpoints include incidence of hemorrhagic events, morbidity related to endovascular coiling, morphological results, overall clinical outcome and quality of life. Statistical tests compare between probabilities at 5- and 10-years of 1/mortality from haemorrhage related to the lesion, excluding per-operative complications; 2/mortality from haemorrhage or from complications of treatment; 3/combined disease or treatment related mortality and morbidity in the absence of other causes of death or disability. The study will be conducted in 60 international centres and will enrol 2,002 patients equally divided between the two groups, a size sufficient to achieve 80% power at a 0.0167 significance to detect differences in 1 disease or treatment-related poor outcomes from 7–9% to 3–5%; 2 overall mortality from 16 to 11%. Duration of the study is 14 years, the first three years being for patient recruitment plus a minimum of 10 years of follow-up. The TEAM trial thus offers a means to reconcile the introduction of a new approach with the necessity to acknowledge uncertainties. Trial registration Current Controlled Trials ISRCTN62758344 http://www.controlled-trials.com

  6. Cluster headache and intracranial aneurysm

    OpenAIRE

    Valença, Marcelo Moraes; Andrade-Valença, Luciana P. A.; Martins, Carolina; de Aragão, Maria Fátima Vasco; Batista, Laécio Leitão; Peres, Mario Fernando Prieto; da Silva, Wilson Farias

    2007-01-01

    In the present study we describe the cases of two patients with cluster-like headache related to intracranial carotid artery aneurysm. One of these patients responded to verapamil prescription with headache resolution. In both cases the surgical clipping of the aneurysm resolved the cluster pain. These findings strongly suggest a pathophysiological link between the two conditions. The authors discuss the potential pathophysiological mechanisms underlying cluster-like headache due to intracran...

  7. Flow Diverters for Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    Yazan J. Alderazi

    2014-01-01

    Full Text Available Flow diverters (pipeline embolization device, Silk flow diverter, and Surpass flow diverter have been developed to treat intracranial aneurysms. These endovascular devices are placed within the parent artery rather than the aneurysm sac. They take advantage of altering hemodynamics at the aneurysm/parent vessel interface, resulting in gradual thrombosis of the aneurysm occurring over time. Subsequent inflammatory response, healing, and endothelial growth shrink the aneurysm and reconstruct the parent artery lumen while preserving perforators and side branches in most cases. Flow diverters have already allowed treatment of previously untreatable wide neck and giant aneurysms. There are risks with flow diverters including in-stent thrombosis, perianeurysmal edema, distant and delayed hemorrhages, and perforator occlusions. Comparative efficacy and safety against other therapies are being studied in ongoing trials. Antiplatelet therapy is mandatory with flow diverters, which has highlighted the need for better evidence for monitoring and tailoring antiplatelet therapy. In this paper we review the devices, their uses, associated complications, evidence base, and ongoing studies.

  8. Post-operative monitoring of cortical taurine in patients with subarachnoid hemorrhage: a microdialysis study.

    Science.gov (United States)

    De Micheli, E; Pinna, G; Alfieri, A; Caramia, G; Bianchi, L; Colivicchi, M A; Della Corte, L; Bricolo, A

    2000-01-01

    Intracerebral MD enables the retrieval of endogenous substances from the extracellular fluid (ECF) of the brain and has been demonstrated to be a sensitive technique for early detection of subtle vasospasm-induced neurometabolic abnormalities in patients with subarachnoid hemorrhage (SAH). The aim of this study was to monitor cortical extracellular concentrations of energy metabolism markers, such as glucose and lactate, neurotransmitter amino acids, such as glutamate, aspartate, GABA and taurine to identify any neurochemical patterns of cerebral ischemia. A prospective clinical study was conducted on a group of 16 patients with non-severe SAH operated on within 72 hours after initial bleeding. Following aneurysm clipping, an MD catheter was inserted in the cortical region where vasospasm could be expected to develop, and perfused with artificial CSF at 0.3 microl/min flow rate. Dialysate was collected every 6 hours and then analyzed on High Performance Liquid Cromatography (HPLC) for glucose, lactate, pyruvate, glutamate, aspartate, GABA and taurine. Mean ECF taurine concentrations ranged from 1.4 + 0.7 to 12.3 + 7.8 micromol/l in single patients: global mean value was 5.8 + 3.8 micromol/l. In this series, the highest absolute taurine value was 25.7 micromol/l, observed in a patient who developed clinical and radiological signs of cerebral ischemia. Nine patients presented clinical disturbances related to cerebral vasospasm. In this setting, representing a mild-to-moderate hypoxic condition, MD data demonstrated that lactate is the most sensitive marker of cellular energy imbalance. Increased lactate levels positively correlated with glutamate (P<0.0001), aspartate (P<0.0001), GABA (P<0.0001) and taurine (P<0.0001) concentrations. These results suggest that also in humans increased taurine levels reflect a condition of cellular stress. This study confirms that MD is a sensitive technique to reveal subtle metabolic abnormalities possibly resulting in cell damage

  9. Intracranial aneurysm associated with relapsing polychondritis

    Energy Technology Data Exchange (ETDEWEB)

    Coumbaras, M.; Boulin, A.; Pierot, L. [Dept. of Neuroradiology, Hopital Foch, Suresnes (France); Piette, A.M.; Bletry, O. [Dept. of Medicine, Hopital Foch, Suresnes (France); Graveleau, P. [Dept. of Neurology, Hopital Foch, Suresnes (France)

    2001-07-01

    We describe a 50-year-old man with relapsing polychondritis (RP) involving auricular cartilage, uveitis and hearing loss, who had an aneurysm of the anterior cerebral artery. Intracranial aneurysm is a rare manifestation of RP. (orig.)

  10. Brain Aneurysm: Early Detection and Screening

    Science.gov (United States)

    ... and Screening A- A A+ Early Detection and Screening Brain aneurysms can be similar to heart attacks. ... aneurysm is about to rupture. Fortunately, through imaging screening techniques, individuals at high risk of harboring a ...

  11. Surveillance intervals for small abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Bown, Matthew J; Sweeting, Michael J; Brown, Louise C;

    2013-01-01

    Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture....

  12. Aneurysms - Multiple Languages: MedlinePlus

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Aneurysms URL of this page: https://medlineplus.gov/languages/aneurysms.html Other topics A-Z A B ...

  13. Aortic aneurysm secondary to umbilical artery catheterization

    International Nuclear Information System (INIS)

    A 14-month-girl presented with an asymptomatic posterior mediastinal mass. She had a history of prematurity, umbilical artery catheterization, and sepsis. The diagnosis of aortic aneurysm was made by dynamic computed tomography. The aneurysm was successfully resected. (orig.)

  14. Tonsilar haemorrhage and re-admission: a questionnaire based study.

    Science.gov (United States)

    Sarny, Stephanie; Habermann, Walter; Ossimitz, Guenther; Schmid, Christoph; Stammberger, Heinz

    2011-12-01

    The aim of our study was to investigate the accuracy of haemorrhage rate in the community (i.e., actual rate versus hospital recorded rate) for tonsil operations. Bleeding episodes were investigated for 695 consecutive patients undergoing tonsillectomy, adenotonsillectomy and tonsillotomy at the Department of ORL, H&NS, MU of Graz, Austria, between January 1 2007 and June 30 2008 by questionnaire. Main purposes of our study were the evaluation of the incidence of postoperative haemorrhage, need for revision surgery, medical care of patients experiencing postoperative bleeding and multiple bleeding episodes. Haemorrhage was defined as any bleeding, be it minimal or significant, after extubation. The study group comprised 407 patients who answered the questionnaire: 61.7% adults, 22.1% school children between 6 and 15 years and 16.2% children aged less than 6 years. Exactly 100 patients (24.6% of 407) showed some kind of postoperative bleeding, but only 79 of them (19.4% of 407) were recorded at hospital. A return to theatre due to haemorrhage was required in 4.7% of all 407 cases. Combining hospital records and data from the questionnaire allowed us to estimate an overall haemorrhage rate of 21.4% for all 695 patients. Every fifth patient experiencing postoperative haemorrhage did not return to the hospital he or she was operated in. We would have missed 21.0% of all bleeding episodes by assessing re-admitting patients suffering postoperative bleeding only. We conclude that haemorrhage rate is considerably higher than assumed by investigating hospital records only and strongly related to the definition of postoperative bleeding and to the study design. PMID:21373896

  15. True Giant Posterior Tibial Artery Aneurysm

    OpenAIRE

    Patrizio Colotto; Gabriele Testi; Giacomo Di Iasio; Alessandro Robaldo

    2012-01-01

    We report an unusual case of true atherosclerotic posterior tibial artery (PTA) aneurysm without any apparent causative history. To our knowledge, in the English Literature only seven previously cases of true PTA aneurysms are reported. Due to its location, this lesion may require surgical intervention and removal. The presentation, the diagnostic evaluation, and the surgical management of the aneurysm are discussed.

  16. Microsurgical cerebral aneurysm training porcine model

    Directory of Open Access Journals (Sweden)

    Jon Olabe

    2011-01-01

    Full Text Available The authors developed a simple reproducible technique for aneurysm creation and adapted it to mimic intracranial dissection conditions using glue application as a pseudo-arachnoid type layer. Ten 1-2-month-old healthy domestic swine were employed under general anesthesia. A novel technique for bifurcation aneurysm creation was developed using two arteries and a vein. After aneurysm creation, diluted sulfuric acid was applied on the dome with a micropipette to increase aneurysm fragility in selected zones. The surgical field was then dried and contact glue was applied around the vascular complex in a circular manner so as to emulate arachnoidal connection fibers. Microsurgical dissection of the aneurysm and surrounding vessels was performed by delicately removing the adhesive substance. Diverse aneurysm clipping techniques, emergency rupture situations and vascular reconstruction procedures were trained. Twenty-two aneurysms were created at several vascular sites, one aneurysm dome ruptured during application of sulfuric acid, two aneurysm models were proved to be thrombosed, two aneurysms ruptured during the dissection and no intraoperative deaths occurred. All aneurysms were clipped in an acceptable manner. This bifurcation aneurysm model provides a novel training system to be used not only by neurosurgeons but also by neurovascular interventionists.

  17. Internal carotid artery bifurcation aneurysms. Surgical experience

    International Nuclear Information System (INIS)

    Internal carotid artery (ICA) bifurcation aneurysms are relatively uncommon and frequently rupture at a younger age compared to other intracranial aneurysms. We have treated a total of 999 patients for intracranial aneurysms, of whom 89 (8.9%) had ICA bifurcation aneurysms, and 42 of the 89 patients were 30 years of age or younger. The present study analyzed the clinical records of 70 patients with ICA bifurcation aneurysms treated from mid 1997 to mid 2003. Multiple aneurysms were present in 15 patients. Digital subtraction angiography films were studied in 55 patients to identify vasospasm and aneurysm projection. The aneurysm projected superiorly in most of these patients (37/55, 67.3%). We preferred to minimize frontal lobe retraction, so widely opened the sylvian fissure to approach the ICA bifurcation and aneurysm neck. Elective temporary clipping was employed before the final dissection and permanent clip application. Vasospasm was present in 24 (43.6%) of 55 patients. Forty-eight (68.6%) of the 70 patients had good outcome, 14 (20%) had poor outcome, and eight (11.4%) died. Patients with ICA bifurcation aneurysms tend to bleed at a much younger age compared to those with other intracranial aneurysms. Wide opening of the sylvian fissure and elective temporary clipping of the ICA reduces the risk of intraoperative rupture and perforator injury. Mortality was mainly due to poor clinical grade and intraoperative premature aneurysm rupture. (author)

  18. Descriptive retrospective analysis of the diagnostic yield and morbidity of four vessel catheter-directed cerebral angiography and multidetector computed tomographic angiography (MDCTA) performed at Inkosi Albert Luthuli Central Hospital (IALCH)

    Energy Technology Data Exchange (ETDEWEB)

    Sabri, A., E-mail: sabri.ali@gmail.com [University of Kwazulu Natal, College of Health Sciences, Nelson R Mandela School of Medicine, School of Surgical Disciplines, Department of Radiology, Private Bag 7, Congella 4013, Durban (South Africa); Robbs, J.V., E-mail: jvrobbs@mweb.co.za [University of Kwazulu Natal, College of Health Sciences, Nelson R Mandela School of Medicine, School of Surgical Disciplines, Department of Surgery, Durban (South Africa); Maharajh, J., E-mail: Jaynund.Maharajh@kznhealth.gov.za [University of Kwazulu Natal, College of Health Sciences, Nelson R Mandela School of Medicine, School of Surgical Disciplines, Department of Radiology, Private Bag 7, Congella 4013, Durban (South Africa); Sikwila, T.C., E-mail: tcsikwila@yahoo.co.uk [University of Kwazulu Natal, College of Health Sciences, Nelson R Mandela School of Medicine, School of Surgical Disciplines, Department of Radiology, Private Bag 7, Congella 4013, Durban (South Africa)

    2011-11-15

    Imaging studies are indispensable in order to determine the source, location and pattern of intra and extra-axial brain haemorrhages. In our study of 277 patients carried out over an 18 month period, the most common reason of referral was subarachnoid haemorrhage followed by trauma. Aneurysms were the most common diagnosis (36%) with anterior and posterior communicating arteries being the most common locations. Fifty percent (50%) of patients investigated had a normal study. Our findings show that the yield from MDCTA and conventional angiography was relatively comparable, however, conventional angiography was superior in detection of aneurysms; hence, in cases were the MDCTA result was found to be normal despite a high index of suspicion for a subarachnoid haemorrhage, a follow-up MDCTA study or conventional angiography is useful. Moreover, conventional angiography was superior in detection of multiple aneurysms.

  19. Descriptive retrospective analysis of the diagnostic yield and morbidity of four vessel catheter-directed cerebral angiography and multidetector computed tomographic angiography (MDCTA) performed at Inkosi Albert Luthuli Central Hospital (IALCH)

    International Nuclear Information System (INIS)

    Imaging studies are indispensable in order to determine the source, location and pattern of intra and extra-axial brain haemorrhages. In our study of 277 patients carried out over an 18 month period, the most common reason of referral was subarachnoid haemorrhage followed by trauma. Aneurysms were the most common diagnosis (36%) with anterior and posterior communicating arteries being the most common locations. Fifty percent (50%) of patients investigated had a normal study. Our findings show that the yield from MDCTA and conventional angiography was relatively comparable, however, conventional angiography was superior in detection of aneurysms; hence, in cases were the MDCTA result was found to be normal despite a high index of suspicion for a subarachnoid haemorrhage, a follow-up MDCTA study or conventional angiography is useful. Moreover, conventional angiography was superior in detection of multiple aneurysms.

  20. [Rapid 3-Dimensional Models of Cerebral Aneurysm for Emergency Surgical Clipping].

    Science.gov (United States)

    Konno, Takehiko; Mashiko, Toshihiro; Oguma, Hirofumi; Kaneko, Naoki; Otani, Keisuke; Watanabe, Eiju

    2016-08-01

    We developed a method for manufacturing solid models of cerebral aneurysms, with a shorter printing time than that involved in conventional methods, using a compact 3D printer with acrylonitrile-butadiene-styrene(ABS)resin. We further investigated the application and utility of this printing system in emergency clipping surgery. A total of 16 patients diagnosed with acute subarachnoid hemorrhage resulting from cerebral aneurysm rupture were enrolled in the present study. Emergency clipping was performed on the day of hospitalization. Digital Imaging and Communication in Medicine(DICOM)data obtained from computed tomography angiography(CTA)scans were edited and converted to stereolithography(STL)file formats, followed by the production of 3D models of the cerebral aneurysm by using the 3D printer. The mean time from hospitalization to the commencement of surgery was 242 min, whereas the mean time required for manufacturing the 3D model was 67 min. The average cost of each 3D model was 194 Japanese Yen. The time required for manufacturing the 3D models shortened to approximately 1 hour with increasing experience of producing 3D models. Favorable impressions for the use of the 3D models in clipping were reported by almost all neurosurgeons included in this study. Although 3D printing is often considered to involve huge costs and long manufacturing time, the method used in the present study requires shorter time and lower costs than conventional methods for manufacturing 3D cerebral aneurysm models, thus making it suitable for use in emergency clipping. PMID:27506842