3 cases of intracranial aneurismal residue following clipping at Viet Duc Hospital were studied. The causes of this condition were anatomical and technical. It is necessary to identified prior surgery the cause of hemorrhage, to limit the disruption of aneurism, to expose entirely the neck of aneurism before the setting of clip and to explore throughly the place of clip- Anterigraphy or systematic Xray control should be made for checking the results
Intracranial Aneurysm ; etiology ; Aneurysm ; Intracranial Arterial Diseases

OBJECTIVEThe aim of the study was to determine the prevalence and the distribution pattern of lesion site of intracranial vascular stenosis and to identify risk factors for the stenosis in patients with essential hypertension.

METHODSA total of 231 consecutive inpatients with essential hypertension were included in this study. Patients with the history of cerebrovascular diseases and relevant neurological symptoms were excluded. Intracranial vascular stenosis (>50% diameter reduction) was detected using CT angiography (CTA).

RESULTSOf 231 patients, 69 (29.87%) had intracranial artery stenosis. The most common stenosis site is middle cerebral artery (43.69%), followed by carotid siphon (20.39%). The stenosis in internal carotid arterial system (78.64%) was more common than in vertebrobasilar arterial system (21.56%, P < 0.05). The patients with intracranial vascular stenosis were older, had longer history of hypertension, higher levels of systolic blood pressure, higher plasma cholesterol, higher LDL-C. Lp (a), higher urinary microalbumin excretion, thicker ventricular septum, and lower levels of HDL-C than the patients without stenosis. Logistic analysis showed that systolic blood pressure (OR 1.650, 95% CI 1.134 - 2.400, P = 0.023), course of hypertension (OR 1.238, 95% CI 1.072 - 1.429, P = 0.006), LDL-C (OR 2.103, 95% CI 1.157 - 3.823, P = 0.014) and type 2 diabetes (OR 2.325, 95% CI 1.161 - 4.341, P = 0.011) were the independent risk factors of asymptomatic intracranial arterial stenosis.

CONCLUSIONSNearly 30% inpatients with essential hypertension had asymptomatic intracranial artery stenosis. The most common site of stenosis was middle cerebral artery. Hypertension, dyslipidemia and diabetes were risk factors for the development of intracranial arterial stenosis.

Aged ; Cerebral Angiography ; Female ; Humans ; Hypertension ; epidemiology ; pathology ; Intracranial Arterial Diseases ; epidemiology ; Male ; Middle Aged ; Prevalence ; Risk Factors

Adult ; Aneurysm, False ; etiology ; therapy ; Embolization, Therapeutic ; Humans ; Intracranial Arterial Diseases ; etiology ; therapy ; Male ; Wounds and Injuries ; therapy

Two angiographic instances of anomalous external carotid artery (ECA) and internal carotid artery (ICA) anastomosis are described, each occurring at the C2-3 level and bearing remnants of proximal ICA. The ICA remnant of one patient (identifiable immediately upon bifurcation of the common carotid artery) was hypoplastic, and that of the other patient was an occluded arterial stump. These features are not typical of non-bifurcating ICA. The occipital artery originated from an anomalous connection in one instance and from the main trunk of the ECA (just past the ECA-ICA connection) in the other.
Adult ; Arterial Occlusive Diseases/radiography ; Carotid Artery, External/*abnormalities/radiography/surgery ; Carotid Artery, Internal/*abnormalities/radiography/surgery ; Cerebral Angiography ; Humans ; Intracranial Aneurysm/*radiography/surgery ; Male ; Middle Aged

Direct laryngoscopy and endotracheal intubation is accompanied by mechanical stimulation of the laryngopharynx & by sympathetic timulation, as reflected by an increase in heart rate and blood pressure. The purpose of this study is to evaluate effects of certain drugs on blood pressure and heart rate during intubation. We intravenously administered some drugs prior to laryngoscopy and endotracheal intubation in adult patients with ASA class 1-2. Seventy-two patients were devided into four groups as follows: Group 1: Control group (none, n=18). Group 2: Lidocaine only (n=18). Group 3: Lidocaine (1 mg/kg) and d-Tubocurarine (3mg)(n=18). Group 4: Lidocaine (1mg/kg), d-Tubocurarine (3mg) and diazepam (0.1mg/kg)(n=18). Blood pressure, heart rate, mean arterial pressure, rate-pressure product, aterial blood gas were measured before induction, after induction, immediately after intubation and at 1, 2, 3 & 5 minutes after intubation. The results were as follows: 1) There were no significant differences in preinduction values of blood pressure, heart rate, rate-pressure product, arterial blood gas. 2) Systolic blood pressure increased significantly 2 minutes after the intubation in all groups and rapidly returned to the preinduction level in group 4, group 3 and then group 2 in that order compared to group l. 3) Diastolic and mean arterial pressure elevated significantly during intubation and rapidly retur- ned to the preinduction level in group 4, group 3 and then group 2 in that order compared to group l. 4) Heart rate increased significantly after the intubation in all groups and more rapidly returned to the preinduction levels 3 minutes after the intubation in group 4. 5) Rate-pressure product following the intubation was over 15,000 mmHg. beat/min in all groups, and more rapidly decreased 15,000 mmHg. beat/min at 2 minutes after the intubtion in group 4, 5 minutes after the intubation in group 3. 6) pH, PaCO2and PaO2values were within normal range following the intubation in all groups. In conclusion, it is suggested that the administration of lidocaine, d-tubocurarine and diazepam prior to the intubation is ideal for those patients with cardiovascular disease & increased intracranial pressure.
Adult ; Arterial Pressure ; Blood Pressure ; Cardiovascular Diseases ; Diazepam* ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypopharynx ; Intracranial Pressure ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy* ; Lidocaine* ; Reference Values ; Tubocurarine*

The greatest advances in understanding and treating stroke have occurred during the past 30 years. The advantages of ultrasound for vascular diagnosis are well known: it is a fast, portable, non-invasive, repeatable and inexpensive technique. Among various clinical situations for the application of ultrasound to stroke care, the best established ones include: (1) early detection and characterization of extracranial atherosclerosis and occlusive diseases especially at the carotid bifurcation; (2) evaluation of consequences of proximal arterial occlusive disease on the distal cerebral vasculature; (3) follow-up of the natural history and response to treatment of acute arterial occlusion that causes hyperacute stroke; (4) detection of microemboli associated with cardiac and aortic pathology and carotid artery surgical manipulation; and (5) follow-up of the time course and reversibility of cerebral vasospasm after subarachnoid hemorrhage. The field of ultrasonic diagnosis also has detractors and limitations. Even now, the technique is 'operator-dependent' in terms of the accuracy and validity of its results. Newer technology has provided significant advances in this regard; however, it is necessary for each laboratory to maintain a strict quality control in order to maximize the benefits that this powerful technology can provide.
Arterial Occlusive Diseases ; Atherosclerosis ; Carotid Arteries ; Diagnosis* ; Follow-Up Studies ; Natural History ; Pathology ; Quality Control ; Stroke* ; Subarachnoid Hemorrhage ; Ultrasonography* ; Vasospasm, Intracranial

OBJECTIVETo investigate the incidence, case fatality and risk factors of acute cerebral arterial thrombosis complicated by multiple organ dysfunction syndrome (MODS).

METHODSA retrospective study was conducted in 830 patients with acute cerebral arterial thrombosis, among whom 89 also developed MODS.

RESULTSThe incidence of MODS in these patients was 10.7% with case fatality of 58.4%. The presence of concurrent infection and increased number of organ involved both resulted in higher case fatality. The preceding health status, number of failing organs and score of neurologic impairment were the main fetal factors according to logistic regression analysis.

CONCLUSIONMODS usually occurs in two weeks after the onset of acute cerebral arterial thrombosis. Prevention of MODS involves rigorous treatment of the compromised organs and comprehensive systemic therapy in addition to the management of the primary diseases.

Cerebral Arterial Diseases ; complications ; diagnosis ; epidemiology ; mortality ; Female ; Humans ; Intracranial Thrombosis ; complications ; diagnosis ; epidemiology ; mortality ; Male ; Middle Aged ; Multiple Organ Failure ; complications ; diagnosis ; epidemiology ; mortality ; Prognosis ; Risk Factors

OBJECTIVETo evaluate the safety and short-term outcome of endovascular stent-assisted angioplasty for the treatment of intracranial arterial stenosis.

METHODSAngioplasty and stent placement were administered to treat 46 patients with lesions of atherosclerotic intracranial stenosis, including 16 lesions of basilar artery, 12 of vertebral artery, 13 of internal carotid artery and 9 of middle cerebral artery.

RESULTSTechnical success was achieved in 49 of 50 vessels (98%), with no procedure-related death or cerebral ischemic attack. Extracranial internal carotid artery dissection occurred in 1 patient and was successfully treated with a self-expand stent. One patient had subarachnoid hemorrhage because of perforation by microwire with no permanent neurologic deficit, and another 2 patients had groin hematoma. Angiographic examination immediately after stenting revealed that the stenosis rate was significantly reduced (72.4% +/- 12.3% vs 10.6% +/- 7.8%). There was no cerebral ischemic attack in the 37 patients who were clinically followed up (6 - 18 months, mean of 8.5 months).

CONCLUSIONAngioplasty and stenting for the treatment of intracranial stenosis is safe and feasible, and it may be favorable for decreasing the incidence of ischemic attack.

Aged ; Angioplasty ; adverse effects ; methods ; Brain Ischemia ; etiology ; metabolism ; Constriction, Pathologic ; surgery ; Female ; Follow-Up Studies ; Humans ; Intracranial Arterial Diseases ; surgery ; Male ; Middle Aged ; Stents

BACKGROUND: In Korean patients, atherosclerotic lesions are more often found in the intracranial rather than in the extracra-nial cerebral arteries compared to Caucasian patients. However, extracranial carotid artery lesions are increasingly recognized in recent years. (recognized by who? Do you mean increasingly found in Korean patients ?) Although some studies have shown Asians to have more intracranial diseases, patients with intracranial stenosis often have extracranial disease. The aim of this investigation was to determine the frequency of combined intracranial atherosclerotic lesions in patients with extracranial carotid disease and to analyze the differences in stroke risk factors between patients with pure extracranial carotid artery disease and those who have combined extra- and intracranial artery disease. METHODS: We reviewed 100 consecutive patients with extracranial carotid artery stenosis (defined as > 30% narrowing of diameter) or occlusion proven by a conventional angiogra-phy. We investigated the distribution of atherosclerotic lesions on the angiography and compared risk factors for atherosclerosis between the pure extracranial carotid occlusive group and the combined extra- and intracranial artery occlusive group. RESULTS: Among 100 patients with extracranial carotid occlusive lesions, combined intracranial stenosis (>30% narrowing of diameter) or occlusion was seen in 67 patients. Multivariate analysis showed that diabetes mellitus was the only factor that was associated with the combined extra- and intracranial artery occlusive groups (p < 0.05). CONCLUSIONS: The combined extra- and intracranial atherosclerotic lesions was were frequently seen in Korean patients. Diabetes mellitus may play an important role in the devel-opment of intracranial atherosclerosis in patients who have combined extra- and intracranial occlusive disease.
Angiography ; Arteries ; Asian Continental Ancestry Group ; Atherosclerosis ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Stenosis ; Cerebral Arterial Diseases ; Cerebral Arteries ; Constriction, Pathologic ; Diabetes Mellitus ; Humans ; Intracranial Arteriosclerosis* ; Multivariate Analysis ; Risk Factors* ; Stroke*

BACKGROUND/AIMS: As an underprivileged population, homeless people have a higher incidence of morbidity and mortality than do non-homeless people. Diabetes mellitus is a chronic disease associated with high complication rates; its incidence is increasing rapidly and it requires prompt, adequate treatment and care. Therefore, we investigated the quality of medical care provided to homeless diabetics in a general hospital and comorbidities associated with diabetes. METHODS: Between March 25, 2011 and December 31, 2012, we retrospectively investigated the medical records of the diabetes patients at a general hospital in Seoul. We assigned the patients into two groups: homeless (n = 82) and non-homeless (n = 242) patients. We subsequently compared the clinical and laboratory findings, comorbidities, and complications between the two groups. RESULTS: The homeless diabetics received treatment less regularly than the non-homeless patients and were diagnosed with diabetes while visiting the hospital for the treatment of other diseases. The homeless patients had higher glycated hemoglobin A1c levels than the non-homeless patients. The homeless patients had a higher rate of other diseases, such as peripheral artery disease, acute infectious disease, intracranial hemorrhage, and pulmonary tuberculosis; a higher incidence of acute infectious disease (odds ratio [OR], 15.671; 95% confidence interval [CI], 5.115-48.070); and a higher prevalence of pulmonary tuberculosis (OR, 6.423; 95% CI, 1.785-23.116) than the non-homeless patients, as determined by multivariate analysis. CONCLUSIONS: Comorbid acute infectious disease and pulmonary tuberculosis were found more frequently in homeless diabetes patients presenting to the hospital than in non-homeless diabetes patients. Therefore, attention should be paid to this differentiating factor.
Chronic Disease ; Communicable Diseases ; Comorbidity* ; Diabetes Mellitus ; Hemoglobin A, Glycosylated ; Homeless Persons ; Hospitals, General* ; Humans ; Incidence ; Intracranial Hemorrhages ; Medical Records ; Mortality ; Multivariate Analysis ; Peripheral Arterial Disease ; Prevalence* ; Retrospective Studies ; Seoul ; Tuberculosis, Pulmonary