Blunt carotid artery injury is uncommon, yet not rare. However, it is often underdiagnosed because of inconsistent early symptoms or masking by the presence of coexisting brain and spinal injuries. The delay between the accident and the onset of cerebral ischemic symptoms is variable and has been reported to range from minutes to ten years. However, to our knowledge, there has been no report on a case presented with delayed intracerebral hemorrhage 25months after blunt carotid artery injury. We report on a case with discussion of supporting evidence and possible mechanisms.
Brain ; Carotid Arteries* ; Carotid Artery Injuries* ; Cerebral Hemorrhage ; Masks ; Spinal Injuries

Although obstruction of the carotid artery after head trauma or non-penetrating injuries of the neck had been well known, reports of occlusion of middle cerebral artery following closed head trauma are rare. Up to now Jacque, et al, have found only 22 cases of posttraumatic middle cerebral artery occlusion including their own one case in the world literatures since DeVeer and Browder reported the first case in 1942. We report a case of posttraumatic middle cerebral artery occlusion. The patient developed right hemiplegia, aphasia and mental confusion 2 days following closed head trauma. Left cerotid angiograms revealed complete occlusion of the horizontal portion of the left middle cerebral artery distal to the origin of the lenticulostriate branches. Previously reported cases are review and possible pathophysiological mechanisms discussed.
Aphasia ; Carotid Arteries ; Craniocerebral Trauma ; Head Injuries, Closed ; Hemiplegia ; Humans ; Infarction, Middle Cerebral Artery* ; Middle Cerebral Artery* ; Neck

Two cases of the traumatic aneurysms of the pericallosal artery that occurred after closed head injury are reported. The mental deterioration, urinary in continence and crural-predominent hemiparesis are attributable to the delayed intracranial hemorrhage after rupture of the traumatic aneurysms of the pericallosal artery. As soon as the diagnosis has been confirmed by the cerebral angiography, surgical treatment is recommended to reduce the high mortality and morbidity and the procedure as in the congenital aneurysm.
Aneurysm* ; Arteries* ; Cerebral Angiography ; Diagnosis ; Head Injuries, Closed ; Intracranial Hemorrhages ; Mortality ; Paresis ; Rupture

We present a case in which an arterial rupture occurring during embolization of an arteriovenous malformation of the left occipital lobe with a flow-directed micro-catheter,was successfully sealed with a small amount of glue. We navigated a 1.8-Fr Magic catheter through the posterior cerebral artery, and during superse-lective test injection, extravasation was observed at the parieto-occipital branch. The catheter was not removed and the perforation site was successfully sealed with a small amount of glue injected through the same catheter. Prompt recogni-tion and closure of the perforation site is essential for good prognosis.
Adult ; Case Report ; Cerebral Arteries/*injuries ; Embolization, Therapeutic/*adverse effects ; *Enbucrilate ; Human ; Intracranial Arteriovenous Malformations/*therapy ; *Iodized Oil ; Male ; Rupture

Traumatic middle cerebral artery occlusion has rarely been discussed in the neurosurgical literature. Since Deveer and Browder reported the first case in 1942, only 24 cases of postraumatic middle cerebral artery occlusion has been reported until now. We experienced 2 cases of posttraumatic middle cerebral artery occlusion recently. One patient was 39 years old male who developed right hemiplegia, aphasia, and mental confusion after blunt head injury. Left carotid angiography was done and it revealed complete obstruction of the moddle cerebral artery in its initial portion. The other patient transfered to our Emergency Room under the semicomatous state with multiple facial laceration wounds. Simple skull X-ray revealed multiple linear skull fractures on the left frontal region. Left carotid angiogram showed complete obstruction of left middle cerebral artery in its proximal portion like as former case. During hospitalization, marked improvement was showed in both cases under the conservative treatment with steroid and low molecular weight dextran.
Adult ; Angiography ; Aphasia ; Cerebral Arteries ; Dextrans ; Emergency Service, Hospital ; Head Injuries, Closed ; Hemiplegia ; Hospitalization ; Humans ; Infarction, Middle Cerebral Artery* ; Lacerations ; Male ; Middle Cerebral Artery* ; Molecular Weight ; Skull ; Skull Fractures ; Wounds and Injuries

Traumatic intracranial aneurysm is a rare complication of severe head injury. Compared with traumatic aneurysm involving the supraclinoid portion of the internal carotid, distal anterior cerebral, and middle cerebral artery, traumatic aneurysm located in the posterior fossa is extremely rare. The authors present a case of traumatic aneurysm involving the posterior inferior cerebellar artery after a severe closed head injury. The patient presented with intraventricular hemorrhage, but there was no evidence of skull fracture. Cerebral angiography revealed a large aneurysm located in the posterior inferior cerebellar artery; repeated angiography demonstrated an enlarged aneurysm following sudden clinical deterioration fifteen days after initial trauma. The PICA was embolized with a tungsten and platinum coil and far lateral suboccipital craniectomy was performed for decompression. Pathologic findings of the resected aneurysm were compatible with a pseudoaneurysm.
Aneurysm* ; Aneurysm, False ; Angiography ; Arteries* ; Cerebral Angiography ; Craniocerebral Trauma ; Decompression ; Embolization, Therapeutic ; Head Injuries, Closed ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Pica ; Platinum ; Skull Fractures ; Tungsten

OBJECTIVETo investigate the application of the expanded submental island flap in facial soft tissue defect.

METHOD12 patients with facial soft tissue defects were treated with the expanded submental island flaps during September 2004 to September 2008. At the first stage, soft tissue expander was implanted in the neck. At the second stage, the submental island flap was designed to repair the facial soft tissue defect. The largest size of the flap was about 16 cm x 9 cm.

RESULTAll flaps survived well except for one case of partial epidermal necrosis at the distal part of the flap. The wound healed with dressing. 4 patients were followed up for 6-24 months with satisfactory results.

CONCLUSIONThe submental artery was a constant branch of facial artery. Large cervical flap with high quality tissue can be provided after expansion. The expanded submental island flap is a good choice for repairing the facial soft tissue defect.

Adolescent ; Adult ; Cerebral Arteries ; transplantation ; Child ; Facial Injuries ; surgery ; Female ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Young Adult

OBJECTIVES: Extracranial-intracranial (EC-IC)bypass procedures have proved useful in selected patients with cerebral ischemia. We have experienced EC-IC bypass procedures in 85 patients with hemodynamic cerebral ischemia, moya moya and complicated aneurysm. In this study, complications after EC-IC bypass procedures was investigated. METHODS: Authors performed EC-IC bypass surgery for augmentation of cerebral blood flow in 85 patients for recent 7 years. Of 85 patients, the pathologic lesions were artherosclerotic hemodynamic cerebral ischemia in 60, moya moya in 14, complicated aneurysm in 9, and traumatic occlusion of the carotid artery in 2. An superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was performed in 67 cases and graft bypass with saphenous vein or radial artery in 18 cases. RESULTS: Of 85 patients who underwent bypass surgery, 63 had an uneventful postoperative course. Fifteen patients had hyperperfusion syndrome that included temporary neurologic deficit in 7, reperfusion hemorrhage in 3, seizure in 3, and neusea and vomiting in 2. Five patients had wound problems. Permanant neurologic deficit and complete obstruction of the preoperative stenotic lesion occured in one respectively. All patients except three cases of reperfusion hemorrhage and one case of permanent neurologic deficit recovered completely. Two of three cases of reperfusion hemorrhage and one case of permanent neurologic deficit recovered with minor neurologic deficit, and the remaining one case of reperfusion hemorrhage died. CONCLUSION: EC-IC bypass surgery is a reliable and reasonably safe method for establishing new pathways of collateral circulation to the brain. However, this operation can have potential complications by relative hyperperfusion of chronically hypoperfused and presumably dysautoregulated region, and new flow pattern after bypass. Bypass is deferred to 8 weeks till impaired autoregulation is restored after acute cerebral infarction. And blood pressure should be controlled closely throughout the immediate postoperative period.
Aneurysm ; Blood Pressure ; Brain ; Brain Ischemia ; Carotid Arteries ; Cerebral Arteries ; Cerebral Infarction ; Collateral Circulation ; Hemodynamics ; Hemorrhage ; Homeostasis ; Humans ; Neurologic Manifestations ; Postoperative Period ; Radial Artery ; Reperfusion ; Saphenous Vein ; Seizures ; Transplants ; Vomiting ; Wounds and Injuries

Cerebral infarcts rarely occur following head injury. Carotid artery dissection is usually proposed mechanism in such cases. We experienced a case of middle cerebral artery (MCA) infarct occurred just after head trauma without evidence of vascular abnormality. A 59-year-old male was transported to the emergency room immediately after traffic accident. He had right zygomatic fracture without neck injury. Left hemiparesis was noticed, and brain CT revealed hyperdense MCA sign in the right side. His neurologic status deteriorated over 2 days, and brain MRI showed total right MCA infarct with midline shift. Cerebral angiography was unremarkable. Two months later he had improved so much, but left hemiparesis with right MCA infarction re-developed. We suggest head trauma immediately can induce cerebral infarct without neck vessel injury, and in differential diagnosis of focal neurologic deficit after trauma, cerebral infarct as well as hemorrhage or contusion must be considered.
Accidents, Traffic ; Brain ; Carotid Arteries ; Cerebral Angiography ; Contusions ; Craniocerebral Trauma* ; Diagnosis, Differential ; Emergency Service, Hospital ; Head* ; Hemorrhage ; Humans ; Infarction, Middle Cerebral Artery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Middle Cerebral Artery* ; Neck ; Neck Injuries ; Neurologic Manifestations ; Paresis ; Zygomatic Fractures

Perfusion study should be preoperatively required for the trapping of an internal carotid artery (ICA) in the traumatic pseudoaneurysm in the petrous ICA. A 23-year-old man was admitted with a semicomatose consciousness after a passenger traffic accident. A fracture on the right petrous apex and a pseudoaneurysm in the right petrous ICA was found in the brain computed tomography (CT) angiogram. The size of aneurysm grew in the catheter angiogram at the 3rd day of trauma. One-day protocol of brain single photon emission CT (SPECT), which the first scan with 20 mCi of technetium-99m-ethyl cysteinate diethylester ((99m)Tc-ECD) and the second scan with 40 mCi in double dose at 15 minutes during the balloon test occlusion (BTO) at the same day, was done for the perfusion evaluation before trapping the right ICA. Perfusion asymmetry was aggravated of 21% at the post-occlusion scan in the right frontal cortex. So, he got a superficial temporal artery-middle cerebral artery anastomosis and then ICA trapping. After the surgery, he recovered consciousness and went back to his normal life. He has not developed new neurologic symptom for 8 years. Brain SPECT with double-dose injection of (99m)Tc-ECD may be a useful tool to be performed with BTO.
Accidents, Traffic ; Aneurysm ; Aneurysm, False* ; Brain ; Carotid Artery Injuries ; Carotid Artery, Internal* ; Catheters ; Cerebral Arteries ; Consciousness ; Humans ; Neurologic Manifestations ; Perfusion* ; Tomography, Emission-Computed, Single-Photon ; Young Adult