Persistent trigeminal artery (PTA) can be associated with hypoplasia of the proximal basilar and ipsilatereal vertebral artery. This can predispose adults to posterior circulation ischemia by a low flow state. A 40 year-old male presented with diplopia, dizziness and motor weakness in all extremities. He had no conventional risk factors of ischemic stroke. In brain Magnetic Resonance Imaging (MRI), acute infarction was observed in medulla, pons and cerebellum. PTA was also discovered with hypoplasia of vertebrobasilar system in brain Magnetic Resonance Angiography (MRA).
Adult ; Arteries* ; Brain ; Cerebellum ; Cerebral Infarction* ; Diplopia ; Dizziness ; Extremities ; Humans ; Infarction ; Ischemia ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Pons ; Risk Factors ; Stroke ; Vertebral Artery

Rare middle cerebral artery (MCA) fenestration and unruptured aneurysms of the both MCA bifurcations was discovered by CT angiography and confirmed during surgery. An aneurysm arising from the left MCA bifurcation was clipped. The postoperative course was excellent. The authors discuss the pathogenesis and clinical meanings of the MCA fenestration.
Aneurysm* ; Angiography ; Middle Cerebral Artery*

Recently, favorable outcomes have been reported after the endovascular treatment of either ruptured or unruptured paraclinoid aneurysms. The complications specifically related to the endovascular treatment of paraclinoid aneurysms have also been reported in other studies. Visual symptoms related to the mass effects associated with giant paraclinoid aneurysm normally improve after coil embolization. However, these symptoms have also been reported to be exacerbated in some cases. The authors here report an unusual case of progressive visual loss occurring after endovascular coiling treatment in a case of a large paraclinoid aneurysm.
Aneurysm* ; Embolization, Therapeutic

The authors present the case of a patient who suffered from cerebellar dysfunction, radiographically documented brainstem compression, and neurological deterioration after proximal artery occlusion in a giant vertebral artery aneurysm. Symptom resolution was achieved after complete embolization of remained lumen of aneurysm. The cause of neurological deterioration is brainstem compression due to mass effect of the aneurysm. In order to avoid this fatal complication, it is necessary to determine appropriate therapy for the vertebral artery giant aneurysm by evaluating cerebral blood flow and other factors about growth of aneurysm.
Aneurysm* ; Arteries* ; Brain Stem ; Cerebellar Diseases ; Humans ; Vertebral Artery*

OBJECTIVE: The authors investigated the role of transcranial Doppler ultrasound (TCD) in clinical decision making about vasospasm due to subarachnoid hemorrhage (SAH). METHODS: In this retrospective study, a total of 383 patients, admitted to our hospital between January 2001 to December 2004 and treated surgically with the diagnosis of aneurysmal SAH, were examined by TCD. RESULTS: Blood flow velocity (BFV) was significantly lower in older patients than in younger patients (p<0.01). BFV in the hypertensive patients were not significantly lower than in the normotensive individuals (p=0.93). The amount of blood clots in the computed tomography after SAH was significantly correlated with BFV (p<0.01). However, there was no statistically significant difference between Hunt-Hess Grade and BFV (p=0.54). The maximum mean flow velocity was greater in 54 patients who developed a delayed ischemic neurological deficit(DIND, 144.1 cm/sec) than in 221 patients who did not develop DIND (94.3 cm/sec, p=0.04). A maximum velocity increase of 40.6 cm/sec/24hr was recorded higher in patients with DIND, compared to that of 22.6 cm/sec/24 hr in patients without DIND (p<0.01). Lindegaard's index (LI) was higher in patients with DIND (4.6) than in those without DIND (2.8, p<0.01). Peak velocity, maximum velocity increase, and LI can thus assist in diagnosis of DIND, however, when those readings made before onset of DIND were considered, there was only significant difference in LI between the groups. CONCLUSION: Serial TCD studies after SAH are of value to detect cerebral vasospasm, especially, LI is significantly correlated with identifying patients who later develop DIND.
Aneurysm* ; Blood Flow Velocity ; Decision Making ; Diagnosis ; Humans ; Intracranial Aneurysm ; Reading ; Retrospective Studies ; Subarachnoid Hemorrhage* ; Ultrasonography ; Vasospasm, Intracranial*

A 47-year-old man was admitted to the emergency department due to a sudden onset of headache during exercise. Brain computed tomography (CT) and CT angiography showed a subarachnoid hemorrhage (SAH) with a small sac in the left posterior communicating (pcom) artery and total obstruction in the proximal portion of the right middle cerebral artery (MCA). Catheter angiography revealed a protruding lesion in the left p-com artery and a total obstruction in the right MCA. It was difficult to differentiate the aneurysm from the occlusion of the pcom artery. We planned to confirm whether or not the protruded lesion was an aneurysm. Intraoperatively, the aneurysmal opacification seen on the preoperative catheter angiography proved it to be the occluded p-com artery filled with thrombus. The possibility of a vascular stump should be considered when diagnosing a protruding vascular lesion at the p-com artery.
Aneurysm ; Angiography ; Arteries ; Brain ; Catheters ; Emergencies ; Headache ; Humans ; Middle Aged ; Middle Cerebral Artery ; Subarachnoid Hemorrhage ; Thrombosis

A 58-year-old man who underwent mitral valve replacement for mitral valve prolapse that was complicated by severe mitral regurgitation was referred to our department due to his sudden onset of drowsiness. Brain computed tomography revealed a hemorrhage in the anterior interhemispheric fissure and left frontal lobe. Cerebral angiography demonstrated a saccular aneurysm at the angular branch of the middle cerebral artery (MCA), but there was no evidence of vascular abnormalities at the hemorrhagic area. End-to-end anastomosis of the angular branch was performed after resection of the friable aneurysm and the perianeurysmal parent artery segment. Follow-up cerebral angiography after three weeks showed an aneurysm in the distal anterior cerebral artery (ACA) in the previously hemorrhagic area. This ruptured aneurysm was successfully clipped. An infectious aneurysm was confirmed on the histopathological examination.
Aneurysm ; Aneurysm, Ruptured ; Anterior Cerebral Artery ; Arteries ; Brain ; Cerebral Angiography ; Follow-Up Studies ; Frontal Lobe ; Hemorrhage ; Humans ; Middle Aged ; Middle Cerebral Artery ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Parents ; Sleep Stages

Patients with achondroplasia manifest various neurologic symptoms including megaencephaly, hydrocephalus, and progressive myelopathy or radiculopathy secondary to spinal stenosis. However, only anecdotal postmortem reports proved ruptured aneurysm or vascular malformation as a source of intracranial hemorrhage. We herein report a case of a 26-year-old woman with achondroplasia who underwent uneventful surgical treatment for the aneurysmal subarachnoid hemorrhage. In this literature, we review the pathophysiologic mechanism and emphasize the necessity of considering the possibility of sudden mental deterioration in achondroplastic patient.
Achondroplasia* ; Adult ; Aneurysm* ; Aneurysm, Ruptured ; Female ; Humans ; Hydrocephalus ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Neurologic Manifestations ; Radiculopathy ; Spinal Cord Diseases ; Spinal Stenosis ; Subarachnoid Hemorrhage* ; Vascular Malformations

Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is often performed for the management of the patients wth chronic cerebral ischemic lesions or moyamoya disease. Postoperative aneurysm formation at the anastomosis site or its close proximity is a very rare complication. A 44-year-old female underwent bilateral STA-MCA bypass due to moyamoya disease. Approximately 2 years after bypass surgery, an aneurysm of the recipient cortical artery near the site of the anastomosis was found. Surgical exploration of the region demonstrated an 5.4 x 6.4 x 5 mm aneurysm arising near the site of the anastomosis. The aneurysm was clipped, taking care to keep the bypass flowing. This aneurysm had a thick wall and appeared to be a true saccular aneurysm caused by hemodynamic stress. The author present a case of this unusual complication and provide a brief review of literature.
Adult ; Aneurysm ; Arteries ; Cerebral Arteries* ; Cerebral Revascularization ; Female ; Hemodynamics ; Humans ; Middle Cerebral Artery* ; Moyamoya Disease

Intraoperative monitoring has been a valuable part in the cerebral aneurysm surgery. Insight into the nervous system and the relationship of the aneurysm to the adjacent structure during the surgery provide critical information to the surgeon allowing reversal or avoidance of neural insults and the complete clipping of the aneurysm. The goal of cerebral aneurysm surgery is to eliminate the risk of hemorrhage but not disrupt the surrounding vascular and neural structures. Several techniques including microvascular doppler ultrasonography, monitoring cerebral blood flow, evoked potentials, intraoperative angiography, endoscope assisted aneurysm surgery and neuronavigator system are used for the surveillance in the aneurysm surgery. The abnormal findings in these procedures can change surgical management during the surgery such as removal or readjustment of temporary or permanent clips and a decrease in brain retraction or manipulation. The additional feedback provided by intraoperative monitoring promises to improve the safety and efficacy of aneurysm surgery.
Aneurysm ; Angiography ; Brain ; Endoscopes ; Evoked Potentials ; Hemorrhage ; Intracranial Aneurysm* ; Monitoring, Intraoperative ; Nervous System ; Ultrasonography, Doppler