We present our recent experience of two rare cases of ruptured aneurysm of the azygos anterior cerebral together with a review of the literature. On admission, the patients were in clinical Grade 4 of Hunt and Hess classification. Cerebral angiograms showed a giant saccular aneurysm(25x10x10mm in size) on the distal bifurcation portion of the azygos anterior cerebral artery in one patient, and a medium sized saccular aneurysm(7x9mm in size) on the proximal portion of azygos anterior cerebral artery in the other patient. Both the patients underwent a successful, direct clipping of the aneurysmal neck through an interhemispheric and left parietal approach, respectively. One month later after the operations, one patient showed mutism and spastic paraparesis and the other remained in a drowsy mental status with left side hemiparesis. The pre-operative neurologic status and further neurologic deficits attributed to cerebral vasospasm are thought to be the most important prognostic factors in deciding the post-operative outcome in these patients.
Aneurysm ; Aneurysm, Ruptured* ; Anterior Cerebral Artery* ; Classification ; Humans ; Mutism ; Neck ; Neurologic Manifestations ; Paraparesis, Spastic ; Paresis ; Rabeprazole ; Vasospasm, Intracranial

In the evaluation of brain function, clinical examination is used for the brain stem, and EEG for the other part of the brain. However, EEG may be falsely silent in some cases due to medical treatment and technical artifact, and not used easily at postoperative state due to opertion wound contamination. We studied the findings of Tc-99m HMPAO Brain SPECT in 9 cases, who were diagnosed as brain death by currently accepted criteria. With normal cerebral perfusion, the radionuclide activity is primarily intracranial, whereas with brain death it is limited to the scalp. Tc-99m HMPAO cerebral perfusion scintigraphy was, non-invasive and reliable method for the diagnosis of the cerebral circulation, safely before apnea test.
Apnea ; Artifacts ; Brain Death* ; Brain Stem ; Brain* ; Diagnosis ; Electroencephalography ; Perfusion ; Perfusion Imaging ; Scalp ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon* ; Wounds and Injuries