Neurogenic pulmonary edema (NPE) leading to cardiopulmonary dysfunction is a potentially life-threatening complication in patients with central nervous system lesions. This case report describes a 28-yr woman with life-threatening fulminant NPE, which was refractory to conventional respiratory treatment, following the rupture of an aneurysm. She was treated successfully with extracorporeal membrane oxygenation (ECMO), although ECMO therapy is generally contraindicated in neurological injuries such as brain trauma and diseases that are likely to require surgical intervention. The success of this treatment suggests that ECMO therapy should not be withheld from patients with life-threatening fulminant NPE after subarachnoid hemorrhage.
Adult ; Brain/radiography ; Decompressive Craniectomy ; Extracorporeal Membrane Oxygenation ; Female ; Humans ; Intracranial Aneurysm/complications/*diagnosis ; Pulmonary Edema/*diagnosis/etiology/therapy ; Subarachnoid Hemorrhage/etiology ; Tomography, X-Ray Computed

Aged ; Craniocerebral Trauma ; complications ; Humans ; Magnetic Resonance Imaging ; Male ; Pituitary Apoplexy ; complications ; etiology ; Pituitary Neoplasms ; complications ; diagnosis ; Subarachnoid Hemorrhage ; etiology ; Tomography, X-Ray Computed

OBJECTIVETo assess the value of (1)H-magnetic resonance spectroscopy ((1)H-MRS) in evaluating cerebral vasospasm resulting from subarachnoid hemorrhage (SAH).

METHODSSix dogs were subjected to autologous non-heparinized blood injection via cisternal puncture twice at one-day interval to establish models of SAH, and another 6 received injections with normal saline in an identical manner. (1)H-MRS scan was performed on the 3rd, 7th and 14th days after the injections to measure the changes of N-acetylaspartate (NAA), creatine (Cr) and choline (Cho). After the (1)H-MRS scan, all the dogs underwent brain digital subtraction angiography (DSA) for determining the basilar artery diameter.

RESULTSDSA results on day 3 presented development of obvious vasospasm of the basilar artery, which was most evident on day 7 and recovered obviously on day 14. (1)H-MRS results demonstrated obvious changes of NAA, Cho and Cr on days 3 and 7 in SAH model group, and NAA declined to the lowest level on day 3 followed by gradual ascending till reaching the normal level on day 14. Cho decreased slightly on day 3, then increased and reached the peak level on day 7 and then decreased. Cr rose steadily from day 3 to 14, but since day 7, the rise slowed down obviously and Cr maintain a level not significantly different from that on day 14 (P>0.05). The functional results of (1)H-MRS were consistent with the DSA results.

CONCLUSION(1)H-MRS can be used to monitor the development of cerebral vasospasm resulting from SAH as a good evaluation method for functional imaging.

Animals ; Aspartic Acid ; analogs & derivatives ; metabolism ; Choline ; metabolism ; Creatine ; metabolism ; Dogs ; Female ; Magnetic Resonance Spectroscopy ; methods ; Male ; Protons ; Subarachnoid Hemorrhage ; complications ; Time Factors ; Vasospasm, Intracranial ; diagnosis ; etiology ; metabolism

Adult ; Cerebral Angiography ; Female ; Humans ; Intracranial Aneurysm ; complications ; diagnostic imaging ; Lupus Erythematosus, Systemic ; complications ; diagnostic imaging ; Subarachnoid Hemorrhage ; diagnosis ; diagnostic imaging ; etiology ; Young Adult

OBJECTIVETo discuss the early diagnostic methods and therapeutic principles of aneurysmal subarachnoid hemorrhage (SAH), and evaluate the therapeutic efficacy objectively.

METHODSUsing neuro-imaging examinations combined with case history and clinical symptoms to make the early diagnosis of 96 case with aneurysmal SAH, and Guglielmi detachable microcoil (GDC) was utilized for early intracapsular embolization in the ruptured aneurysms. Efficient symptomatic treatment was done early after operation.

RESULTSAll of 96 cases were early diagnosed and successfully embolized; Among them, the aneurysmal lumen was 100% occluded in 83 cases, 95% in 8 cases, 90% in 5 cases. There were 3 cases complicating with aneurysms rupture during operation, 5 cases with cerebral vasospasm. One case was affected by microcoil terminal escape after operation, 3 recurrent cases were all cured with secondary GDC embolization. There were 9 complications associated with embolization techniques and 13 cases (13.5%) occurring permanent sequelae associated with SAH. According to the Glasgow prognosis score, 77 patients got grade I, 7 grade II, 6 grade III, 3 grade IV, and 3 grade V. The mortality rate was 3.1%.

CONCLUSIONSTo make early etiological diagnosis of the SAH patients, using GDC to embolize the aneurysms, and earlier efficient symptomatic treatment are important methods to improve the curative rate and reduce the mortality rate.

Adult ; Aged ; Aneurysm, Ruptured ; complications ; diagnosis ; therapy ; Angiography ; methods ; Early Diagnosis ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; complications ; diagnosis ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Subarachnoid Hemorrhage ; diagnosis ; etiology ; therapy ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUNDIntracranial vessel injury is a severe complication of transsphenoidal surgery (TSS) for lesions of sellar region. The purpose of this study was to improve recognition of the complication.

METHODSThe clinical data of 400 cases of TSS for sellar region from 1964 to 2004 were reviewed retrospectively. Ten patients with complications of intracranial vessel injury were included in this study, 7 underwent transsphenoidal microsurgery and 3 underwent endoscopic TSS. Subarachnoid hemorrhage (SAH) occurred in 8 cases, hemorrhage of cavernous sinus in one, and post-operative cerebral hemorrhagic infarction caused by thrombosis of injured right internal carotid artery in one. The clinical data of all the patients were analyzed.

RESULTSThe SAH resulted from hemorrhage of residues of tumor in 2 patients and from damaged sellar and arachnoidea in 6 patients. The cause of hemorrhage of anterior intercavernous sinus was malformation of anterior intercavernous sinus. The reason of thrombus of internal carotid artery was manipulation of operation. Three patients died and six patients were cured. One patient lived with hemiplegia.

CONCLUSIONSThe cause of intracranial vessels injury of TSS is complicated. Detailed anatomic knowledge of seller and skilled operation is helpful to reduce the complication.

Adult ; Cerebral Infarction ; diagnosis ; etiology ; prevention & control ; Female ; Humans ; Intracranial Hemorrhages ; diagnosis ; etiology ; prevention & control ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Postoperative Complications ; diagnosis ; etiology ; prevention & control ; Retrospective Studies ; Sella Turcica ; surgery ; Subarachnoid Hemorrhage ; diagnosis ; etiology ; prevention & control ; Tomography, X-Ray Computed

Gnathostoma spinigerum can cause subarachnoid hemorrhage (SAH). The detection of specific antibodies in serum against G. spinigerum antigen is helpful for diagnosis of neurognathostomiasis. There is limited data on the frequency of G. spinigerum infection in non-traumatic SAH. A series of patients diagnosed as non-traumatic SAH at the Srinagarind Hospital, Khon Kaen University, Thailand between January 2011 and January 2013 were studied. CT or MR imaging of the brain was used for diagnosis of SAH. Patients were categorized as aneurysmal subarachnoid hemorrhage (A-SAH) or non-aneurysmal subarachnoid hemorrhage (NA-SAH) according to the results of cerebral angiograms. The presence of specific antibodies in serum against 21- or 24-kDa G. spinigerum antigen was determined using the immunoblot technique. The detection rate of antibodies was compared between the 2 groups. Of the 118 non-traumatic SAH patients for whom cerebral angiogram and immunoblot data were available, 80 (67.8%) patients had A-SAH, whereas 38 (32.2%) had NA-SAH. Overall, 23.7% were positive for specific antibodies against 21- and/or 24-kDa G. spinigerum antigen. No significant differences were found in the positive rate of specific antibodies against G. spinigerum in both groups (P-value=0.350).
Adult ; Aged ; Animals ; Antibodies, Helminth/*blood ; Antigens, Helminth/diagnostic use ; Brain/radiography ; Female ; Gnathostoma/immunology/*isolation & purification ; Gnathostomiasis/*diagnosis/*parasitology ; Humans ; Immunoblotting ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Serum/immunology ; Subarachnoid Hemorrhage/*diagnosis/*etiology ; Thailand ; Tomography, X-Ray Computed