Female ; Humans ; Middle Aged ; Radiography ; Subarachnoid Hemorrhage ; cerebrospinal fluid ; diagnosis ; diagnostic imaging

Simultaneous occurrence of aneurysmal subarachnoid hemorrhage (SAH) and hypertensive intracerebral hemorrhage (ICH) is very rare and only two cases have been previously reported in the literatures. We present a case of 68-yr-old man with a history of untreated hypertension, who suffered from sudden onset of headache followed by right hemiparesis. Computed tomographic (CT) scan revealed SAH in the basal cistern and remote ICH at the left putamen. Cerebral angiography showed a saccular aneurysm at the anterior communicating artery. No other vascular anomaly could be found at left putaminal area. Nine days after the ictal attack of SAH, the neck of aneurysm was clipped via the left frontotemporal craniotomy. Because of the ICH at the left frontal lobe and intraventricular hematoma on postoperative CT, we performed hematoma removal and external ventricular drainage 3 hours after the first operation. Postoperative neurological status had been improved to be drowsy and he was discharged in a severely disabled state 4 weeks after surgery. We suggest that the rupture of aneurysm possibly caused a rapid increase in blood pressure and subsequently resulted in hypertensive ICH.
Aged ; Aneurysm, Ruptured/*complications/radiography/surgery ; Carotid Arteries/radiography ; Humans ; Intracranial Hemorrhage, Hypertensive/*complications/radiography/surgery ; Male ; Putaminal Hemorrhage/*complications/radiography/surgery ; Subarachnoid Hemorrhage/*etiology/radiography/surgery ; Tomography, X-Ray Computed

We have had 37 patients with cerebral arteriovenous malformation and subarachnoid hemorrhage, who were admitted to the Department of Neurosurgery, Yonsei Medical Center from 1964 to 1976. All of the cerebral arteriovenous malformations were proved by cerebral angiography. Since the site of the lesions were considered to have a close relation to the neurologic deficit and the results of surgery, various analysis of clinical manifestations and of the cerebral angiographic findings were attempted. Out of 37 patients, surgery was performed in 28 and the results were analysed according to the various type of surgical procedure.
Adolescent ; Adult ; Cerebral Angiography ; Child ; Child, Preschool ; Female ; Human ; Infant ; Infant, Newborn ; Intracranial Arteriovenous Malformations/radiography ; Intracranial Arteriovenous Malformations/surgery* ; Male ; Methods ; Middle Age ; Subarachnoid Hemorrhage/radiography ; Subarachnoid Hemorrhage/surgery

Branchio-oto-dysplasia is characterized by abnormalities of embryonic branchial arch system and deafness inherited as autosomal dominant with variable gene expression. We present a rare case of multiple intracranial aneurysms associated with branchio-oto-dysplasia. A 40-yr-old man with severe headache presented as spontaneous subarachnoid hemorrhage on brain computed tomographic scan. The patient also manifested clinical features of branchio-oto-dysplasia and right hemifacial hypoplasia. Carotid angiogram confirmed an aneurysm in the anterior communicating artery. Intraoperative findings demonstrated multiple aneurysms in the anterior communicating artery and in the left posterior communicating artery, which were clipped successfully. Postoperative course was uneventful. This condition has not been reported previously. We also reviewed literatures to discuss whether the intracranial aneurysm was as a coincidental finding or a part of this malformation.
Adult ; Branchio-Oto-Renal Syndrome/*complications ; Cerebral Angiography ; Human ; Intracranial Aneurysm/*etiology/radiography ; Subarachnoid Hemorrhage/etiology/radiography ; Temporal Bone/abnormalities ; Tomography, X-Ray Computed ; Zygoma/abnormalities

OBJECTIVE: We wanted to present our experiences for performing transradial cerebral angiography during the learning period, and we also wanted to demonstrate this procedure's technical feasibility and utility in various clinical situations. MATERIALS AND METHODS: Thirty-two patients were enrolled in the study. All of them had unfavorable situations for performing transfemoral angiography, i.e., IV lines in the bilateral femoral vein, a phobia for groin puncture, decreased blood platelet counts, large hematoma or bruise, atherosclerosis in the bilateral femoral artery and the insistence of patients for choosing another procedure. After confirming the patency of the ulnar artery with a modified Allen's test and a pulse oximeter, the procedure was done using a 21-G micorpuncture set and 5-F Simon II catheters. After angiography, hemostasis was achieved with 1-2 minutes of manual compression and the subsequent application of a hospital-made wrist brace for two hours. The technical feasiblity and procedure-related immediate and delayed complications were evaluated. RESULTS: The procedure was successful in 30/32 patients (93.8%). Failure occurred in two patients; one patient had hypoplasia of the radial artery and one patient had vasospasm following multiple puncture trials for the radial artery. Transradial cerebral angiography was technically feasible without significant difficulties even though it was tried during the learning period. Pain in the forearm or arm developed in some patients during the procedures, but this was usually mild and transient. Procedure-related immediate complications included severe bruising in one patient and a small hematoma in one patient. Any clinically significant complication or delayed complication such as radial artery occlusion was not demonstrated in our series. CONCLUSION: Transradial cerebral angiography is a useful alternative for the patients who have unfavorable clinical situations or contraindications for performing transfemoral cerebral angiography. For the experienced neurointerventionalists, it seems that additional training for perfoming transradial cerebral angiography is not needed.
Subarachnoid Hemorrhage/radiography ; Radial Artery ; Middle Aged ; Male ; Intracranial Hemorrhages/radiography ; Humans ; Female ; Feasibility Studies ; Cerebral Angiography/*methods ; Catheterization/*methods ; Aged ; Adult

OBJECTIVE: The purpose of this retrospective study was to report the outcome of the endovascular treatment of eight patients with eight saccular posterior inferior cerebellar artery (PICA) aneurysms. MATERIALS AND METHODS: Over the last seven years (1999-2006), eight consecutive patients with saccular PICA aneurysms were treated by endovascular methods. Five of the aneurysms were presented with subarachnoid hemorrhaging, whereas three were discovered incidentally. Four of the aneurysms (3 ruptured and 1 incidental) were treated by intrasaccular coiling, whereas the remaining four (1 ruptured and 3 incidental) were treated by vertebral artery (VA) occlusion. RESULTS: Of the four aneurysms treated by intrasaccular coiling, three were completely packed with coils and one was partially packed. In three of four patients who underwent vertebral artery occlusions, follow-up digital subtraction angiographies demonstrated thrombosed aneurysms and PICA. No procedure-related morbidity occurred and no re-bleed was encountered during a follow-up examination (mean; 31 months). CONCLUSION: As a result of this study, we found that the endovascular management of saccular PICA aneurysms should be considered as safe and effective.
Adult ; Aged ; Aneurysm, Ruptured/radiography/*therapy ; Cerebellum/blood supply/*radiography ; Cerebral Angiography ; Embolization, Therapeutic/*methods ; Female ; Humans ; Incidental Findings ; Intracranial Aneurysm/radiography/*therapy ; Male ; Middle Aged ; Retrospective Studies ; Subarachnoid Hemorrhage/radiography/*therapy ; Treatment Outcome

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

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

OBJECTIVETo simulate the surgical approaches for intracranial aneurysms using three-dimensional CT angiography (3D-CTA) and assess the value of 3D-CTA in early microneurosurgery for ruptured intracranial aneurysms.

METHODSForty-eight patients with spontaneous subarachnoid hemorrhage due to ruptured intracranial aneurysm were confirmed by early operation. All the patients were classified according to Hunt-Hess, including 11 of grade I, 29 of grade II, and 8 of grade III. CTA was performed before the operation and surgical simulation was conducted. The preoperative findings on CTA and the intraoperative findings were compared and the clinical value of cerebral 3D-CTA was analyzed.

RESULTSPre-operative 3D-CTA clearly displayed the location, size and shape of the aneurysms, the axis direction of the aneurysm apex and the width of aneurysm neck. The spatial relation between the parent aneutysm artery, the aneurysm, the peripheral vessels and the bony structures were also demonstrated. These findings were basically consistent with the intraoperative findings. The Glasgow outcome score was 5 in 41 patients, 4 in 4 patients, 3 in 2 patients, and 2 in 1 patient upon discharge from the hospital.

CONCLUSIONSPreoperative 3D-CTA examination can simulate the surgery for ruptured aneurysms to help improve the surgical success rate.

Adult ; Aged ; Aneurysm, Ruptured ; diagnostic imaging ; surgery ; Cerebral Angiography ; methods ; Computer Simulation ; Female ; Humans ; Imaging, Three-Dimensional ; Intracranial Aneurysm ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography, Interventional ; Subarachnoid Hemorrhage ; diagnostic imaging ; etiology ; surgery ; Tomography, Spiral Computed