No abstract available.
Diagnosis* ; Ischemia* ; Subarachnoid Hemorrhage*

No abstract available.
Latex* ; Polystyrenes* ; Potassium Channels* ; Potassium* ; Vasospasm, Intracranial*

No abstract available.
Bacteremia* ; Staphylococcus aureus* ; Staphylococcus*

The authors recently reported that over the years, the outcome of aneurysm surgery improved, and that surgical complications importantly affected this change. The present study was conducted to determine whether the incidence of symptomatic vasospasm in fact changed during the period under review, and the factors contributing to any changes. Between 1990 and 1995, 219 Hunt-Hess grade I to III patients with ruptured intracranial aneurysm underwent surgery within 3 days of subarachnoid hemorrhage ; all operations were performed by the same surgeon. Age, Hunt-Hess grade on admission, Fisher grade, hypertension, and hydrocephalus were analyzed to determine which factors were significant for syptomatic vasospasm, and for the periods 1990 to 1993, and 1994 to 1995, the distribution of each significant factor was then examined. Syptomatic vasospasm decreased significantly (p<0.05), but was seen in 28 of 124 patients(22.6%) treated beween 1990 and 1993 and 11 of 95(11.6%) treated between 1994 and 1995 ; no significant reduction of syptomatic vasospasm as a cause of mortality and morbidity (irreversible vasospasm) was seen, however, Fisher grade(p<0.05) and Hunt-Hess grade(p<0.05) significantly contributed to the development of symptomatic vasospasm, though the distribution of these two biologically significant factors was not statistically different. The question of whether or not surgery aggravates symptomatic vasospasm is controversial, and symptomatic vasospasm is, in addition, still an ill-defined disease entity. Except for the occurrence of fewer surgical complication and the fact that the incidence of reversible symptomatic vasospasm was less during the second period of treatment, no differences were found in the distribution of factors which significantly influenced symptomatic vasospasm, and this suggests that surgery affects the development of reversible symptomatic vasospasm. On the basis of increased risk of cerebral ischemia associated with surgery in vulnerable ischemic brain resulting from subarachnoid hemorrhage, the use of the term 'delayed ischemic neurologic deficit' after such hemorrhage appears to be more suitable than 'symptomatic vasospasm'.
Aneurysm* ; Brain ; Brain Ischemia ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Aneurysm ; Mortality ; Neurologic Manifestations* ; Subarachnoid Hemorrhage

A case of isolated dissecting aneurysm of the posterior cerebral artery responsible for ischemic episode and subarachnoid hemorrhage is reported. Angiogram showed a fusiform dilatation of the P1-P2 segment of the right posterior cerebral artery. The dissecting aneurysm was disappeared spontaneously on follow-up angiogram. It is recommended that, in a subset of neurologically stable patient who represents fusiform dilatation angiographically, angiographic monitoring should be undertaken to assess the tendency for spontaneous resolution before planning of surgical intervention.
Aneurysm, Dissecting* ; Dilatation ; Follow-Up Studies ; Humans ; Posterior Cerebral Artery* ; Subarachnoid Hemorrhage

Options for extracranial-intracranial bypass surgery of anterior circulation include saphenous vein grafts, occipital to middle cerebral artery (MCA) anastomosis, and most commonly superficial temporal artery (STA) to MCA anastomosis. Although less common, posterior circulation revascularization has been successfully peformed. The operative techniques and perioperative management such as anesthetic techniques and electrophysiologic monitoring are reviewed. Finally the author's surgical experiences of STA-MCA anastomosis in 30 patients with symptomatic internal carotid artery or MCA stenoocclusion are reported.
Carotid Artery, Internal ; Humans ; Middle Cerebral Artery ; Saphenous Vein ; Temporal Arteries ; Transplants

Three dimensional computed tomographic angiography is a rapid and minimally invasive method of detecting intracranial aneurysms, however, there are some limitation to identify the associated cerebrovascular lesions. We report a case of ruptured dorsal wall aneurysm of internal carotid artery in a 50-year-old man who had underlying stenosis of cervical internal carotid artery, which was overlooked due to lesion outside the scan field of view.
Aneurysm ; Angiography* ; Carotid Artery, Internal ; Constriction, Pathologic ; Humans ; Intracranial Aneurysm* ; Middle Aged

Many factors contributing to outcome of aneurysmal rupture patients have been studied but clinical significance of hemorrhage location based on CT in poor grade aneurysm(Hunt-Hess grade IV or V) patients is still unclear. The study was undertaken in order to try to outline the relative influence of hemorrhage location upon eventual outcome in poor grade patients with aneurysmal subarachnoid hemorrhage(SAH). Sixty-six SAH patients with early aneurysm surgery during the recent 3.5-year period, who were grouped into patients with intraventricular hemorrhage(IVH), intracerebral hematoma(ICH), ICH combined with IVH(ICH+IVH), and SAH according to hemorrhage locations were comparatively analyzed. Most of the poor grade patients(84.8%) were associated with ICH or IVH and the high frequency(67.9%) of IVH patients had an associated with ICH in contrast with the small number(32.1%) of pure IVH. Outcome was good in 26(39.4%) and poor in 40(60.6%). The presence of ICH on initial CT revealed better outcome compared to patients without ICH(60.7% vs 23.7%) However, ICH+IVH revealed poor outcome compared to patients without ICH+IVH(100% vs 44.7%). Ruptured anterior cerebral aneurysm caused an ICH+IVH more frequently and consequently more poor outcome than aneurysms in other anterior circulation. Additionally we relatively compared surgical outcome between aneurysmal sylvian or temporoparietal hematoma(ICH+sylvian or t-p) and hypertensive putaminal hematoma(H-ICH-putamen) sampled randomly under the similar conditions as much as motor weakness)was significantly lower in patients with aneurysmal ICH-sylvian or t-p(8.7% vs 50.0%). Overall results suggest that in Hunt-Hess IV-V aneurysm patients IVH itself does not independently correlate with prognosis, but when associated with an ICH it is related to a grave prognostic significance, and aggressive surgery for ICH lead to a better outcome with less morbidity.
Aneurysm* ; Hemorrhage* ; Humans ; Intracranial Aneurysm ; Prognosis ; Rupture

Papaverine has been widely used to reverse cerebral vasospasm because of its vasodilatory effect. However, its therapeutic value has been limited at least in part. In a previous study, low concentration papaverine was observed to potentiate a phorbol dibutyrate induced constriction of rat cerebral microvessels in vitro. The purpose of this study was to investigate the above effect in large cerebral arteries. Rabbit basilar artery was constricted in vivo by topical application of phorbol dibutyrate. The basilar artery was visualized using transclival exposure, and its diameter monitored using videomicroscopy. At the concentrations of 50, 100, and 500 M, papaverine elicits a dose-dependent vasodilatation of basilar artery that had been preconstricted with 20 nM phorbol dibutyrate. Subsequently, the above procedure was repeated, using lower concentrations of papaverine at 0.1, 1 and 10 M with no observable consistent potentiation effect. These results suggest that structural and pharmacological differences between large cerebral arteries and cerebral microvessels may contribute to the differences in their vasospastic response.
Animals ; Basilar Artery* ; Cerebral Arteries ; Constriction ; Microscopy, Video ; Microvessels ; Papaverine* ; Rats ; Vasodilation ; Vasospasm, Intracranial

Anomalies and variations of the middle cerebral artery(MCA) are less frequently encountered than variations in other major intracranial arteries. This is our report of a rare case of MCA duplication, including an aneurysm at its origin, confirmed by angiography and surgery. The clinical implications of these anatomical findings are reviewed.
Aneurysm* ; Angiography ; Arteries ; Middle Cerebral Artery*