No abstract available.
Hemorrhagic Fever with Renal Syndrome*

OBJECTIVE: Vasospasm of cerebral vessels remains a major source of morbidity and mortality after an aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to evaluate the safety and efficacy of transluminal balloon angioplasty (TBA) for SAH-induced vasospasm. METHODS: Eleven patients with an angiographically confirmed significant vasospasm (>50% vessel narrowing and clinical deterioration) were studied. A total of 54 vessel segments with significant vasospasm were treated by TBA. Digital subtraction angiography was used to confirm the presence of vasospasm, and TBA was performed to dilate vasospastic arteries. Medical and angiographic reports were reviewed to determine technical efficacy and for procedural complications. RESULTS: TBA using Hyper-Glide or Hyper-Form balloons (MicroTherapeutics, Irvine, CA) was successfully accomplished in 88.9% vasospastic segments (48 of 54), namely, in the distal internal carotid artery (100%, n=7), the middle cerebral artery (100%), including the M1 (n=10), M2 (n=10), and M3 segments (n=4), in the vertebral artery (100%, n=2), basilar artery (100%, n=1), and in the anterior cerebral artery (ACA), including the A1 (66%), A2 (66%), and A3 segments (100%). Vessel diameters significantly increased after TBA. There were no cases of vessel rupture or thromboembolic complications. GCS at one day after TBA showed an improvement in all patients except one. CONCLUSION: This study suggests that TBA using Hyper-Glide or Hyper-Form balloons is a safe and effective treatment for subarachnoid hemorrhage-induced cerebral vasospasm.
Aneurysm ; Angiography, Digital Subtraction ; Angioplasty, Balloon ; Anterior Cerebral Artery ; Arteries ; Basilar Artery ; Carotid Artery, Internal ; Endovascular Procedures ; Glycosaminoglycans ; Humans ; Middle Cerebral Artery ; Rupture ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial ; Vertebral Artery

A 57-year-old man presented with a 2-day history of left oculomotor palsy. Digital subtraction angiography revealed a pseudoaneurysm of the left cavernous internal carotid artery (ICA) measuring 37x32 mm. The pseudoaneurysm was treated with a balloon expandable graft-stent to occlude the aneurysmal neck and preserve the parent artery. A post-procedure angiogram confirmed normal patency of the ICA and complete sealing of the aneurysmal neck with no opacification of the sac. After the procedure, the oculomotor palsy improved gradually, and had completely resolved 3 months after the procedure. A graft-stent can be an effective treatment for a pseudoaneurysm of the cavernous ICA with preservation of the parent artery.
Aneurysm ; Aneurysm, False ; Angiography, Digital Subtraction ; Arteries ; Carotid Artery, Internal ; Caves ; Humans ; Middle Aged ; Neck ; Paralysis ; Parents

OBJECTIVE: The anatomy of middle cerebral artery (MCA) bifurcation aneurysms has been noted to be unfavorable for endovascular treatment. Our purpose was to analyze the clinical and angiographic results of coiling of the MCA bifurcation aneurysms. METHODS: From January 2004 to April 2007, 26 patients harboring 29 MCA bifurcation aneurysms were treated with coils. Of these patients, 16 had subarachnoid hemorrhages (SAH). The bleeding source was a ruptured MCA bifurcation aneurysm in 11 patients and a ruptured aneurysm in a different location in 5 patients, respectively. Treatment-related complications, clinical outcomes, and postprocedural and follow-up angiography results were retrospectively evaluated. RESULTS: 29 MCA bifurcation aneurysms (11 ruptured, 18 unruptured) were occluded with coils in 26 patients. Occlusion was complete for 24 (82.8%) of the 29 aneurysms, incomplete for 3 (10.3%), and partial for 2 (6.9%) aneurysms. Procedural complications included thromboembolism in 6, a small nonocclusive thrombus formation in 1, and intraprocedural aneurysmal rupture in 1. All of symptomatic complications were thromboembolic events that occurred 3 patients with unruptured aneurysm and they discharged with moderate disability state. Follow-up angiograms were available on 16 patients with 18 aneurysms and 1 patient with an initial complete occlusion had a slight neck recanalization. CONCLUSION: Coiling of MCA bifurcation aneurysm could be achieved without treatment-induced neurologic deficit in 88.5% (23/26) of the patients while at the same time obtaining favorable anatomic results. Improvements in device technology and technique will certainly greatly increase the safety of coiling of MCA bifurcation aneurysm, widening its indications.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neck ; Neurologic Manifestations ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage ; Thromboembolism ; Thrombosis

An internal carotid artery (ICA) tear during or after trans-sphenoidal surgery (TSS) is rare but may cause potentially lethal complications. A 23-year-old female patient visited our hospital for treatment of a Rathke's cleft cyst. The patient had massive hemorrhage during surgery and angiography performed after surgery showed laceration of the cavernous ICA. We successfully controlled the hemorrhage with emergency placement of an endovascular stent-graft.
Angiography ; Carotid Artery Injuries ; Carotid Artery, Internal ; Caves ; Emergencies ; Female ; Hemorrhage ; Humans ; Lacerations ; Stents ; Young Adult

We describe a case of an unruptured basilar top aneurysm that was associated with early rupture after incomplete coiling. A 62-year-old woman with a history of several small infarctions has undergone coiling of unruptured basilar top aneurysm. Two weeks after initial coiling the patient presented with Hunt and Hess grade IV subarachnoid hemorrhage consistent with a ruptured basilar top aneurysm. Repeat angiography revealed a rupture of recanalized basilar top aneurysm. Second embolization with additional coils resulted in complete occlusion. However, her neurological status was not improved afterward and she was transferred to department of rehabilitation one month after hemorrhage with comatous state. To our knowledge, this is the first case of fatal early rupture after coiling of unruptured aneurysm. It has been speculated that coiling could cause injury to aneurysmal wall and facilitate rupture.
Aneurysm* ; Angiography ; Female ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Middle Aged ; Rehabilitation ; Rupture* ; Subarachnoid Hemorrhage

PURPOSE: The purpose of the study was to investigate the health status(present illness, ADL and IADL), health perception, and health promotion behaviors of low-income elderly who are receiving the visiting nurse service in the community. METHOD: The sample of the study was 735 elderly over 65years old with basic livelihood security, who were conveniently selected from 245 public health centers nation-wide. Data collection was done using a structured questionnaire through interviews by visiting nurses. RESULT: The average number of present illnesses in the study subjects was 4.18. The average scores of ADL and IADL were 15.903.39and 9.772.97 respectively, which indicates a relatively independent everyday life. However, 64.2% of the subjects perceived their health status as 'not healthy'. In terms of health promotion behaviors, 77.8% of the subjects had ceased smoking, 83.9% stopped drinking, 56.4% had a regular diet, 45.8% received regular physical check-ups during the past two years, and 66% received flu shots. Approximately 50% of the subjects were practicing 3-4 health promotion behaviors. Significant factors associated with health promotion behaviors were ADL, IADL and self-efficacy. CONCLUSION: Health promotion programs which focus on regular diet, exercise, and regular physical check-ups should be developed to improve independence of everyday life and quality of life among low-income elderly.
*Poverty ; Male ; Korea ; Humans ; *Health Status ; *Health Promotion ; Health Behavior ; Female ; Data Collection ; Community Health Nursing ; *Attitude to Health ; Aged, 80 and over ; Aged ; Activities of Daily Living

OBJECTIVE: To assess the feasibility, safety, and effectiveness of the balloon-assisted technique with HyperForm balloon in the endovascular treatment of wide-necked intracranial aneurysms. METHODS: A total of 34 patients with 34 wide-necked intracranial aneurysms were treated with endovascular coil embolization using balloon-assisted technique with Hyperform balloon. Twenty-nine aneurysms (85.3%) were located in the anterior circulation. The group of patients was comprised of 16 men and 18 women, aged 33 to 72 years (mean : 60.6 years). The size of aneurysms was in the range of 2.0 to 22.0 mm (mean 5.5 mm) and one of neck was 2.0 to 11.9 mm (mean 3.8 mm). The dome to neck ratio was ranged from 0.83 to 1.43 (1.15). Sixteen patients were treated for unruptured aneurysms and the remaining 18 presented with a subarachnoid hemorrhage. RESULTS: In the 34 aneurysms treated by the remodeling technique with HyperForm balloon, immediate angiographic results consisted of total occlusion in 31 cases (91.2%) and partial occlusion in three cases (8.8%). There were five procedure-related complications (14.7%), including two coil protrusions and three thromboembolisms; Except one patient, all were successfully resolved without permanent neurologic deficit. No new bleeding occurred during the follow-up. Twenty patients (59%) underwent angiographic follow-up from 2 to 33 months (mean 9.2 months) after treatment. Focal recanalization with coil compaction of the neck portion was observed in 5 cases (25%). Only one case showed major recanalization and underwent stent-assisted coil embolization. CONCLUSION: The balloon-assisted technique with Hyperform balloon is a feasible, safe, and effective endovascular treatment of wide-necked cerebral aneurysms.
Aged ; Aneurysm ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Male ; Neck ; Neurologic Manifestations ; Subarachnoid Hemorrhage

Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.
Adhesives ; Aged ; Aneurysm ; Arteries ; Basal Ganglia ; Brain ; Carotid Artery, Internal ; Cerebral Hemorrhage ; Consciousness ; Female ; Glasgow Coma Scale ; Globus Pallidus ; Headache ; Hemorrhage ; Humans ; Neurologic Manifestations ; Subarachnoid Hemorrhage ; Surgical Instruments ; Unconsciousness

Endovascular embolization is being increasingly used to treat intracranial arteriovenous malformations (AVMs). However, we experienced two patients with retained microcatheters after AVM embolization using Onyx.
Arteriovenous Malformations ; Humans ; Intracranial Arteriovenous Malformations