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Traumatic Pseudoaneurysm Related to Calcified Nodules of Cerebral Convexity Dura Mater in an American College Football Player.

Yoo Sung JEON ; Jong Gon LEE ; Young Il CHUN ; Joon CHO ; Woo Jin CHOE

Journal of Cerebrovascular and Endovascular Neurosurgery.2016;18(3):322-326. doi:10.7461/jcen.2016.18.3.322

Repeated concussion is common among football players; however, these minor blunt head trauma rarely result in serious complications. We report a case of a young college football player who presented acute subdural hematoma, cerebral edema, and seizure due to pseudoaneurysm rupture. The pseudoaneurysm, located at the cortical branch of the middle cerebral artery, was speculated to be formed by dural calcification and adhesion with the underlying brain, possibly due to repeated concussions. Following successful excision of the pseudoaneurysm and control of brain swelling, the patient recovered without sequelae and was discharged after a short while.
Aneurysm, False* ; Athletic Injuries ; Brain ; Brain Edema ; Craniocerebral Trauma ; Dura Mater* ; Football* ; Hematoma, Subdural, Acute ; Humans ; Middle Cerebral Artery ; Rupture ; Seizures

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Subdural Hematoma without Subarachnoid Hemorrhage Caused by the Rupture of Middle Cerebral Artery Aneurysm.

Jinsol HAN ; Dong Jun LIM ; Sang Dae KIM ; Sung Kon HA ; Seung Hwan LEE ; Se Hoon KIM

Journal of Cerebrovascular and Endovascular Neurosurgery.2016;18(3):315-321. doi:10.7461/jcen.2016.18.3.315

Pure subdural hematomas caused by a ruptured intracranial aneurysm are extremely rare. We describe the case of a 42-year-old woman who presented with headache without evidence of head trauma. Magnetic resonance angiography and conventional cerebral angiography revealed a ruptured aneurysm at the right middle cerebral artery bifurcation. The patient underwent surgical treatment and had a good outcome without any neurological deficit. The mechanisms and clinical characteristics of this condition are discussed.
Adult ; Aneurysm, Ruptured ; Cerebral Angiography ; Craniocerebral Trauma ; Female ; Headache ; Hematoma, Subdural* ; Humans ; Intracranial Aneurysm* ; Magnetic Resonance Angiography ; Middle Cerebral Artery* ; Rupture* ; Subarachnoid Hemorrhage*

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Recurrent Carotid Cavernous Fistula Originating from a Giant Cerebral Aneurysm after Placement of a Covered Stent.

Jung Wook BAEK ; Sung Tae KIM ; Young Seo LEE ; Young Gyun JEONG ; Hae Woong JEONG ; Jin Wook BAEK ; Jung Hwa SEO

Journal of Cerebrovascular and Endovascular Neurosurgery.2016;18(3):306-314. doi:10.7461/jcen.2016.18.3.306

We report the case of a recurrent carotid cavernous fistula (CCF) originating from a giant cerebral aneurysm (GCA) after placement of a covered stent. A 47-year-old woman presented with sudden onset of severe headache, and left-sided exophthalmos and ptosis. Cerebral angiography revealed a CCF caused by rupture of a GCA in the cavernous segment of the left internal carotid artery. Two covered stents were placed at the neck of the aneurysm. The neurological symptoms improved at first, but were aggravated in the 6 months following the treatment. Contrast agent endoleak was seen in the distal area of the stent. Even though additional treatments were attempted via an endovascular approach, the CCF could not be cured. However, after trapping the aneurysm using coils and performing superficial temporal artery-middle cerebral artery bypass, the neurological symptoms improved. In cases of recurrent CCF originating from a GCA after placement of a covered stent, it is possible to treat the CCF by endovascular trapping and surgical bypass.
Aneurysm ; Carotid Artery, Internal ; Carotid-Cavernous Sinus Fistula ; Cerebral Angiography ; Cerebral Arteries ; Endoleak ; Exophthalmos ; Female ; Fistula* ; Headache ; Humans ; Intracranial Aneurysm* ; Middle Aged ; Neck ; Rupture ; Stents*

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Pure Subdural Hemorrhage Caused by Internal Carotid Artery Dorsal Wall Aneurysm Rupture.

Young Woon LEE ; Taek Min NAM ; Jong Soo KIM ; Seung Chyul HONG ; Je Young YEON

Journal of Cerebrovascular and Endovascular Neurosurgery.2016;18(3):302-305. doi:10.7461/jcen.2016.18.3.302

A 37-year-old woman was admitted to our hospital with altered mentality. The patient was diagnosed an internal carotid artery (ICA) dorsal wall aneurysm leading to acute subdural hemorrhage (SDH) without occurring subarachnoid hemorrhage and/or internal parenchymal hemorrhage. An aneurysmal neck clipping and hematoma evacuation were performed at once. A pure SDH by ruptured aneurysm is unusual, but it is important to consider it if a SDH patient has no other medical history.
Adult ; Aneurysm* ; Aneurysm, Ruptured ; Carotid Artery, Internal* ; Female ; Hematoma ; Hematoma, Subdural* ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Neck ; Rupture* ; Subarachnoid Hemorrhage

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Pseudoaneurysm Formation after Repetitive Suction Thrombectomy Using a Penumbra Suction Catheter.

Eun Oh JEONG ; Hyon Jo KWON ; Seung Won CHOI ; Hyeon Song KOH

Journal of Cerebrovascular and Endovascular Neurosurgery.2016;18(3):296-301. doi:10.7461/jcen.2016.18.3.296

With the recent advent of suction catheters, the use of manual aspiration thrombectomy (MAT) for patients with acute ischemic stroke with large vessel occlusion has increased. Although contrast leakage and subarachnoid hemorrhage have been reported during MAT procedures, pseudoaneurysm formation due to vessel injury by suction catheters has not been. We discuss the case of a 60-year-old woman who presented to our emergency room with dysarthria and left-sided weakness. She underwent suction thrombectomy 5 times for acute middle cerebral artery occlusion and significant contrast leakage occurred during the procedure. On follow-up angiogram on post-operative day 15, we noticed a pseudoaneurysm, which was treated with detachable coil embolization. Surgeons who perform suction thrombectomy should keep in mind the possibility of vessel injury that results in the formation of a pseudoaneurysm, especially at the branching site or tortuous segments.
Aneurysm, False* ; Catheters* ; Dysarthria ; Embolization, Therapeutic ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Humans ; Infarction, Middle Cerebral Artery ; Middle Aged ; Stroke ; Subarachnoid Hemorrhage ; Suction* ; Surgeons ; Thrombectomy*

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Onyx Embolization of Intracranial Pial Arteriovenous Fistula.

Hae Min KIM ; Jae Hoon CHO ; Ki Hong KIM

Journal of Cerebrovascular and Endovascular Neurosurgery.2016;18(3):291-295. doi:10.7461/jcen.2016.18.3.291

Intracranial pial arteriovenous fistulas (AVFs) are rare cerebrovascular lesions consisting of one or more arterial connections to a single venous channel without an intervening nidus. Because of the location and high flow dynamics of these lesions, neurosurgeons may have a difficulty deciding between endovascular treatment and open surgical treatment. We report on a patient who underwent endovascular treatment with liquid embolic agent. A 50-year-old man with a decreased mental state and a tonic seizure event was brought to our hospital. Computed tomography (CT) of the brain showed a subcortical hematoma in the right temporoparietal lobe. On three-dimensional cerebral artery CT, there was no evidence of definite cerebrovascular abnormality. Cerebral angiography showed a pial AVF supplied by the right middle cerebral artery with early drainage into the right superior cerebral vein. The patient was treated with Onyx embolization for definitive closure of the fistula. The patient was transferred to the department of rehabilitation medicine two weeks later with grade 4 left hemiparesis. The application of advanced equipment, such as the latest angiography and endovascular tools, will facilitate the correct diagnosis and delicate treatment of pial AVF.
Angiography ; Arteriovenous Fistula* ; Brain ; Cerebral Angiography ; Cerebral Arteries ; Cerebral Veins ; Diagnosis ; Drainage ; Fistula ; Hematoma ; Humans ; Middle Aged ; Middle Cerebral Artery ; Neurosurgeons ; Paresis ; Rehabilitation ; Seizures

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Multiple Spontaneous Intracerebral Hematoma without Presenting Risk Factors.

Sangman PARK ; Eun Kyung PARK ; Ju Seong KIM ; Kyu Won SHIM

Journal of Cerebrovascular and Endovascular Neurosurgery.2016;18(3):286-290. doi:10.7461/jcen.2016.18.3.286

The incidence of intracerebral hemorrhage in those aged 45–84 years is 0.3-0.5%. In people over 80 years of age, this incidence increases 25-fold compared with that of the total population. The most common causes of spontaneous intracerebral hemorrhage in the younger population are vascular malformation, aneurysm, and overuse of drugs. In contrast, common causes in the elderly include hypertension, tumors, and coagulation disorders. Here, we present a case involving a 72-year-old male patient who, without any of these predisposing conditions, was admitted to the hospital with spontaneous intracerebral hemorrhage and showed signs of multifocal intracerebral hemorrhage during his stay. We conclude that spontaneous intracerebral hemorrhage can occur without any predisposing factors, and can lead to a patient's death. Therefore, the possibility of recurrent spontaneous intracerebral hemorrhage must be considered in patients with primary spontaneous intracerebral hemorrhage.
Aged ; Aneurysm ; Antibodies, Anticardiolipin ; Autoimmune Diseases ; Causality ; Cerebral Hemorrhage ; Hematoma* ; Humans ; Hypertension ; Incidence ; Male ; Risk Factors* ; Vascular Malformations

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Incomplete Clipping Resulting from Scissoring of the Clip Blades during Treatment of a Large Atheromatous Aneurysm.

Jin Seong KIM ; Seung Hwan LEE ; Hak Cheol KO ; Hee Sup SHIN ; Jun Seok KOH

Journal of Cerebrovascular and Endovascular Neurosurgery.2016;18(3):281-285. doi:10.7461/jcen.2016.18.3.281

The cerebral aneurysm 'clip scissoring' phenomenon resulting from clip blade twisting is an unpredictable surgical complication. Additionally, incomplete clipping resulting from the presence of an atherosclerotic wall in the neck of the aneurysm can also cause unforeseen problems. Here, the authors present an unusual case of incomplete clipping of a large, atheromatous aneurysm resulting from clip scissoring, which was treated with additional endovascular coiling.
Aneurysm* ; Intracranial Aneurysm ; Neck ; Plaque, Atherosclerotic ; Surgical Instruments ; Treatment Failure

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Fusiform Superior Cerebellar Artery Aneurysm Treated with Endovascular Treatment.

Joon Bok JEON ; Se yang OH ; Dong Keun HYUN ; Yu Shik SHIM

Journal of Cerebrovascular and Endovascular Neurosurgery.2016;18(3):276-280. doi:10.7461/jcen.2016.18.3.276

An aneurysm of the distal superior cerebellar artery (SCA) is a highly rare disease. Fusiform aneurysms of the distal SCA are particularly challenging to treat. Clipping, trapping with or without bypass using microsurgery or endovascular treatment (EVT) were used to treat this condition. We describe the case of fusiform distal SCA aneurysms treated successfully with endovascular coiling with a 3-month follow-up. A 39 year-old male was presented with subarachnoid hemorrhage (SAH) and a 15 mm fusiform aneurysm of the ambient segment of the left distal SCA. EVT for parent artery occlusion and packing of the aneurysm was done. Left sixth nerve palsy appeared after 1 day of EVT. The symptom completely recovered within 1 week of the post-procedural period. No neurological deficit was seen during the clinical 3-month follow-up. EVT of fusiform distal SCA aneurysms with coils is a safe and feasible option to manage this rare condition. However, the treatment options must be carefully selected depending on the neurologic condition, development of collateral circulation, and configuration of the dissection.
Abducens Nerve Diseases ; Aneurysm* ; Arteries* ; Collateral Circulation ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Male ; Microsurgery ; Parents ; Rare Diseases ; Subarachnoid Hemorrhage

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Evaluation and Treatment of the Acute Cerebral Infarction with Convexal Subarachnoid Hemorrhage.

Min Hyung LEE ; Sang Uk KIM ; Dong Hoon LEE ; Young Il KIM ; Chul Bum CHO ; Seung Ho YANG ; Il Sup KIM ; Jae Taek HONG ; Jae Hoon SUNG ; Sang Won LEE

Journal of Cerebrovascular and Endovascular Neurosurgery.2016;18(3):271-275. doi:10.7461/jcen.2016.18.3.271

Non-traumatic convexal subarachnoid hemorrhage (CSAH) is a comparatively infrequent with various vascular and nonvascular causes, it rarely occurs concomitant to acute ischemic stroke. We report a case of a 59-year-old woman, visited emergency room with right side subjective weakness spontaneously. Magnetic resonance diffusion-weighted images revealed an acute infarction of anterior cerebral arterial territory. Computed tomographic angiography showed a left frontal CSAH without any vascular lesions. And other laboratory studies were non-specific. We treated with dual antiplatelet drugs (cilostazole [Otsuka Pharmaceutical Co., Ltd. tokyo, Japan] and Aspirin [Bayer Pharma AG., Leverkusen, Germany]). She has done well for a follow-up period. (5 months) This case demonstrates the CSAH with acute infarction is rare but need to work up to identify the etiology and antiplatelet dugs are taken into account for treatments.
Angiography ; Aspirin ; Cerebral Infarction* ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Humans ; Infarction ; Middle Aged ; Platelet Aggregation Inhibitors ; Stroke ; Subarachnoid Hemorrhage*

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