A 39-year-old male patient was admitted to hospital with abdominal distension, unconsciousness, and anuria. Head computed tomography (CT) showed subarachnoid hemorrhage and diffuse cerebral edema. The high-density area of contrast accumulation region in the high-density CT plaque was 38 HU, and the preliminary diagnosis was SAH, incomplete intestinal obstruction, and sepsis caused by acute cerebrovascular disease. After admission, the patient displayed upturned eyes, limb convulsions, serum procalcitonin level exceeding 100 ng/mL, low blood pressure and septic shock. Imipenem was given for intensive anti-infection therapy. After treatment, procalcitonin levels showed a slow decline, renal function, and intra-abdominal pressure returned to normal, urine volume gradually increased, but platelets still showed a downward trend. Lumbar puncture showed colorless and clear cerebrospinal fluid, and the biochemical and routine results of cerebrospinal fluid were normal. SAH and intracranial infection were excluded, and it was considered that the head CT showed pseudo-subarachnoid hemorrhage. On the 3rd day of admission, laparoscopic exploratory laparotomy+appendectomy+abdominal drainage under general anesthesia were performed. During surgery, purulent gangrene in the appendix was found, with pus adhering to the surface of the intestines and a large amount of pus present in the abdominal cavity. Rhabdomyolysis syndrome developed after surgery. After continuous renal replacement therapy, the indicators gradually returned to normal. The patient was conscious, and the head CT results were normal. The patient was discharged from the hospital on the 19th day after surgery, and no special discomfort and abdominal pain and distension occurred during the 3-month follow-up.
Humans ; Male ; Adult ; Tomography, X-Ray Computed ; Sepsis/diagnostic imaging* ; Multiple Organ Failure/etiology* ; Subarachnoid Hemorrhage/complications*

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

PURPOSE: Contrast-induced acute kidney injury (CI-AKI) is associated with poor outcomes after percutaneous coronary intervention. However, CI-AKI has rarely been evaluated within the neurovascular field. The aim of this study was to investigate the incidence and clinical implication of CI-AKI after coil embolization in patients with an aneurysmal subarachnoid hemorrhage (aSAH). MATERIALS AND METHODS: Between January 2005 and March 2016, 192 patients who underwent coil embolization were enrolled in this study. CI-AKI was defined as an increase from baseline serum creatinine concentration of >25% or >0.5 mg/dL within 72 hours after coil embolization. A poor clinical outcome was defined as a score of ≥3 on the modified Rankin Scale at one-year post-treatment. RESULTS: A total of 16 patients (8.3%) died as a result of medical problems within one year. CI-AKI was identified in 14 patients (7.3%). Prominent risk factors for one-year mortality included CI-AKI [odds ratio (OR): 16.856; 95% confidence interval (CI): 3.437–82.664] and an initial Glasgow Coma Scale (GCS) score ≤8 (OR: 5.565; 95% CI: 1.703–18.184). A poor clinical outcome was associated with old age (≥65 years) (OR: 7.921; 95% CI: 2.977–21.076), CI-AKI (OR: 11.281; 95% CI: 2.138–59.525), an initial GCS score ≤8 (OR 31.02; 95% CI, 10.669–90.187), and a ruptured aneurysm (p=0.016, OR: 4.278) in posterior circulation. CONCLUSION: CI-AKI seems to be an independent predictor of the overall outcomes of aSAH after endovascular treatment.
Acute Kidney Injury/chemically induced ; Acute Kidney Injury/diagnostic imaging ; Acute Kidney Injury/etiology ; Acute Kidney Injury/mortality ; Adult ; Aged ; Aged, 80 and over ; Aneurysm/complications ; Aneurysm/diagnostic imaging ; Aneurysm/therapy ; Angiography ; Contrast Media/adverse effects ; Embolization, Therapeutic/adverse effects ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Subarachnoid Hemorrhage/complications ; Subarachnoid Hemorrhage/diagnostic imaging ; Subarachnoid Hemorrhage/therapy ; Treatment Outcome ; Young Adult

A 58-year-old Indian woman presented with asystole after an episode of haemetemesis, with a patient downtime of 20 mins. After initial resuscitation efforts, computed tomography of the brain, obtained to evaluate neurological injury, demonstrated evidence of severe hypoxic ischaemic brain injury. The imaging features of hypoxic ischaemic brain injury and the potential pitfalls with regard to image interpretation are herein discussed.
Adolescent ; Brain Ischemia ; diagnosis ; diagnostic imaging ; Cerebellum ; diagnostic imaging ; Critical Care ; Female ; Heart Arrest ; diagnosis ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Shock, Cardiogenic ; complications ; Subarachnoid Hemorrhage ; diagnosis ; diagnostic imaging ; Tomography, X-Ray Computed

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

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

PURPOSE: Misdiagnosis of subarachnoid hemorrhage (SAH) can result in considerable mortality and morbidity. Computed tomography (CT) has high sensitivity for detection of acute SAH, but falls off rapidly over time, and approaches 0% at three weeks. The aim of this study was to conduct a comparison of magnetic resonance imaging (MRI) and CT in detection of SAH in acute and subacute, and chronic stages. METHODS: This retrospective study included 62 patients with spontaneous SAH from January 2006 to December 2011. For each patient, we obtained non-enhanced CT scans, fluid-attenuated inversion recovery (FLAIR), and T2-weighted gradient-echo (T2*) MRI images. We defined SAH based on areas of high attenuation on non-enhanced CT scans, regions of hyperintensity on FLAIR images, and regions of hypointensity on T2* images in intracranial subarachnoid spaces. In order to investigate the superiority of tools for diagnosis of SAH, comparison of sensitivity of CT scans and MRI was performed. RESULTS: Sensitivity of CT to SAH was 93.5% on the first day, but fell off rapidly with time, and approached 0% at 20 days. Sensitivity of MRI was not affected by stages and amounts of bleeding (p>0.05). Sensitivity of MRI was higher than that of CT in SAH of Fisher grade 0-1 of subacute stage of bleeding (p=0.001) and in all cases of chronic stage of bleeding (p=0.000). FLAIR images were superior to T2* images, but without statistical significance (p>0.1). CONCLUSION: MRI was superior to CT in detection of subacute and chronic SAH, as well as a small amount of SAH.
Diagnostic Errors ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Retrospective Studies ; Subarachnoid Hemorrhage ; Subarachnoid Space

OBJECTIVETo investigate the feasibility of virtual non-enhanced images in evaluating the spontaneous subarachnoid hemorrhage (SAH) by dual-energy computed tomography angiography.

METHODSDual-energy computed tomography angiography was performed in 43 SAH patients.Virtual non-enhanced images were obtained by using Liver VNC software. paired t-test was performed to compare the signal to noise ratio between the conventional plain scan and virtual non-enhanced images. Diagnostic accuracy for SAH by virtual non-enhanced images was calculated by using the conventional plain scan images as a gold standard. Quality score was calculated to evaluate whether virtual non-enhanced images can meet the imaging requirements of SAH.

RESULTSThe signal to noise ratio was 8.63?0.53 among plain scan images and 3.96?0.52 among virtual non-enhanced images ( t=43.18,P=0.000) . The sensitivity, specificity, and accuracy of virtual non-enhanced imaging in diagnosing the SAH were 97.05%, 100%, and 97.67% in per-patient analysis, and were 94.64%, 100%, and 98.97% in per-lesion analysis. The quality scores were 3 in six patients, 2 in 27 patients, and 1 in two patients.

CONCLUSIONSVirtual non-enhanced images can meet the clinical requirements of diagnosis, although it has more intensive noise than conventional plain scan images. Furthermore, it has higher accuracy in evaluating SAH.

Adult ; Aged ; Cerebral Angiography ; methods ; Female ; Humans ; Image Processing, Computer-Assisted ; Male ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity ; Subarachnoid Hemorrhage ; diagnostic imaging ; Tomography, X-Ray Computed ; methods

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

Intracranial vertebrobasilar artery (VBA) dissection can be classified into three major clinical types: subarachnoid hemorrhage, headache, and nonhemorrhagic ischemic symptoms. And it has been more frequently identified since the introduction of advanced diagnostic imaging modalites including MR angiography and multidetector CT angiography. Aggressive treatment has been considered due to their tendency for early rebleeding and a fatal natural course. We describe approproiate neurointerventional options, based on he patterns of angiographic features and location of dissection.
Angiography ; Arteries* ; Diagnostic Imaging ; Embolization, Therapeutic ; Headache ; Subarachnoid Hemorrhage