An Angiographic Study of the Carotid Arterial System and CT Scan in the Cat After Experimentally Induced Subarachnoid Hemorrhage

ABSTRACTSubarachnoid hemorrhage (SAH) is an important but uncommon condition in the differential diagnosis of acute headache. Most authorities recommend that patients with suspected SAH undergo noncontrast computed tomography (CT) as a first diagnostic intervention. If the results of the CT scan are negative, a lumbar puncture should be performed. Many nonurban Canadian hospitals do not have CT scanners and must either transfer patients or consider performing lumbar puncture prior to CT. In selected patients, performing lumbar puncture first may be an option, but timing of the procedure and the interpretation of results is important.

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Subarachnoid hemorrhage in a case of segmental arterial mediolysis with coexisting intracranial and intraabdominal aneurysms

Journal of Neurosurgery ◽

10.3171/2012.1.jns111967 ◽

2012 ◽

Vol 116 (5) ◽

pp. 948-951 ◽

Cited By ~ 13

Author(s):

Ryosuke Matsuda ◽

Yasuo Hironaka ◽

Yasuhiro Takeshima ◽

Young-Su Park ◽

Hiroyuki Nakase

Keyword(s):

Subarachnoid Hemorrhage ◽

Distal Portion ◽

Dissecting Aneurysm ◽

Arterial System ◽

Left Vertebral Artery ◽

Retroperitoneal Hemorrhage ◽

Segmental Arterial Mediolysis ◽

History Of ◽

The Right ◽

Distal Anterior Cerebral Artery

The authors report the rare case of a 58-year-old man with segmental arterial mediolysis (SAM) with associated intracranial and intraabdominal aneurysms, who suffered subarachnoid hemorrhage (SAH) due to rupture of an intracranial aneurysm. This disease primarily involves the intraabdominal arterial system, resulting in intraabdominal and retroperitoneal hemorrhage in most cases. The patient presented with severe headache and vomiting. The CT scans of the head revealed SAH. Cerebral angiography revealed 3 aneurysms: 1 in the right distal anterior cerebral artery (ACA), 1 in the distal portion of the A1 segment of the right ACA, and 1 in the left vertebral artery. The patient had a history of multiple intraabdominal aneurysms involving the splenic, gastroepiploic, gastroduodenal, and bilateral renal arteries. He underwent a right frontotemporal craniotomy and fibrin coating of the dissecting aneurysm in the distal portion of the A1 segment of the right ACA, which was the cause of the hemorrhage. Follow-up revealed no significant changes in the residual intracranial and intraabdominal aneurysms. An SAH due to SAM with associated multiple intraabdominal aneurysms is extremely rare. The authors describe their particular case and review the literature pertaining to SAM with associated intracranial and intraabdominal aneurysms.

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P.097 Subarachnoid hemorrhage associated with a thromboembolic ischemic stroke- an unexpected observation

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.199 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S42-S42

Author(s):

A Almutlaq ◽

S Alhusaini ◽

C Chalk ◽

R Cote

Keyword(s):

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Ct Scan ◽

Inferior Frontal Gyrus ◽

Brain Mri ◽

Significant Risk ◽

Significant Risk Factor ◽

Ct Angiogram ◽

External Capsule ◽

Diagnostic Confusion

Atherosclerosis is a significant risk factor for ischemic stroke, and is a frequent cause for extra- and intra-cranial vessels stenosis. Here, we present an unusual case of ischemic stroke associated with intra-cranial vessel stenosis and subarachnoid hemorrhage (SAH) secondary to carotid artery atheroma. A 64-year old female known for hypertension and dyslipidemia presented with a three-day history of three transient episodes (< 30 minutes) of dysarthria and right hand weakness. An initial brain CT scan revealed left frontal SAH. She was admitted to our Stroke Unit for observation and management. CT-angiogram revealed 90% ICAs stenosis bilaterally with several short focal stenotic lesions, involving several left MCA branches. Brain MRI revealed acute infarcts in the left insula, external capsule and inferior frontal gyrus. The clinical picture was attributed to a thromboembolic left MCA ischemic stroke. She was managed with maximum medical therapy, and later underwent successful left carotid endarterectomy. The presence of SAH on our patient’s presenting CT scan lead to an initial radiological diagnosis of RCVS. However, subsequent imaging studies indicated that SAH had occurred in association with a thromboembolic ischemic stroke. Despite its rarity, this clinical association is important to recognize to avoid diagnostic confusion and guide appropriate management.

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Intracranial Aneurysms: A Clinical, Angiographic and Computerized Tomographie Study

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100120499 ◽

1977 ◽

Vol 4 (2) ◽

pp. 99-105 ◽

Cited By ~ 17

Author(s):

Bryce Weir ◽

Jack Miller ◽

Don Russell

Keyword(s):

Subarachnoid Hemorrhage ◽

Ct Scan ◽

Intracranial Aneurysms ◽

Percent Level ◽

Ct Scans

SummaryFifty-six patients with 63 aneurysms were selected from a larger group of patients because they had at least one angiographic and one CT scan study. A total of 102 CT scans and 136 angiograms were analyzed. In five patients the aneurysm was visualized on the CT scan. There was a tendency for the location of the subarachnoid hemorrhage and intracerebral hematomas visualized on the CT scans to correlate with the site of the aneurysm as seen on the angiogram. The CT scan was useful in demonstrating the evolution of hydrocephalus and in differentiating hematoma from edema. The patients with normal CT scans were more likely to have good neurological grades. No single angiographic or CT scan feature correlated significantly with survival at lower than the 5 percent level.

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The effective use of hyperbaric oxygen therapy (HBOT) in the management of air embolism – rare and potentially fatal acute complication of hemodialysis

Polish Annals of Medicine ◽

10.29089/2021.21.00198 ◽

2021 ◽

Author(s):

Grzegorz Kade ◽

Sebastian Spaleniak ◽

Artur Maliborski ◽

Jacek Siewiera ◽

Stefan Antosiewicz ◽

...

Keyword(s):

Ct Scan ◽

Hyperbaric Oxygen ◽

Vascular Access ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Rare Complication ◽

Air Embolism ◽

Arterial System ◽

Sensor Failure ◽

Acute Complication

Introduction: Air embolism is a rare and potentially fatal acute complication. Its causes are mainly iatrogenic. It requires rapid diagnostics and treatment, including hyperbaric oxygen therapy (HBOT). Aim: The main aim was to present the potential causes of air embolism during hemodialysis (HD) and show the importance of quick clinical diagnosis and therapy – on the base of clinical case. Case study: 65-years old male patient with diabetic nephropathy was treated with HD. The permanent dialysis catheters were used as vascular access due to the difficulties with formation of arteriovenous fistula. The massive air embolism occurred during one of the dialysis sessions. The clinical suspicion was confirmed by CT scan which showed the presence of gas bubbles in abdominal arteries. The cause of air embolism was sensor failure. The presence of patent foramen ovale (PFO) with reversed leakage caused the air ingress into arterial system. Patient was qualified for the immediate hyperbaric therapy. The quick improvement in the condition of the patient took place. Results and discussion: The massive air embolism may occur in HD patients, particularly in those who are dialyzed with use of catheters as vascular access. This rare complication should be considered in the case of sudden worsening of patient condition during HD procedure. The use of CT scan to confirm the air embolism suspicion and availability of HBOT are necessary for successful management of this complication. Conclusions: HBOT is a safe and effective method of air embolism treatment in HD patients.

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Clinical results of extracranial-intracranial bypass surgery in patients with hemodynamic cerebrovascular disease

Journal of Neurosurgery ◽

10.3171/jns.1989.70.1.0061 ◽

1989 ◽

Vol 70 (1) ◽

pp. 61-67 ◽

Cited By ~ 73

Author(s):

William J. Powers ◽

Robert L. Grubb ◽

Marcus E. Raichle

Keyword(s):

Cerebrovascular Disease ◽

Bypass Surgery ◽

Clinical Results ◽

Arterial System ◽

Control Group ◽

Arterial Lesion ◽

Content Type ◽

Positron Emission ◽

Nonsurgical Patients ◽

Carotid Arterial

✓ The importance of hemodynamic factors in the pathogenesis and treatment of cerebrovascular disease remains uncertain. The extracranial-intracranial (EC-IC) bypass trial has been criticized for failing to identify and separately analyze those patients with chronic reduction in regional cerebral perfusion pressure (rCPP) who might be most likely to benefit from surgery. Positron emission tomography (PET) measurements of regional cerebral blood flow (rCBF) and blood volume (rCBV) were performed on 29 patients with symptomatic occlusion or intracranial stenosis of the carotid arterial system prior to undergoing EC-IC bypass surgery. Twenty-four patients had evidence of reduced rCPP (increased rCBV/rCBF ratio) distal to the arterial lesion. Of 21 patients who survived surgery without stroke, three suffered ipsilateral ischemic strokes during the 1st postoperative year. A nonrandomized control group of 23 nonsurgical patients with similar clinical, arterio-graphic, and PET characteristics experienced no ipsilateral ischemic strokes during the 1st year following PET. Based on these results in 44 patients, the probability that successful surgery reduces the occurrence of ipsilateral ischemic stroke 1 year later was calculated. This probability ranged from 0.045 for a 50% reduction to 0.168 for a 10% reduction. Thus, there was little evidence to suggest that measurements of cerebral hemodynamics can identify a group of patients who would benefit from EC-IC bypass surgery.

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