Correlation of carbon dioxide and systolic velocity of the middle cerebral artery in patients with spontaneous subarachnoid hemorrhage of aneurysmal origin

A spontaneous subarachnoid hemorrhage (SAH) from the middle cerebral artery is most commonly caused by the rupture of saccular aneurysms and rarely by fusiform aneurysms or arterial dissections/dissecting aneurysms. To the authors' knowledge, this is the first report of an intraarterial neoplasm causing an SAH. A 44-year-old woman presented with an SAH in the basal cisterns. Subsequent internal carotid artery angiography demonstrated a small bulge on the superior wall of the horizontal (M1) segment of the middle cerebral artery. However, a pterional craniotomy revealed a well-circumscribed solitary tumor with a diameter of 15 mm involving the superior wall of the M1 segment as the cause of the SAH. Pathological examination demonstrated typical findings of a schwannoma, elongated cells with tapered, spindle-shaped nuclei and indistinct cell borders, and diffuse immunoreactivity for the S100 protein.

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Serial Quantitative Computed Tomography Perfusion in Aneurysmal Subarachnoid Hemorrhage

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

10.1017/cjn.2015.351 ◽

2016 ◽

Vol 43 (3) ◽

pp. 375-380 ◽

Cited By ~ 2

Author(s):

Cheemun Lum ◽

Matthew J. Hogan ◽

John Sinclair ◽

Shane English ◽

Howard Lesiuk ◽

...

Keyword(s):

Computed Tomography ◽

Subarachnoid Hemorrhage ◽

Middle Cerebral Artery ◽

Transit Time ◽

Cerebral Artery ◽

Computed Tomography Angiography ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Mean Transit Time ◽

Arterial Diameter ◽

Computed Tomography Perfusion

AbstractPurpose: Computed tomography perfusion (CTP) has been performed to predict which patients with aneurysmal subarachnoid hemorrhage are at risk of developing delayed cerebral ischemia (DCI). Patients with severe arterial narrowing may have significant reduction in perfusion. However, many patients have less severe arterial narrowing. There is a paucity of literature evaluating perfusion changes which occur with mild to moderate narrowing. The purpose of our study was to investigate serial whole-brain CTP/computed tomography angiography in aneurysm-related subarachnoid hemorrhage (aSAH) patients with mild to moderate angiographic narrowing. Methods: We retrospectively studied 18 aSAH patients who had baseline and follow-up whole-brain CTP/computed tomography angiography. Thirty-one regions of interest/hemisphere at six levels were grouped by vascular territory. Arterial diameters were measured at the circle of Willis. The correlation between arterial diameter and change in CTP values, change in CTP in with and without DCI, and response to intra-arterial vasodilator therapy in DCI patients was evaluated. Results: There was correlation among the overall average cerebral blood flow (CBF; R=0.49, p<0.04), mean transit time (R=–0.48, p=0.04), and angiographic narrowing. In individual arterial territories, there was correlation between changes in CBF and arterial diameter in the middle cerebral artery (R=0.53, p=0.03), posterior cerebral artery (R=0.5, p=0.03), and anterior cerebral artery (R=0.54, p=0.02) territories. Prolonged mean transit time was correlated with arterial diameter narrowing in the middle cerebral artery territory (R=0.52, p=0.03). Patients with DCI tended to have serial worsening of CBF compared with those without DCI (p=0.055). Conclusions: Our preliminary study demonstrates there is a correlation between mild to moderate angiographic narrowing and serial changes in perfusion in patients with aSAH. Patients developing DCI tended to have progressively worsening CBF compared with those not developing DCI.

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The Effect of Stellate Ganglion Block on Mean Blood Flow Velocity and Carbon Dioxide Reactivity of the Middle Cerebral Artery

Korean Journal of Anesthesiology ◽

10.4097/kjae.1994.27.2.184 ◽

1994 ◽

Vol 27 (2) ◽

pp. 184

Author(s):

Hye Won Lee ◽

Myung Hyun Kim ◽

Byung Kook Chae ◽

Seong Ho Chang

Keyword(s):

Carbon Dioxide ◽

Blood Flow ◽

Middle Cerebral Artery ◽

Flow Velocity ◽

Cerebral Artery ◽

Blood Flow Velocity ◽

Stellate Ganglion ◽

Stellate Ganglion Block ◽

Ganglion Block ◽

Carbon Dioxide Reactivity

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THE IMPACT OF BALLOON ANGIOPLASTY ON THE EVOLUTION OF VASOSPASM-RELATED INFARCTION AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

Neurosurgery ◽

10.1227/01.neu.0000311351.32904.8b ◽

2008 ◽

Vol 62 (3) ◽

pp. 610-617 ◽

Cited By ~ 47

Author(s):

Leonie Jestaedt ◽

Mirko Pham ◽

Andreas J. Bartsch ◽

Ekkehard Kunze ◽

Klaus Roosen ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Balloon Angioplasty ◽

Anterior Cerebral Artery ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Fisher Exact Test ◽

Computed Tomographic ◽

Fisher Grade ◽

The Impact

Abstract OBJECTIVE Vasospasm of the cerebral vessels remains a major source for morbidity and mortality after aneurysmal subarachnoid hemorrhage. The purpose of this study was to evaluate the frequency of infarction after transluminal balloon angioplasty (TBA) in patients with severe subarachnoid hemorrhage-related vasospasm. METHODS We studied 38 patients (median Hunt and Hess Grade II and median Fisher Grade 4) with angiographically confirmed severe vasospasm (>70% vessel narrowing). A total of 118 vessels with severe vasospasm in the anterior circulation were analyzed. Only the middle cerebral artery, including the terminal internal carotid artery, was treated with TBA (n = 57 vessel segments), whereas the anterior cerebral artery was not treated (n = 61 vessel segments). For both the treated and the untreated vessel territories, infarction on unenhanced computed tomographic scan was assessed as a marker for adverse outcome. RESULTS Infarction after TBA occurred in four middle cerebral artery territories (four out of 57 [7%]), whereas the infarction rate was 23 out of 61 (38%) in the anterior cerebral artery territories not subjected to TBA (P < 0.001, Fisher exact test). Three procedure-related complications occurred during TBA (dissection, n = 1; temporary vessel occlusions, n = 2). One of these remained asymptomatic, whereas this may have contributed to the development of infarction on follow-up computed tomographic scans in two cases. CONCLUSION In a population of patients with a high risk of infarction resulting from vasospasm after subarachnoid hemorrhage, the frequency of infarction in the distribution of vessels undergoing TBA amounts to 7% and is significantly lower than in vessels not undergoing TBA despite some risk inherent to the procedure.

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Hidden Dense Middle Cerebral Artery Sign in a 4-Year-Old Boy With Traumatic Subarachnoid Hemorrhage

Journal of Child Neurology ◽

10.1177/0883073813510357 ◽

2013 ◽

Vol 29 (12) ◽

pp. NP189-NP192

Author(s):

Bum-Joon Kim ◽

Jong-Il Choi ◽

Sung-Kon Ha ◽

Dong-Jun Lim ◽

Sang-Dae Kim

Keyword(s):

Subarachnoid Hemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Traumatic Subarachnoid Hemorrhage

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Endovascular and Surgical Options for Ruptured Middle Cerebral Artery Aneurysms: Review of the Literature

Stroke Research and Treatment ◽

10.1155/2014/315906 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

David R. Santiago-Dieppa ◽

Jeffrey S. Pannell ◽

Alexander A. Khalessi

Keyword(s):

Subarachnoid Hemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Review Of The Literature ◽

Surgical Options ◽

Mca Aneurysm ◽

Middle Cerebral Artery Aneurysms

Middle cerebral artery (MCA) aneurysms are common entities, and those of the bifurcation are the most frequently encountered sublocation of MCA aneurysm. MCA bifurcation (MBIF) aneurysms commonly present with subarachnoid hemorrhage (SAH), are devastating, and are often lethal. At the present time, the treatment of ruptured MBIF aneurysms entails either endovascular or open microneurosurgical methods to permanently secure the aneurysm(s). The purpose of this report is to review the current available data regarding the relative superiority of endovascular versus open microneurosurgical clipping for the treatment of ruptured middle cerebral artery bifurcation aneurysms.

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RUPTURED ANEURYSM AT THE PERFORATING ARTERY SUPPLYING THE INSULA

Neurosurgery ◽

10.1227/01.neu.0000346270.89755.1e ◽

2009 ◽

Vol 65 (1) ◽

pp. E206-E207 ◽

Cited By ~ 2

Author(s):

Servet Inci ◽

Atila Akbay ◽

Burcu Hazer ◽

Kivilcim Yavuz ◽

Tuncalp Ozgen

Keyword(s):

Subarachnoid Hemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Clinical Presentation ◽

Artery Aneurysm ◽

Intracerebral Hematoma ◽

Aged Patients ◽

Perforating Artery ◽

Proximal Middle Cerebral Artery ◽

Small Aneurysm

Abstract OBJECTIVE Aneurysms originating from perforating branches of the middle cerebral artery are quite rare. Most of them arise from the lenticulostriate arteries, frequently located within the basal ganglia. We report a perforating artery aneurysm that was entirely embedded within the limen insulae. CLINICAL PRESENTATION A 41-year-old man presented with an insular hematoma without subarachnoid hemorrhage caused by rupture of a small aneurysm on a perforating artery of the proximal middle cerebral artery supplying the insula. INTERVENTION This rare aneurysm was resected via the transsylvian-insular approach. CONCLUSION Although very rare, perforating artery aneurysms should be considered in young or middle-aged patients with an atypical intracerebral hematoma. This report discusses radiological and surgical characteristics of this unusual aneurysm.

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Effect of Nimodipine on Cerebrovascular Response to CO2 in Asymptomatic Individuals and Patients with Subarachnoid Hemorrhage: A Transcranial Doppler Ultrasound Study

Neurosurgery ◽

10.1227/00006123-199008000-00013 ◽

1990 ◽

Vol 27 (2) ◽

pp. 247-251 ◽

Cited By ~ 20

Author(s):

Rolf W. Seiler ◽

Arto C. Nirkko

Keyword(s):

Subarachnoid Hemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Transcranial Doppler ◽

Doppler Ultrasonography ◽

Transcranial Doppler Ultrasound ◽

Initial Value ◽

Ruptured Aneurysms ◽

Ultrasound Study ◽

Asymptomatic Individuals

Abstract The cerebrovascular response to CO2was evaluated by measuring relative changes in blood flow velocity within the middle cerebral artery by transcranial Doppler ultrasonography during normo-, hypo-, and hypercapnia. In seven patients without subarachnoid hemorrhage (five with unruptured arteriovenous malformations and two with aneurysms), the CO2vasoreactivity was tested on the side of the middle cerebral artery with normal flow velocities opposite the lesion. A baseline CO2reactivity test was obtained in each patient and then repeated under constant intravenous infusion of nimodipine, 2 mg/hr. Nine patients with ruptured aneurysms who were rated at Hunt and Hess Grades 1 or 2 were operated on within 1 to 3 days after the hemorrhage and treated with nimodipine, 2 mg/hr, given intravenously. In these patients. CO2vasoreactivity was tested during the second week after the hemorrhage, when the middle cerebral artery velocity was increased by at least 50% of the initial value or more. Nimodipine was then discontinued and, 48 hours later, when the middle cerebral artery velocity was still in the same range, CO2vasoreactivity was tested again. Two months later, after full recovery from the subarachnoid hemorrhage and normalization of the velocities, a third measurement of CO2reactivity was obtained as a baseline control. No significant effect of nimodipine on CO2vasoreactivity could be demonstrated in any of the test periods. In the second week after a subarachnoid hemorrhage, a significant reduction of the cerebrovascular response to CO2was found (P < 0.005).

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