scholarly journals Intracranial Malignant Glioma Presenting as Subarachnoid Hemorrhage

2003 ◽  
Vol 30 (1) ◽  
pp. 63-66 ◽  
Author(s):  
Stephen Hentschel ◽  
Brian Toyota
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Magnetic Resonance ◽  
Magnetic Resonance Image ◽  
Clinical Presentation ◽  
Cerebral Aneurysms ◽  
Short List ◽  
Metastatic Lesions ◽  
The Right ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Cerebral Neoplasms

Objective:Cerebral aneurysms are the predominant cause of spontaneous subarachnoid hemorrhage (SAH). However, if an aneurysmal cause has been excluded, there remains but a short list of other potential etiologies. Cerebral neoplasms are clearly on this list but are most commonly meningiomas or metastatic lesions. This article details a case of a neoplasm that presented exclusively with SAH.Clinical Presentation:A 40-year-old male presented with a SAH with normal cerebral angiography. The initial magnetic resonance image revealed a lesion in the right insula thought to be resolving hemorrhage. Subsequent images, however, revealed the mass to be enlarging.Intervention:Craniotomy and resection of the lesion established a diagnosis of a malignant oligodendroglioma.Conclusion:An affirmation is made that patients experiencing ’angiographically-negative’ SAH should undergo MRI, occasionally on a serial basis, to exclude other etiologies for hemorrhage, including neoplasia.

STENT REMODELING TECHNIQUE FOR COILING OF RUPTURED WIDE-NECK CEREBRAL ANEURYSMS: CASE REPORT

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E1007-E1008 ◽  
Author(s):  
Demetrius K. Lopes ◽  
Kalani Wells
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Acute Subarachnoid Hemorrhage ◽  
The Right ◽  
Wide Neck ◽  
Cordis Corporation

Abstract OBJECTIVE To describe a novel stent remodeling technique for the coiling of ruptured wide-neck cerebral aneurysms. CLINICAL PRESENTATION A 46-year-old man presented with acute subarachnoid hemorrhage (Hunt and Hess grade IV), intracerebral hemorrhage, and hydrocephalus. Cerebral angiography revealed a wide-neck small anterior communicating artery aneurysm. Conventional coiling was not successful because of coil instability and compromise of the dominant anterior cerebral artery. TECHNIQUE A 6-French shuttle sheath (Cook Medical, Indianapolis, IN) was advanced from a right femoral approach into the right common carotid artery. To protect the parent vessel during coiling without compromising blood flow, a Prowler Select Plus catheter (Cordis Corporation, Bridgewater, NJ) was navigated across the aneurysm neck. Subsequently, an Enterprise stent (22-mm length; Cordis Corporation) was partially deployed across the aneurysm's wide neck. It was very important to watch the distal markers of the stent and lock the stent delivery wire to the Prowler Select Plus with a hemostatic valve once the stent was halfway deployed. This maneuver was essential to prevent further deployment of the stent. The SL-10 microcatheter and Synchro 14 wire (Boston Scientific, Natick, MA) were carefully navigated to the aneurysm passing through the partially deployed stent. Coils were then delivered to the aneurysm using the stent as a scaffold. After coiling, the SL-10 microcatheter was removed and the stent was recaptured into the Prowler Select Plus catheter. During the recapture, there was initial resistance. This was easily overcome after deploying the stent a little more before resheathing. During the procedure, the patient received 2000 U of heparin after the first coil was detached in the aneurysm. CONCLUSION The stent remodeling technique is a novel endovascular technique that can be used to treat ruptured wide-neck aneurysms and maintain patency of parent vessels, avoiding the use of antiplatelet therapy in acute subarachnoid hemorrhage.

Acute Spinal Epidural Hematoma and Cranial Interdural Hematoma Due to a Rupture of a Posterior Communicating Artery Aneurysm: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. E1000-E1004 ◽  
Author(s):  
Andrea Bartoli ◽  
Marc Kotowski ◽  
Vitor Mendes Pereira ◽  
Karl Schaller
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Epidural Hematoma ◽  
Clinical Presentation ◽  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
Spinal Epidural Hematoma ◽  
Anterior Communicating Artery ◽  
Posterior Communicating Artery Aneurysm ◽  
The Right ◽  
Spinal Epidural

Abstract BACKGROUND AND IMPORTANCE: We describe an unusual presentation of a ruptured aneurysm of the posterior communicating artery with an acute intracranial hematoma between the dural layers associated with an acute spinal epidural hematoma descending to L1. CLINICAL PRESENTATION: A 35-year-old woman presented 3 hours after ictus with a postcoital headache, neck stiffness, and bilateral abducens cranial nerve palsy. No other neurological deficits were present. Clinically, she had a subarachnoid hemorrhage World Federation of Neurosurgical Societies grade 1. CT scan demonstrates an acute subdural hematoma, extending from the right parasellar region, around the clivus, tentorium, and falx. Angio-CT showed a posterior communicating artery aneurysm and an anterior communicating artery aneurysm and an extension of the hematoma to the cervical spine. This justified a spinal and cerebral MRI that confirmed an extension of the hematoma to the epidural space at the cervical, thoracic, and lumbar levels. Three-dimensional digital subtraction angiography confirmed aneurysms on the right posterior communicating artery and on the anterior communicating artery. Both aneurysms were completely occluded by coiling. With reference to the concept of the cranial subdural compartment described in studies conducted using an electron microscope, this group of hematomas was classified as interdural. CONCLUSION: Ruptured aneurysm of the posterior communicating artery may cause cranial acute interdural hematoma with a typical subarachnoid hemorrhage clinical presentation, and it rarely can extend to spinal epidural space.

Cervical Spine Dural Arteriovenous Fistula With Coexisting Spinal Radiculopial Artery Aneurysm Presenting as Subarachnoid Hemorrhage

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 259-263 ◽  
Author(s):  
Joshua W. Lucas ◽  
Jesse Jones ◽  
Azadeh Farin ◽  
Paul Kim ◽  
Steven L. Giannotta
Keyword(s):  
Native American ◽  
Cervical Spine ◽  
Subarachnoid Hemorrhage ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Clinical Presentation ◽  
Artery Aneurysm ◽  
Sudden Onset ◽  
Spinal Dural Arteriovenous Fistula ◽  
The Right

Abstract BACKGROUND AND IMPORTANCE We present a patient with a cervical spine dural arteriovenous fistula associated with a radiculopial artery aneurysm at the same vertebral level presenting with subarachnoid hemorrhage. CLINICAL PRESENTATION A 45-year-old Native American man presented with sudden-onset severe headache, lethargy, and right hemiparesis. Computed tomography (CT) of the head showed subarachnoid hemorrhage and hydrocephalus. A subsequent CT of the neck showed an anterior spinal subdural hematoma from C2 to C4 causing mild cord compression. Carotid and vertebral angiography failed to demonstrate an intracranial aneurysm, but showed a spinal dural arteriovenous fistula originating from the right vertebral artery at the C5 neuroforamen. The severity of the patient's symptoms, atypical for rupture of a dural arteriovenous fistula, prompted more thorough angiographic evaluation. Thus, injection of the right thyrocervical trunk was performed, demonstrating a 4-mm spinal radiculopial artery aneurysm. Following ventriculostomy, a hemilaminectomy from C4 to C7 was performed with disconnection of the fistula from its drainage system. Subsequent resection of the aneurysm, which was determined to be the cause of the hemorrhage, was accomplished. The patient improved neurologically and was discharged to rehabilitation. CONCLUSION Spinal cord aneurysms from a separate vascular distribution may coexist with spinal dural arteriovenous fistulas. In the setting of spinal hemorrhage, especially in situations with an atypical clinical presentation, comprehensive imaging is indicated to rule out such lesions.

scholarly journals Single-stage clipping with bifrontal and bilateral frontotemporal craniotomies for subarachnoid hemorrhage with multiple cerebral aneurysms using Sugita head holding system: A case report

2020 ◽  
Vol 11 ◽  
pp. 76
Author(s):  
Masahito Katsuki ◽  
Naomichi Wada ◽  
Yasunaga Yamamoto
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Treatment Strategies ◽  
Cerebral Aneurysms ◽  
Single Stage ◽  
Ruptured Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Multiple Aneurysms ◽  
Single Fixation ◽  
The Right

Background: Subarachnoid hemorrhage with multiple aneurysms is very challenging because it is difficult to identify the ruptured aneurysm. We could not identify the ruptured aneurysm preoperatively, so we decided to treat all of the aneurysms as a single-stage surgery. Case Description: A 79-year-old woman was diagnosed with subarachnoid hemorrhage with multiple cerebral aneurysms at the right distal anterior cerebral artery, left middle cerebral artery, and right internal carotid artery- posterior communicating artery bifurcation. We could not identify the ruptured aneurysm preoperatively. We fixed her head using the Sugita head holding system (Mizuho Co., Ltd., Tokyo) and performed clipping for each aneurysm with bifrontal craniotomy and bilateral frontotemporal craniotomy as a single-stage operation. The last aneurysm seemed ruptured, and clipping for all the aneurysms was successful. She was discharged with a good postoperative course. The Sugita head holding system allowed turning the head of the patient toward the right and left with single fixation, leading to this single-stage operation. Conclusion: Several methods for identifying a ruptured aneurysm from multiple aneurysms have been reported, but under limited medical resources, this procedure would be one of the treatment strategies.

scholarly journals Cervical Tuberculosis Infection and its Treatment

2018 ◽  
pp. 6-9
Author(s):  
Ivan Copete-González ◽  
Joan Ferràs-Tarragó ◽  
Teresa Bas-Hermida
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Image ◽  
Posterior Approach ◽  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Low Frequency ◽  
Tuberculosis Infection ◽  
Correct Treatment ◽  
Tracheal Compression

Background: Extrapulmonar tuberculosis (TBC) frequently includes vertebral affection but cervical levels are the less frequently affected. Its clinical presentation is very variable depending on the age. Both the low frequency and the clinical variations are the reason because its treatment in children is controversial and different depending on the hospitals. Methods: We show a 3 years woman with an cervical abscess and spondylodiscitis because extrapulmonar TBC which presented with medullar and tracheal compression. Patient needed anterior and posterior approach during the surgery to release of the compression and arthrodesis. Results: Clinical symptoms resolved after surgery. No new signs neither symptoms after 18 months of fellowship and Magnetic Resonance Image (MRI) controls. Conclusions: According with bibliography and our own experience, we recommend to personalize each treatment for each patient to the correct treatment of this disease, overall in the strange cases when surgery will be needed

Trigeminal Neuralgia Caused by a Pontine Abscess: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (6) ◽  
pp. E1450-E1452 ◽  
Author(s):  
Ahmet Bekar ◽  
Hasan Kocaeli ◽  
Emel Yilmaz ◽  
Şeref Doğan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Sphenoid Sinus ◽  
Clinical Presentation ◽  
Resonance Imaging ◽  
Repeat Magnetic Resonance Imaging ◽  
Corneal Reflex ◽  
History Of ◽  
The Right

Abstract OBJECTIVE AND IMPORTANCE: Various intracranial abnormalities, including infectious conditions, may manifest as trigeminal neuralgia. CLINICAL PRESENTATION: A 33-year-old man presented with a 15-day history of right-sided facial pain and numbness. Neurological examination revealed diminished corneal reflex and facial sensation in the right V1–V2 distribution. Magnetic resonance imaging revealed a contrast-enhancing lesion centered at the right pons with extension of the enhancement to the sphenoid sinus. INTERVENTION: Broad-spectrum antibiotics were administered for 6 weeks. This resulted in alleviation of symptoms and resolution of the lesion as revealed by repeat magnetic resonance imaging. CONCLUSION: Presentation of a pons abscess with trigeminal neuralgia is rare, and to the best of our knowledge has not been reported previously. The patient was treated successfully with antibiotics alone.

Diagnostic yield of computed tomography angiography and magnetic resonance angiography in patients with catheter angiography–negative subarachnoid hemorrhage

2012 ◽  
Vol 117 (2) ◽  
pp. 309-315 ◽  
Author(s):  
Josser E. Delgado Almandoz ◽  
Bharathi D. Jagadeesan ◽  
Daniel Refai ◽  
Christopher J. Moran ◽  
DeWitte T. Cross ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Cerebral Aneurysm ◽  
Computed Tomography Angiography ◽  
Diagnostic Yield ◽  
Cerebral Aneurysms ◽  
Valuable Adjunct ◽  
Noncontrast Ct

Object The yield of CT angiography (CTA) and MR angiography (MRA) in patients with subarachnoid hemorrhage (SAH) who have a negative initial catheter angiogram is currently not well understood. This study aims to determine the yield of CTA and MRA in a prospective cohort of patients with SAH and a negative initial catheter angiogram. Methods From January 1, 2005, until September 1, 2010, the authors instituted a prospective protocol in which patients with SAH—as documented by noncontrast CT or CSF xanthochromia and a negative initial catheter angiogram— were evaluated using CTA and MRA to assess for causative cerebral aneurysms. Two neuroradiologists independently evaluated the noncontrast CT scans to determine the SAH pattern (perimesencephalic or not) and the CT and MR angiograms to assess for causative cerebral aneurysms. Results Seventy-seven patients were included, with a mean age of 52.8 years (median 54 years, range 19–88 years). Fifty patients were female (64.9%) and 27 male (35.1%). Forty-three patients had nonperimesencephalic SAH (55.8%), 29 patients had perimesencephalic SAH (37.7%), and 5 patients had CSF xanthochromia (6.5%). Computed tomography angiography demonstrated a causative cerebral aneurysm in 4 patients (5.2% yield), all of whom had nonperimesencephalic SAH (9.3% yield). Mean aneurysm size was 2.6 mm (range 2.1–3.3 mm). Magnetic resonance angiography demonstrated only 1 of these aneurysms. No causative cerebral aneurysms were found in patients with perimesencephalic SAH or CSF xanthochromia. Conclusions Computed tomography angiography is a valuable adjunct in the evaluation of patients with nonperimesencephalic SAH who have a negative initial catheter angiogram, demonstrating a causative cerebral aneurysm in 9.3% of patients.

scholarly journals Spontaneous non-aneurysmal subarachnoid hemorrhage in Takayasu arteritis: a case implicating hyperperfusion and cerebral dysautoregulation

2019 ◽  
Vol 5 (2) ◽  
pp. 20180113
Author(s):  
Hena Joshi ◽  
Jason Allen ◽  
Deqiang Qiu ◽  
Junjie Wu ◽  
Fadi Nahab ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Takayasu Arteritis ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Pulmonary Arteries ◽  
Young Female ◽  
Unexpected Finding ◽  
Cerebrovascular Autoregulation ◽  
The Right ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Arterial Stenoses

Takayasu arteritis (TA) is a systemic chronic inflammatory large-vessel vasculitis that affects the aorta, its major branches, and the pulmonary arteries. In this report, we describe a case of a young female with TA presenting with spontaneous subarachnoid hemorrhage (SAH), an unusual manifestation of the disease. Magnetic resonance angiography (MRA) of the head and neck demonstrates multifocal carotid and vertebral arterial stenoses, but no aneurysm or vascular malformation to account for SAH. A novel and unexpected finding in this case was increased cerebral perfusion in the right frontotemporal parenchyma and transient abnormally reduced augmentation of flow in response to the cerebral vasodilator acetazolamide. The etiology of SAH thus may be related to hyperperfusion and loss of cerebrovascular autoregulation leading to small vessel damage.

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