Conus Perimedullary Arteriovenous Fistula with Intracranial Drainage: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 457-462 ◽  
Author(s):  
G. Edward Vates ◽  
Alfredo Quiñones-Hinojosa ◽  
Van V. Halbach ◽  
Michael T. Lawton
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Venous Drainage ◽  
Sudden Onset ◽  
Clinical Findings ◽  
Left Middle Cerebral Artery ◽  
Lower Extremity Weakness ◽  
Posterior Laminectomy ◽  
Cerebral Artery Aneurysm ◽  
Left Middle

Abstract OBJECTIVE AND IMPORTANCE Perimedullary arteriovenous fistulae (AVFs) do not commonly present with subarachnoid hemorrhage or intracranial venous drainage causing neurological symptoms. We present a case with both of these features. The patient was inadvertently treated for an unruptured intracranial aneurysm before his true problem was recognized. CLINICAL PRESENTATION A 65-year-old man presented with sudden-onset lower-extremity weakness, diplopia, nausea, and dysarthria on the day of admission. A lumbar puncture documented subarachnoid hemorrhage, and imaging studies revealed a left middle cerebral artery aneurysm. It was noted during surgery that this aneurysm was unruptured, and the patient did not exhibit improvement after surgery. INTERVENTION Spinal angiography demonstrated a spinal perimedullary AVF feeding from the left T12 radicular artery; venous drainage extended rostrally into the posterior fossa venous system. The AVF was surgically occluded via a posterior laminectomy at the level of the AVF. After surgery, the patient's symptoms began to abate. CONCLUSION Conus perimedullary AVFs can have venous drainage that extends as far as intracranial veins, which can lead to confusing clinical findings because the symptoms may suggest an intracranial process, although the lesion is in the spine. Surgeons must be aware of this confusing presentation.

Giant Intracranial Aneurysms Presenting with Massive Cerebral Edema

Neurosurgery ◽  
1984 ◽  
Vol 15 (4) ◽  
pp. 572-577 ◽  
Author(s):  
Roberto C. Heros ◽  
Sastry Kolluri
Keyword(s):  
Cerebral Hemisphere ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Brain Swelling ◽  
Middle Cerebral Artery Aneurysm ◽  
Computed Tomographic ◽  
Computed Tomographic Scan ◽  
Cerebral Artery Aneurysm ◽  
Left Middle

Abstract Two cases of giant left middle cerebral artery aneurysm presenting with rapidly progressing hemiparesis and aphasia are presented. In both, the computed tomographic scan showed recent intraaneurysmal thrombosis and massive edema and swelling of the cerebral hemisphere. There was no evidence of recent hemorrhage in either case. In both patients, surgical resection of the aneurysm was accomplished, but the outcome was disastrous. The literature is reviewed and the possible mechanisms responsible for brain swelling in these cases are discussed.

scholarly journals A Rare Case ofStreptococcus alactolyticusInfective Endocarditis Complicated by Septic Emboli and Mycotic Left Middle Cerebral Artery Aneurysm

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Patricia Almeida ◽  
Jaclyn Railsback ◽  
James Benjamin Gleason
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Left Middle Cerebral Artery ◽  
Middle Cerebral Artery Aneurysm ◽  
Microsurgical Clipping ◽  
Cerebral Artery Aneurysm ◽  
Left Middle

To date,S. alactolyticusendocarditis complicated by middle cerebral artery aneurysm has not been reported. We describe the case of a 65-year-old female with a history of hypertrophic cardiomyopathy with left ventricular outflow tract obstruction presenting with confusion and a apical holosystolic murmur. Angiography of the brain identified new bilobed left middle cerebral artery aneurysm. Serial blood cultures grewS. alactolyticus, and aortic and mitral valve vegetation were discovered on transesophageal echocardiography. The patient was treated with antimicrobial therapy, mitral and aortic valve replacements, and microsurgical clipping of cerebral aneurysm. This case serves to highlight the pathogenicity of a sparsely described bacterium belonging to the heterogenousS. boviscomplex.

Unilateral Fixed Dilation of the Pupil as a False-localizing Sign with Intracranial Hemorrhage: Case Report and Literature Review

Neurosurgery ◽  
2001 ◽  
Vol 49 (5) ◽  
pp. 1251-1256 ◽  
Author(s):  
Laurence A.G. Marshman ◽  
Charles E. Polkey ◽  
Christopher C. Penney
Keyword(s):  
Artery Aneurysm ◽  
Mass Effect ◽  
Left Middle Cerebral Artery ◽  
Eye Opening ◽  
The Right ◽  
False Localizing Sign ◽  
Mass Lesions ◽  
Cerebral Artery Aneurysm ◽  
Supratentorial Mass ◽  
Left Middle

ABSTRACT OBJECTIVE AND IMPORTANCE Although other focal signs may prove “false localizing,” it is a neurosurgical axiom that unilateral fixed dilation of the pupil occurs ipsilateral to a supratentorial mass. CLINICAL PRESENTATION A 25-year-old man collapsed with a dense right hemiplegia and a Glasgow Coma Scale score of 6 (eye opening, 1; motor, 4; verbal, 1) after rupture of a left middle cerebral artery aneurysm associated with an intrasylvian hematoma. Initially, both pupils had remained equal-sized and reactive: however, within hours, the right (contralateral) pupil became fixed and dilated (i.e., false localizing). For some time, the left (ipsilateral) pupil remained small and reactive; at emergency craniotomy, this also became fixed and equally dilated. INTERVENTION After evacuation of the clot and wrapping of the aneurysm, both pupils rapidly became equal-sized and reactive. Twenty-four hours later, concurrent with massive left hemispheric swelling and a midline shift, the left (ipsilateral) pupil became unilaterally fixed and dilated (i.e., false localizing). Eventually, the right (contralateral) pupil also became fixed and dilated, concurrent with cardiovascular collapse. Death occurred within 10 hours. CONCLUSION Unilateral fixed dilation of the pupil in patients with hemispheric mass lesions may be false localizing. Furthermore, disparate “herniating mechanisms” can arise despite mass effect emanating from the same side. Because such mechanisms cannot be witnessed, their nature remains speculative. An extensive review is contained in this article.

scholarly journals Granuloma formation and arterial thrombosis following cotton wrapping of an intracranial aneurysm a case report

1992 ◽  
Vol 50 (4) ◽  
pp. 534-538 ◽  
Author(s):  
Alexandre Varella Gianetti ◽  
Francisco Otaviano Lima Perpetuo
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Arterial Thrombosis ◽  
Artery Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Middle Cerebral Artery Aneurysm ◽  
Cerebral Artery Aneurysm ◽  
Expansive Lesion ◽  
Tomography Scan ◽  
Left Middle

The authors report the case of a patient whose left middle cerebral artery aneurysm was wrapped with cotton. Occlusion of the middle cerebral artery, probably secondary to a foreign-body inflammatory reaction, developed late in the postoperative course. A computerized tomography scan revealed cerebral infarct, and an enhancing expansive lesion at the site of the aneurysm suggesting the formation of a granuloma. These findings are discussed and the literature is reviewed.

Surgical clipping of a large left middle cerebral artery aneurysm

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video13
Author(s):  
M. Yashar S. Kalani ◽  
Peter Nakaji ◽  
Joseph M. Zabramski ◽  
Robert F. Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Middle Cerebral Artery Aneurysm ◽  
Surgical Clipping ◽  
Microsurgical Clipping ◽  
Middle Cerebral Artery Aneurysms ◽  
Cerebral Artery Aneurysm ◽  
Left Middle

Middle cerebral artery aneurysms, especially those with complex morphology, are considered excellent aneurysms for surgical clipping, given the challenges that exist with current endovascular techniques. We present a case of a large, complex, left middle cerebral artery aneurysm treated with microsurgical clipping. This video highlights critical steps in obtaining proximal and distal control as well as subarachnoid dissection necessary to prepare the aneurysm for final clipping.The video can be found here: http://youtu.be/RlKH2Km9z5Y.

scholarly journals De novo aneurysm formation after the contralateral middle cerebral aneurysm clipping operation: a case report and review of literature

2021 ◽  
Author(s):  
zhiwu wu ◽  
Meihua Li
Keyword(s):  
De Novo ◽  
Artery Aneurysm ◽  
Contralateral Side ◽  
Left Middle Cerebral Artery ◽  
Review Of Literature ◽  
Middle Cerebral Artery Aneurysm ◽  
Aneurysm Clipping ◽  
De Novo Aneurysm ◽  
Cerebral Artery Aneurysm ◽  
Left Middle

A left middle cerebral artery aneurysm was ruptured and clipped, but a de novo aneurysm on contralateral side ruptured within 5 years in a 38-year-old man. The cause of the formation of de novo aneurysms is unknown and is not consistent with most of current reports.

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