Anterior Communicating Artery Aneurysm Rupture After Intravenous Thrombolysis for Acute Middle Cerebral Artery Thromboembolism

Neurosurgery ◽  
2011 ◽  
Vol 70 (6) ◽  
pp. E1603-E1607 ◽  
Author(s):  
Stylianos K. Rammos ◽  
David M. Neils ◽  
Kenneth Fraser ◽  
Jeffrey D. Klopfenstein
Keyword(s):  
Middle Cerebral Artery ◽  
Intracranial Hemorrhage ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Intravenous Thrombolysis ◽  
Vascular Lesions ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Anterior Communicating Artery Aneurysm ◽  
Left Middle

Abstract BACKGROUND AND IMPORTANCE: The use of intravenous recombinant tissue plasminogen activator (IV rtPA) has become an integral part of modern acute ischemic stroke management; however, its use has been associated with the development of intracranial hemorrhage in 6.4% of patients. It is possible that underlying and unsuspected vascular lesions, such as cerebral aneurysms, may lead to intracranial hemorrhage after IV rtPA thrombolysis. CLINICAL PRESENTATION: We present a previously unreported case of a 51-year-old woman who presented with subarachnoid hemorrhage from an acutely ruptured a nterior communicating artery aneurysm after IV rtPA treatment for acute left middle cerebral artery thromboembolism. The patient underwent mechanical thromboembolectomy of the left middle cerebral artery occlusion with resultant TIMI (Thrombolysis In Myocardial Infarction) grade I recanalization, followed by coil embolization of the anterior communicating artery aneurysm. The patient never improved neurologically, and she ultimately died. CONCLUSION: Screening to identify patients at risk for development of hemorrhagic complications from underlying structural vascular lesions before the use of IV rtPA with computed tomography angiography should be considered.

A CASE OF MIDDLE CEREBRAL ARTERY INFARCT FOLLOWING UNEVENTFUL CLIPPING OF ANTERIOR COMMUNICATING ARTERY ANEURYSM

2021 ◽  
pp. 6-7
Author(s):  
T S Vasan ◽  
Rahul Vyas ◽  
Karan Mathur
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Middle Cerebral Artery Infarction ◽  
Anterior Communicating Artery Aneurysm ◽  
Ct Angiogram

Background: Aneurysms of the anterior communicating artery are the most frequently encountered intracerebral aneurysms in routine neurosurgical practice. Management of intracerebral aneurysm involves aneurysm clipping or endovascular coil aneurysm embolisation. However, to the best of our knowledge, there is no reported case of an isolated ipsilateral middle cerebral artery infarction following clipping of anterior communicating artery aneurysm. Case Description: A 65-year-old female with hypertension presented with a history of giddiness, fall and altered sensorium. The patient had a Glasgow Coma Scale (GCS) score of 12, and further investigation of the magnetic resonance imaging on suspicion of stroke revealed subarachnoid haemorrhage in the bilateral parietal sulcus, left Sylvain ssure, left ambient and quadrigeminal cisterns with intra-ventricular extension. The patient was subsequently referred for neurosurgery consultation. Computed tomography (CT) angiogram conrmed the presence of a ruptured anterior communicating artery aneurysm. The neurological assessment showed reduced responsiveness to verbal commands, with a Hunt and Hess score of 3. The patient underwent uneventful clipping of the aneurysm. Postoperatively, the patient did not wake up from anaesthesia and had persistently elevated blood pressure and right-sided hemiplegia. On the third day of postoperative care, a CT head scan revealed a left middle cerebral artery infarction with a midline shift. Decompressive craniotomy was performed, and following this procedure, the patient improved in sensorium with residual right-sided hemiplegia Conclusion: This case report presents an undetected new micro embolism or postoperative cerebral vasospasm as possible causes for the development of cerebral infarct in patients with subarachnoid haemorrhage following an aneurysm rupture.

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.

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.

Sign in / Sign up

Export Citation Format

Share Document