Late Recurrence of Subarachnoid Hemorrhage Associated with Aneurysmal Regrowth Originating from the Anterior Communicating Artery after Neck Clipping

Terson's sign (TS) is classically defined as vitreous hemorrhage associated with subarachnoid hemorrhage of aneurysmal origin, being an important predictor of severity, indicating greater morbidity and mortality when compared to patients without the sign. The objective of this study is to review the relationship of Terson syndrome/Terson sign with the prognosis of aneurysmal subarachnoid hemorrhage. A search for original articles, research and case reports was performed on the PubMed, Scielo, Cochrane and ScienceDirect platform, with the following descriptors: Terson sign and subarachnoid hemorrhage. Retrospective, prospective articles and case reports published in the last 5 years and which were in accordance with the established objective and inclusion criteria were selected. Ten (10) articles were selected, in which the available results show an unfavorable prognostic relationship of TS and subarachnoid hemorrhage, because these patients had a worse clinical status assessed on the Glasgow scales ≤ 8, Hunt & Hess > III, Fisher > 3, in addition to intracranial hypertension and location of the aneurysm in the anterior communicating artery complex. The early recognition of this condition described by Albert Terson in 1900 brought an important contribution to neurosurgery, being recognized until nowadays.

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Influence of Lamina Terminalis Fenestration on the Occurrence of the Shunt-Dependent Hydrocephalus in Anterior Communicating Artery Aneurysmal Subarachnoid Hemorrhage

Journal of Korean Medical Science ◽

10.3346/jkms.2006.21.1.113 ◽

2006 ◽

Vol 21 (1) ◽

pp. 113 ◽

Cited By ~ 10

Author(s):

Jae Min Kim ◽

Ji Young Jeon ◽

Jae Hoon Kim ◽

Jin Hwan Cheong ◽

Koang Hum Bak ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Anterior Communicating Artery ◽

Lamina Terminalis

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Vasa Vasorum Formation is Associated With Rupture of Intracranial Aneurysms

Neurosurgery ◽

10.1093/neuros/nyz310_676 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Haruka Miyata ◽

Hirokazu Koseki ◽

Kampei Shimizu ◽

Yu Abekura ◽

Mieko Oka ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Aneurysms ◽

Histopathological Examination ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Vasa Vasorum ◽

Systemic Hypertension ◽

External Carotid ◽

Anterior Communicating Artery ◽

Sprague Dawley ◽

The Right

Abstract INTRODUCTION Subarachnoid hemorrhage has a poor outcome despite a modern advancement in medical care. The development of a novel therapeutic strategy to prevent rupture of intracranial aneurysms (IAs) or a novel diagnostic marker to predict rupture-prone lesions is thus mandatory. Therefore, in the present study, we established a rat model in which IAs spontaneously rupture and examined this model to clarify histopathological features associated with rupture of lesions. METHODS In detail, female Sprague-Dawley rats were subjected to the bilateral ovariectomy, the ligation of the left common carotid, the right external carotid, and the right pterygopalatine arteries, the induced systemic hypertension, and the administration of a lysyl oxidase inhibitor. RESULTS Aneurysmal subarachnoid hemorrhage occurred one-thirds of manipulated animals and locations of ruptured IAs were exclusively at a posterior or an anterior communicating artery. Histopathological examination using ruptured IAs, rupture-prone ones induced at a posterior or an anterior communicating artery, ones induced at an anterior cerebral artery-olfactory artery bifurcation that never rupture revealed the formation of vasa vasorum as an event associated with rupture of IAs. CONCLUSION We thus proposed the contribution of a structural change in an adventitia, vasa vasorum formation, to rupture of IAs. Findings from this study provide important insights about the pathogenesis of IAs.

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Saccular Intracranial Aneurysm Disease

Neurosurgery ◽

10.1227/01.neu.0000367634.89384.4b ◽

2010 ◽

Vol 66 (4) ◽

pp. 631-638 ◽

Cited By ~ 67

Author(s):

Terhi Huttunen ◽

Mikael von und zu Fraunberg ◽

Juhana Frösen ◽

Martin Lehecka ◽

Gerard Tromp ◽

...

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Intracranial Aneurysm ◽

Anterior Communicating Artery ◽

Sporadic Group ◽

Site Distribution ◽

Median Diameter ◽

Age And Sex ◽

Eastern Finland ◽

First Admission

Abstract OBJECTIVE Finnish saccular intracranial aneurysm (sIA) disease associates to 2q33, 8q11, and 9p21 loci and links to 19q13, Xp22, and kallikrein cluster in sIA families. Detailed phenotyping of familial and sporadic sIA disease is required for fine mapping of the Finnish sIA disease. METHODS Eastern Finland, which is particularly isolated genetically, is served by Kuopio University Hospital's Department of Neurosurgery. We studied the site and size distribution of unruptured and ruptured sIAs in correlation to age and sex in 316 familial and 1454 sporadic sIA patients on first admission from 1993 to 2007. RESULTS The familial and sporadic aneurysmic subarachnoid hemorrhage patients had slightly different median ages (46 vs 51 years in men; 50 vs 57 years in women), different proportion of males (50% vs 42%), equal median diameter of ruptured sIAs (7 mm vs 7 mm) with no correlation to age, and equally unruptured sIAs (30% vs 28%). The unruptured sIAs were most frequent at the middle cerebral artery (MCA) bifurcation (44% vs 39%) and the anterior communicating artery (12% vs 13%), in contrast to the ruptured sIAs at the anterior communicating artery (37% vs 29%) and MCA bifurcation (29% vs 29%). The size of unruptured sIAs increased by age in the sporadic group. CONCLUSION The MCA bifurcation was most prone to develop unruptured sIAs, suggesting that MCA branching during the embryonic period might be involved. The different site distribution of ruptured and unruptured sIAs suggests different etiologies for sIA formation and rupture. The lack of correlation of size and age at rupture (exposure to risk factors) suggests that the size at rupture is more dependent on hemodynamic stress.

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

Neurosurgery ◽

10.1227/01.neu.0000350984.86323.61 ◽

2009 ◽

Vol 65 (5) ◽

pp. E1007-E1008 ◽

Cited By ~ 10

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.

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De Novo Aneurysm of the Anterior Communicating Artery Presenting with Subarachnoid Hemorrhage 7 Years After Initial Cryptogenic Subarachnoid Hemorrhage: A Case Report and Review of the Literature

Clinical Neuroradiology ◽

10.1007/s00062-013-0278-y ◽

2014 ◽

Vol 25 (1) ◽

pp. 93-97 ◽

Cited By ~ 2

Author(s):

H. Wenz ◽

M.-M. al Mahdi ◽

G. Ehrlich ◽

J. Scharf ◽

P. Schmiedek ◽

...

Keyword(s):

Case Report ◽

Subarachnoid Hemorrhage ◽

De Novo ◽

Anterior Communicating Artery ◽

Review Of The Literature ◽

De Novo Aneurysm

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Use of spiral computerized tomography angiography in patients with subarachnoid hemorrhage in whom subtraction angiography did not reveal cerebral aneurysms

Journal of Neurosurgery ◽

10.3171/jns.2000.92.2.0278 ◽

2000 ◽

Vol 92 (2) ◽

pp. 278-283 ◽

Cited By ~ 77

Author(s):

Hiroyuki Hashimoto ◽

Jun-Ichi Iida ◽

Yasuo Hironaka ◽

Masato Okada ◽

Toshisuke Sakaki

Keyword(s):

Subarachnoid Hemorrhage ◽

Ct Angiography ◽

Cerebral Aneurysms ◽

Spiral Ct ◽

The Other ◽

Anterior Communicating Artery ◽

Content Type ◽

Spiral Ct Angiography ◽

Spiral Computerized Tomography ◽

Fine Print

Object. Patients with subarachnoid hemorrhage (SAH) in whom angiography does not demonstrate diagnostic findings sometimes suffer recurrent disease and actually harbor undetected cerebral aneurysms. The management strategy for such cases remains controversial, but technological advances in spiral computerized tomography (CT) angiography are changing the picture. The purpose of this prospective study was to examine how spiral CT angiography can contribute to the detection of cerebral aneurysms that cannot be visualized on angiography.Methods. In 134 consecutive patients with SAH, a prospective search for the source of bleeding was performed using digital subtraction (DS) and spiral CT angiography. In 21 patients in whom initial DS angiography yielded no diagnostic findings, spiral CT angiography was performed within 3 days. Patients in whom CT angiography provided no diagnostic results underwent second and third DS angiography sessions after approximately 2 weeks and 6 months, respectively.Six patients with perimesencephalic SAH were included in the 21 cases. Six of the other 15 patients had small cerebral aneurysms detectable by spiral CT angiography, five involving the anterior communicating artery and one the middle cerebral artery. Two patients in whom initial angiograms did not demonstrate diagnostic findings proved to have a ruptured dissecting aneurysm of the vertebral artery; in one case this was revealed at autopsy and in the other during the second DS angiography session. A third DS angiography session revealed no diagnostic results in 13 patients.Conclusions. Spiral CT angiography was useful in the detection of cerebral aneurysms in patients with SAH in whom angiography revealed no diagnostic findings. Anterior communicating artery aneurysms are generally well hidden in these types of SAH cases. A repeated angiography session was warranted in patients with nonperimesencephalic SAH and in whom initial angiography revealed no diagnostic findings, although a third session was thought to be superfluous.

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Neuropsychological Function in Patients after Subarachnoid Hemorrhage

Neurosurgery ◽

10.1227/00006123-198711000-00008 ◽

1987 ◽

Vol 21 (5) ◽

pp. 651-654 ◽

Cited By ~ 80

Author(s):

R. A. Bornstein ◽

B. K. A. Weir ◽

K. C. Petruk ◽

L. B. Disney

Keyword(s):

Subarachnoid Hemorrhage ◽

Neurological Outcome ◽

Neuropsychological Testing ◽

Anterior Communicating Artery ◽

Good Neurological Outcome ◽

Neuropsychological Outcome ◽

Neuropsychological Function ◽

Good Outcome ◽

The Mean ◽

Psychological Impairment

Abstract Neuropsychological testing of 48 patients who had undergone operation for subarachnoid hemorrhage (SAH) due to aneurysm was performed. Before this, the patients had their level of neurological recovery classified by neurosurgeons (37 good outcome vs. 9 poor outcome). These clinical categories correlated well with the results of neuropsychological testing. The degree of psychological impairment was related to age. The mean duration between SAH and clipping of the ruptured aneurysm was 4.6 days (range, 1-16 days), and 59% had operations on or before Day 3 post-SAH. Of the 37 patients with good neurological outcome, 26 patients had good neuropsychological outcome (no more than mild deficit). Poor neuropsychological outcome was associated with age and anterior communicating artery aneurysms. The incidence of significant neuropsychological deficit was considerably less than in previous reports, and possible explanations are discussed.

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Fusiform Aneurysm of the Anterior Communicating Artery Treated by Vascular Reconstruction

Neurosurgery ◽

10.1227/01.neu.0000367768.41781.cd ◽

2010 ◽

Vol 66 (5) ◽

pp. E1025-E1026 ◽

Cited By ~ 6

Author(s):

Toshikazu Kimura ◽

Kengo Nishimura ◽

Syunsuke Fukaya ◽

Akio Morita

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Vascular Reconstruction ◽

Cerebral Revascularization ◽

Anterior Communicating Artery ◽

Fusiform Aneurysm ◽

Digital Subtraction ◽

Case Presentation ◽

Ischemic Complications

Abstract OBJECTIVE Fusiform aneurysm of the anterior cerebral artery is rare and difficult to treat because of perforators. We encountered a patient with subarachnoid hemorrhage due to rupture of a fusiform aneurysm of the anterior communicating artery complex, and treated this patient with cerebral revascularization. CASE PRESENTATION A 39-year-old man presented with sudden severe headache resulting from subarachnoid hemorrhage. Digital subtraction angiography showed dilatation from the distal A1 segment to the proximal A2 segment of the left anterior cerebral artery. Despite intensive conservative treatment, repetitive angiography showed aneurysmal growth from this dilated portion. INTERVENTION Proximal clipping and clip-on wrapping on the A2 segment was successfully performed with a A3-A3 bypass. He was discharged without neurological deficit. CONCLUSION Cerebral revascularization technique is necessary to achieved appropriate obliteration without ischemic complications.

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Aneurysmal subarachnoid hemorrhage and severe, catheter-induced vasospasm associated with excessive consumption of a caffeinated energy drink

Interventional Neuroradiology ◽

10.1177/1591019916660868 ◽

2016 ◽

Vol 22 (6) ◽

pp. 674-678 ◽

Cited By ~ 6

Author(s):

Ryan A Grant ◽

Branden J Cord ◽

Lovemore Kuzomunhu ◽

Kevin Sheth ◽

Emily Gilmore ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cardiac Death ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Energy Drink ◽

Anterior Communicating Artery ◽

Over The Counter ◽

Vasoactive Substances ◽

Energy Drink Consumption ◽

Thrombotic Complications ◽

Excessive Consumption

Excessive consumption of over-the-counter stimulants is associated with coronary vasospasm, thrombotic complications, and sudden cardiac death. Their effects on cerebrovascular physiology are not yet described in the neurointerventional literature. Patients are increasingly exposed to high levels of these vasoactive substances in the form of caffeinated energy drinks and specialty coffees. We report a case of aneurysmal subarachnoid hemorrhage (SAH) and severe, catheter-induced vasospasm during attempted endovascular repair of a ruptured anterior communicating artery (AComA) aneurysm in the setting of excessive energy drink consumption. We review the literature and alert clinicians to this potentially serious complication.

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