Aneurysmal subarachnoid hemorrhage accompanied by changes in the patterns of chronic migraine: a case report

2021 ◽  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Chronic Migraine ◽  
Cerebral Aneurysm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Neurological Diseases ◽  
Clinical Signs ◽  
Good Prognosis ◽  
Specific Medication ◽  
The Right ◽  
A Minor

Subarachnoid hemorrhage (SAH) has a high mortality rate, and cerebral aneurysm ruptures account for 80% of all cases. Although several previous case studies have reported a headache before aneurysmal SAH, no previous study has reported a case of SAH after a change in the existing migraine pattern without any other clinical signs. A 43-year-old male patient who had suffered chronic migraines for 10 years visited the emergency department due to migraine symptoms, which exacerbated 3 days before the visit. He was admitted for symptom management, and his condition improved after taking migraine-specific medication. However, his consciousness deteriorated, and he became drowsy 8 days from the onset of headache aggravation. Brain computed tomography angiography revealed SAH. A small ruptured aneurysm, which was not detected by brain magnetic resonance angiography performed a few days earlier, was found in the A1 segment of the right anterior cerebral artery. We performed emergency endovascular coil embolization in the right A1 without any other complications. After the procedure, his neurological symptoms no longer exacerbated during hospitalization. He showed only a mild headache after 2 weeks and was discharged. Aneurysmal SAH is one of the most devastating neurological diseases, but early detection and treatment of aneurysms before major rupture may facilitate a good prognosis. If the pattern of previously diagnosed chronic migraine changes suddenly, a minor leak before the major rupture of a cerebral aneurysm should be considered, even if a sentinel headache has not been suggested.

scholarly journals Carotid rete mirabile associated with subarachnoid hemorrhage from intracranial aneurysm: A case report and systematic review

2015 ◽  
Vol 21 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Eric Homero Albuquerque Paschoal ◽  
Vitor Nagai Yamaki ◽  
Fernando Mendes Paschoal Júnior ◽  
Ronie Leo Piske ◽  
Manoel Jacobsen Teixeira ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Group Iv ◽  
Rete Mirabile ◽  
Collateral Network ◽  
Carotid Rete Mirabile ◽  
Clinical Signs And Symptoms ◽  
The Right

Carotid rete mirabile (CRM) is a rare physiological vascular network in humans that is most often found in Eastern populations. This paper describes a CRM associated with an aneurysmal subarachnoid hemorrhage (aSAH) and discusses the details of the patient’s treatment. A 28-year-old woman was admitted to our service with clinical signs and symptoms of a spontaneous aSAH. Computed tomography revealed a diffuse and extensive SAH (Fisher group IV), while an angiogram showed an abnormal collateral network in the right carotid system and a hypoplastic aspect to the internal carotid artery (ICA) on the same side. In addition, a saccular aneurysm with a diameter of 9.5 mm was present in the ophthalmic segment of the left ICA. This case is extremely uncommon. To avoid rebleeding in the patient, we successfully treated the patient by clipping the aneurysmal lesion. No procedure was performed for the CRM.

Rapidly Spreading Deep Dissecting Hematoma Occurring One Month After A Minor Trauma: A Case Report.

2021 ◽  
Author(s):  
Rémy Hamdan ◽  
Narcisse Zwetyenga ◽  
Yvan Macheboeuf ◽  
Patrick Ray
Keyword(s):  
Skin Necrosis ◽  
Clinical Signs ◽  
International Normalized Ratio ◽  
Blood Collection ◽  
Minor Trauma ◽  
Surgical Emergency ◽  
Superficial Skin ◽  
Muscle Fascia ◽  
The Right ◽  
A Minor

Abstract Background: Deep dissecting hematoma (DDH) is a rapidly extending blood collection that splits the hypodermis from muscle fascia, constituting a medical surgical emergency. The natural history of this condition includes trauma (even minor physical injury) shortly before onset of the lesion, occurring in a patient with advanced dermatoporosis. A delay of several weeks between the appearance of a superficial haematoma following a minor trauma and its sudden decompensation into a rapidly spreading DDH has been scarcely mentioned in the medical literature. Case presentation: We report the admission of a 70-year-old woman under anticoagulation to the emergency department of our hospital for the sudden appearance of a rapidly evolving hematoma one month after a negligible trauma to the right leg. A complete skin examination revealed clinical signs (spontaneous superficial skin haematomas, lacerations, wrinkles, stellate pseudo-scars) of advanced dermatoporosis, especially on the forearms. The initial biological testing disclosed an International Normalized Ratio of 3.15. The clinical aspect of the haematoma, its rapid extension and the cutaneous signs of dermatoporosis on the forearms allowed the diagnosis of DDH. Bedside ultrasound examination was used to eliminate differential or additional diagnoses and to assess the main features of the hematoma (dimensions, existence of blood supply). Due the extent of the lesion and the risk of extended skin necrosis, surgical debridement and hematoma drainage were performed. The operative report confirmed the diagnosis of DDH. Wound healing was obtained spontaneously after three months. Conclusion: DDH is the most serious complication of dermatoporosis. Given its rapid horizontal extension and the risk of skin necrosis it induces, DDH is a medical-surgical emergency and must be diagnosed early. This observation emphasises that in patients with severe dermatoporosis, on the occasion of a Vitamin K Antagonist overdose, a limb-threatening DDH can develop suddenly, even several weeks after a minor impact.

scholarly journals Vasa Vasorum Formation is Associated With Rupture of Intracranial Aneurysms

Neurosurgery ◽  
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.

scholarly journals Cigarette smoking and outcomes after aneurysmal subarachnoid hemorrhage: a nationwide analysis

2017 ◽  
Vol 129 (2) ◽  
pp. 446-457 ◽  
Author(s):  
Hormuzdiyar H. Dasenbrock ◽  
Robert F. Rudy ◽  
Pui Man Rosalind Lai ◽  
Timothy R. Smith ◽  
Kai U. Frerichs ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Subarachnoid Hemorrhage ◽  
Cigarette Smoking ◽  
Cerebral Aneurysm ◽  
Scale Score ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Institutional Care ◽  
Care Facility ◽  
Severity Scale ◽  
The Impact

OBJECTIVEAlthough cigarette smoking is one of the strongest risk factors for cerebral aneurysm development and rupture, there are limited data evaluating the impact of smoking on outcomes after aneurysmal subarachnoid hemorrhage (SAH). Additionally, two recent studies suggested that nicotine replacement therapy was associated with improved neurological outcomes among smokers who had sustained an SAH compared with smokers who did not receive nicotine.METHODSPatients who underwent endovascular or microsurgical repair of a ruptured cerebral aneurysm were extracted from the Nationwide Inpatient Sample (NIS, 2009–2011) and stratified by cigarette smoking. Multivariable logistic regression analyzed in-hospital mortality, complications, tracheostomy or gastrostomy placement, and discharge to institutional care (a nursing or an extended care facility). Additionally, the composite NIS-SAH outcome measure (based on mortality, tracheostomy or gastrostomy, and discharge disposition) was evaluated, which has been shown to have excellent agreement with a modified Rankin Scale score greater than 3. Covariates included in regression constructs were patient age, sex, race/ethnicity, insurance status, socioeconomic status, comorbidities (including hypertension, drug and alcohol abuse), the NIS-SAH severity scale (previously validated against the Hunt and Hess grade), treatment modality used for aneurysm repair, and hospital characteristics. A sensitivity analysis was performed matching smokers to nonsmokers on age, sex, number of comorbidities, and NIS-SAH severity scale score.RESULTSAmong the 5784 admissions evaluated, 37.1% (n = 2148) had a diagnosis of tobacco use, of which 31.1% (n = 1800) were current and 6.0% (n = 348) prior tobacco users. Smokers were significantly younger (mean age 51.4 vs 56.2 years) and had more comorbidities compared with nonsmokers (p < 0.001). There were no significant differences in mortality, total complications, or neurological complications by smoking status. However, compared with nonsmokers, smokers had significantly decreased adjusted odds of tracheostomy or gastrostomy placement (11.9% vs 22.7%, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.51–0.78, p < 0.001), discharge to institutional care (OR 0.71, 95% CI 0.57–0.89, p = 0.002), and a poor outcome (OR 0.65, 95% CI 0.55–0.77, p < 0.001). Similar statistical associations were noted in the matched-pairs sensitivity analysis and in a subgroup of poor-grade patients (the upper quartile of the NIS-SAH severity scale).CONCLUSIONSIn this nationwide study, smokers experienced SAH at a younger age and had a greater number of comorbidities compared with nonsmokers, highlighting the negative ramifications of cigarette smoking among patients with cerebral aneurysms. However, smoking was also associated with paradoxical superior outcomes on some measures, and future research to confirm and further understand the basis of this relationship is needed.

Partly reversible central auditory dysfunction induced by cerebral vasospasm after subarachnoid hemorrhage

2013 ◽  
Vol 119 (5) ◽  
pp. 1125-1128 ◽  
Author(s):  
Ester Ponzetto ◽  
Marco Vinetti ◽  
Cécile Grandin ◽  
Thierry Duprez ◽  
Vincent van Pesch ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Auditory Evoked Potentials ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Rare Complication ◽  
Brain Mri ◽  
Temporal Cortex ◽  
Intraarterial Infusion ◽  
Auditory Dysfunction ◽  
The Right

The authors describe a rare case of central auditory dysfunction induced by cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). A 55-year-old woman who was admitted after aneurysmal SAH developed cerebral vasospasm on Day 3 affecting mainly the right middle cerebral artery (MCA) and partly the left MCA. The vasospasm became refractory to conventional therapy and was ultimately improved by intraarterial infusion of nimodipine in the right MCA and angioplasty. Severe auditory dysfunction was apparent from Day 10 as the patient was not reactive to speech or environmental sounds. Brain MRI on Day 17 demonstrated infarcted areas mainly in the right hippocampus, medial occipital lobe, and thalamus. The patient underwent further examination using audiometry, speech testing, auditory evoked potentials, functional MRI, and cerebral PET. The initial diagnosis was extended nonverbal agnosia and total pure word deafness. The central auditory dysfunction improved over 6 months, with persisting hyperacusis, tinnitus, and amusia. Central auditory dysfunction is a rare complication after SAH. While cortical deafness may be associated with bilateral lesions of the temporal cortex, partly reversible central auditory dysfunction was observed in this patient after prominently unilateral right temporal lesions. The role of the interthalamic connections can be discussed, as well as the possibility that a less severe vasospasm on the left MCA could have transiently impaired the left thalamocortical auditory pathways.

Association of renin-angiotensin system genetic polymorphisms and aneurysmal subarachnoid hemorrhage

2018 ◽  
Vol 128 (1) ◽  
pp. 86-93 ◽  
Author(s):  
Christoph J. Griessenauer ◽  
R. Shane Tubbs ◽  
Paul M. Foreman ◽  
Michelle H. Chua ◽  
Nilesh A. Vyas ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysm ◽  
Genetic Polymorphisms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Renin Angiotensin System ◽  
The United States ◽  
Dominant Effect ◽  
Potential Implication ◽  
Angiotensin System ◽  
Renin Angiotensin

OBJECTIVERenin-angiotensin system (RAS) genetic polymorphisms are thought to play a role in cerebral aneurysm formation and rupture. The Cerebral Aneurysm Renin-Angiotensin System (CARAS) study prospectively evaluated common RAS polymorphisms and their relation to aneurysmal subarachnoid hemorrhage (aSAH).METHODSThe CARAS study prospectively enrolled aSAH patients and controls at 2 academic centers in the United States. A blood sample was obtained from all patients for genetic evaluation and measurement of plasma angiotensin-converting enzyme (ACE) concentration. Common RAS polymorphisms were detected using 5′ exonuclease (TaqMan) genotyping assays and restriction fragment length polymorphism analysis.RESULTSTwo hundred forty-eight patients were screened, and 149 aSAH patients and 50 controls were available for analysis. There was a recessive effect of the C allele of the angiotensinogen (AGT) C/T single-nucleotide polymorphism (SNP) (OR 1.94, 95% CI 0.912–4.12, p = 0.0853) and a dominant effect of the G allele of the angiotensin II receptor Type 2 (AT2) G/A SNP (OR 2.11, 95% CI 0.972–4.57, p = 0.0590) on aSAH that did not reach statistical significance after adjustment for potential confounders. The ACE level was significantly lower in aSAH patients with the II genotype (17.6 ± 8.0 U/L) as compared with the ID (22.5 ± 12.1 U/L) and DD genotypes (26.6 ± 14.2 U/L) (p = 0.0195).CONCLUSIONSThe AGT C/T and AT2 G/A polymorphisms were not significantly associated with aSAH after controlling for potential confounders. However, a strong trend was identified for a dominant effect of the G allele of the AT2 G/A SNP. Downregulation of the local RAS may contribute to the formation of cerebral aneurysms and subsequent presentation with aSAH. Further studies are required to elucidate the relevant pathophysiology and its potential implication in treatment of patients with aSAH.

scholarly journals Neopterin plasma concentrations in patients with aneurysmal subarachnoid hemorrhage: correlation with infection and long-term outcome

2016 ◽  
Vol 124 (5) ◽  
pp. 1287-1299 ◽  
Author(s):  
Leire Azurmendi ◽  
Vincent Degos ◽  
Natalia Tiberti ◽  
Natacha Kapandji ◽  
Paola Sanchez-Peña ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Antibiotic Therapy ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Plasma Concentrations ◽  
Clinical Signs ◽  
World Federation ◽  
Long Term Outcome ◽  
Poor Outcome ◽  
Positive Bacterial Culture

OBJECT Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high rates of mortality and morbidity. The main predictor for the poor outcome is the World Federation of Neurosurgical Societies (WFNS) scale. However, this scale does not take into account proinflammatory events, such as infection occurring after the aSAH, which could modify the long-term status of patients. The aim of this study was to evaluate neopterin as an inflammatory biomarker for outcome and infection prediction in aSAH patients. METHODS Plasma concentrations of neopterin were measured in 61 aSAH patients (22 male and 39 female; mean age [± SD] 52.8 ± 11.8 years) using a commercial ELISA kit. Samples were collected daily for 10 days. Outcome at 12 months was determined using the Glasgow Outcome Scale (GOS) and dichotomized as poor (GOS score 1, 2, or 3) or good (GOS score 4 or 5). Infection was determined by the presence of a positive bacterial culture. RESULTS Patients with poor outcome at 12 months had higher concentrations of neopterin than patients with good outcome. In the same way, patients who had an infection during the hospitalization had significantly higher concentrations of neopterin than patients without infection (p = 0.001). Moreover, neopterin concentrations were significantly (p < 0.008) elevated in infected patients 2 days before infection detection and antibiotic therapy. CONCLUSIONS Neopterin is an efficient outcome predictor after aSAH. Furthermore, it is able to differentiate between infected and uninfected patients as early as 2 days before clinical signs of infection, facilitating earlier antibiotic therapy and better management.

Posterior Internal Frontal Artery Vascularization of the Precentral Gyrus Responsible for Proximal Arm Movement: Insight from a Case of Coil Migration

2020 ◽  
Vol 17 (4) ◽  
pp. 518-521
Author(s):  
David Bergeron ◽  
Harrison J. Westwick ◽  
Sami Obaid ◽  
Michel W. Bojanowski
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Anterior Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Clinical Signs ◽  
Arm Movement ◽  
Precentral Gyrus ◽  
Clinical Correlation ◽  
Distal Branch ◽  
Lateral Portion ◽  
Coil Migration

Our knowledge of the vascularization of the precentral gyrus by branches of the anterior cerebral artery (ACA) relies mainly on anatomical cadaveric dissection. A distal branch of the ACA known as the posterior internal frontal artery (PIFA) is thought to vascularize the precentral gyrus responsible for proximal arm movement; however, no clinical correlation has yet been reported to confirm this relation. In this manuscript, we report a case of coil migration in the PIFA, causing proximal arm weakness in a 58-year-old woman treated for aneurysmal subarachnoid hemorrhage. The occurrence of clinical signs immediately following coil migration into the PIFA, combined with evidence of stroke in the cortical territory related to arm movement as seen on imaging, indicates that the PIFA indeed can vascularize this lateral portion of the precentral gyrus. This case confirms our current understanding of the vascularization of the precentral gyrus by distal ACA branches, in particular the PIFA.

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