Cavernous carotid aneurysms: to treat or not to treat?

2009 ◽  
Vol 26 (5) ◽  
pp. E4 ◽  
Author(s):  
Christopher S. Eddleman ◽  
Michael C. Hurley ◽  
Bernard R. Bendok ◽  
H. Hunt Batjer
Keyword(s):  
Natural History ◽  
Clinical Presentation ◽  
Cerebral Aneurysms ◽  
Expectant Management ◽  
Difficult Decision ◽  
Life Threatening ◽  
History Of ◽  
Carotid Aneurysms ◽  
Cavernous Carotid Aneurysms ◽  
Revascularization Procedures

Most cavernous carotid aneurysms (CCAs) are considered benign lesions, most often asymptomatic, and to have a natural history with a low risk of life-threatening complications. However, several conditions may exist in which treatment of these aneurysms should be considered. Several options are currently available regarding the management of CCAs with resultant good outcomes, namely expectant management, luminal preservation strategies with or without addressing the aneurysm directly, and Hunterian strategies with or without revascularization procedures. In this article, we discuss the sometimes difficult decision regarding whether to treat CCAs. We consider the natural history of several types of CCAs, the clinical presentation, the current modalities of CCA management and their outcomes to aid in the management of this heterogeneous group of cerebral aneurysms.

Clinical Presentation and Natural History of Mesothelioma: Abdominal

2006 ◽  
pp. 391-401 ◽  
Author(s):  
Claire F. Verschraegen ◽  
Charles R. Key ◽  
Raffit Hassan
Keyword(s):  
Natural History ◽  
Clinical Presentation ◽  
History Of

scholarly journals Spontaneous thrombosis of internal carotid artery: a natural history of giant carotid cavernous aneurysms

2009 ◽  
Vol 67 (2a) ◽  
pp. 278-283 ◽  
Author(s):  
Lucas Perez de Vasconcellos ◽  
Juan Antônio Castro Flores ◽  
Mário Luiz Marques Conti ◽  
José Carlos Esteves Veiga ◽  
Carmen Lúcia Penteado Lancellotti
Keyword(s):  
Carotid Artery ◽  
Natural History ◽  
Internal Carotid Artery ◽  
Collateral Circulation ◽  
Internal Carotid ◽  
Clinical Presentation ◽  
Spontaneous Thrombosis ◽  
Related Factors ◽  
Trigeminal Neuropathy ◽  
History Of

OBJECTIVE: To describe five cases of giant carotid cavernous aneurysms which evolved with spontaneous thrombosis of internal carotid artery (STICA), with emphasis at epidemiology, clinical presentation, natural history, related factors and neurological outcome. METHOD: There were 711 consecutives patients with 802 aneurysms with and without surgical treatment during a period of 19 years. We selected 35 patients with 40 carotid cavernous aneurysms (5%) of which 20 (50%) were giant aneurysms. Among those cases, 5 patients evolved with STICA (25%). Symptoms and findings at presentation were recorded and compared with those at outcome. RESULTS: Clinical presentation was commonly related to atherosclerotic factors such as elevated blood pressure (80%), diabetes mellitus (40%) and dislipidemy (40%). All patients presented with hemicranial headache, ophthalmparesy and retro bulbar pain, and after STICA all presented improvement of symptoms. After STICA, 4 patients had regression of deficit, 2 partial and 2 complete. Four patients had sensorial trigeminal neuropathy in V1 and V2 territories, also showing improvement of symptoms after STICA. CONCLUSION: STICA is a common outcome in giant carotid cavernous aneurysms, and is related with significant improvement of symptoms; however, it may be catastrophic for those patients without efficient collateral circulation.

scholarly journals Clinical presentation and natural history of autoimmune hepatitis

2014 ◽  
Vol 3 (1) ◽  
pp. 9-11 ◽  
Author(s):  
Michael R. Lucey ◽  
John M. Vierling
Keyword(s):  
Natural History ◽  
Autoimmune Hepatitis ◽  
Clinical Presentation ◽  
History Of

scholarly journals Management of intracranial aneurysms associated with arteriovenous malformations

2014 ◽  
Vol 37 (3) ◽  
pp. E11 ◽  
Author(s):  
Bruno C. Flores ◽  
Daniel R. Klinger ◽  
Kim l. Rickert ◽  
Samuel l. Barnett ◽  
Babu G. Welch ◽  
...  
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Case Series ◽  
Classification Systems ◽  
Vascular Lesions ◽  
Difficult Decision ◽  
Hemorrhagic Events ◽  
History Of ◽  
Hemorrhage Risk

Intracranial or brain arteriovenous malformations (BAVMs) are some of the most interesting and challenging lesions treated by the cerebrovascular neurosurgeon. It is generally believed that the combination of BAVMs and intracranial aneurysms (IAs) is associated with higher hemorrhage rates at presentation and higher rehemorrhage rates and thus with a more aggressive course and natural history. There is wide variation in the literature on the prevalence of BAVM-associated aneurysms (range 2.7%–58%), with 10%–20% being most often cited in the largest case series. The risk of intracranial hemorrhage in patients with unruptured BAVMs and coexisting IAs has been reported to be 7% annually, compared with 2%–4% annually for those with BAVM alone. Several different classification systems have been applied in an attempt to better understand the natural history of this combination of lesions and implications for treatment. Independent of the classification used, it is clear that a few subtypes of aneurysms have a direct hemodynamic correlation with the BAVM itself. This is exemplified by the fact that the presence of a distal flow-related or an intranidal aneurysm appears to be associated with an increased hemorrhage risk, when compared with an aneurysm located on a vessel with no direct supply to the BAVM nidus. Debate still exists regarding the etiology of the association between those two vascular lesions, the subsequent implications for patients’ risk of hemorrhagic stroke, and finally the determination of which patients warrant treatment and when. The ultimate goals of the treatment of a BAVM associated with an IA are to prevent hemorrhage, avoid stepwise neurological deterioration, and eliminate the mortality risk associated with recurrent hemorrhagic events. The treatment is only justifiable if the risks associated with an intervention are lower than or equivalent to the long-term risks of disability or mortality caused by the lesion itself. When faced with this difficult decision, a few questions need to be answered by the treating neu-rosurgeon: What is the mode of presentation? What is the symptomatic lesion? Which one of the lesions bled? What is the relationship between the BAVM and IA? Is it possible to safely treat both BAVM and IA? The objective of this review is to discuss the demographics, natural history, classification, and strategies for management of BAVMs associated with IAs.

Adult Presentation of a Familial-Associated Vein of Galen Aneurysmal Malformation: Case Report

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. E1845-E1851 ◽  
Author(s):  
David S Xu ◽  
Asad A Usman ◽  
Michael C Hurley ◽  
Christopher S Eddleman ◽  
Bernard R Bendok
Keyword(s):  
Case Report ◽  
Natural History ◽  
Vein Of Galen ◽  
Review Of The Literature ◽  
Time Resolved ◽  
Presenting Symptoms ◽  
First Case ◽  
Life Threatening ◽  
History Of ◽  
Asymptomatic Adult

Abstract BACKGROUND AND IMPORTANCE: Vein of Galen aneurysmal malformations (VGAMs) arise from persistent arteriovenous shunting from primitive choroidal vessels into the median prosencephalic vein of Markowski, the embryonic precursor of the vein of Galen. VGAMs rarely present past infancy, and their natural history in adults is unknown. We report the first case of a familial-associated VGAM in an asymptomatic adult female patient. The clinical features of this case are presented alongside a systematic review of the literature on adult VGAM cases to assess the natural history, clinical management, and genetic basis of this rare neurovascular lesion. CLINICAL PRESENTATION: A previously healthy 44-year-old woman with a family history of a VGAM in a stillborn presented with an 8-week onset of dizziness and vertigo that spontaneously resolved. Time-resolved magnetic resonance angiography identified a choroidal VGAM. No intervention was undertaken at this time because of the patient's asymptomatic status after 9 months of follow-up. CONCLUSION: Based on our review of the literature, this is the first case report of a familial-associated VGAM in an adult patient and suggests that VGAM development can be genetically linked. Of 15 adult VGAM cases previously reported, all patients were either symptomatic or treated, thus precluding determination of VGAM natural history in adults. Patient outcomes correlated with the severity of presenting symptoms, which ranged from asymptomatic to immediately life-threatening. We hypothesize that self-selection may render VGAMs to be more benign for them to persist past childhood. Further investigation of the molecular biology underlying VGAM development is warranted.

scholarly journals Significant predictive factors of the severity and outcomes of the first attack of acute angioedema in children

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yuan-Jhen Syue ◽  
Chao-Jui Li ◽  
Wen-Liang Chen ◽  
Tsung-Han Lee ◽  
Cheng-Chieh Huang ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Respiratory Symptoms ◽  
Clinical Presentation ◽  
Preschool Age ◽  
Short Term ◽  
Patient Demographics ◽  
Life Threatening ◽  
History Of ◽  
Initial Episode

Abstract Background The initial episode of angioedema in children can be potential life-threatening due to the lack of prompt identification and treatment. We aimed to analyze the factors predicting the severity and outcomes of the first attack of acute angioedema in children. Methods This was a retrospective study with 406 children (< 18 years) who presented in the emergency department (ED) with an initial episode of acute angioedema and who had subsequent follow-up visits in the out-patient department from January 2008 to December 2014. The severity of the acute angioedema was categorized as severe (requiring hospital admission), moderate (requiring a stay in the short-term pediatric observation unit [POU]), or mild (discharged directly from the ED). The associations among the disease severity, patient demographics and clinical presentation were analyzed. Result In total, 109 (26.8%) children had severe angioedema, and the majority of those children were male (65.1%). Most of the children were of preschool age (56.4%), and only 6.4% were adolescents. The co-occurrence of pyrexia or urticaria, etiologies of the angioedema related to medications or infections, the presence of respiratory symptoms, and a history of allergies (asthma, allergic rhinitis) were predictors of severe angioedema (all p < 0.05). Finally, the duration of angioedema was significantly shorter in children who had received short-term POU treatment (2.1 ± 1.1 days) than in those who discharged from ED directly (2.3 ± 1.4 days) and admitted to the hospital (3.5 ± 2.0 days) (p < 0.001). Conclusion The co-occurrence of pyrexia or urticaria, etiologies related to medications or infections, the presence of respiratory symptoms, and a history of allergies were predictors of severe angioedema. More importantly, short-term POU observation and prompt treatment might be benefit for patients who did not require hospital admission.

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