Subarachnoid hemorrhage in a case of segmental arterial mediolysis with coexisting intracranial and intraabdominal aneurysms

2012 ◽  
Vol 116 (5) ◽  
pp. 948-951 ◽  
Author(s):  
Ryosuke Matsuda ◽  
Yasuo Hironaka ◽  
Yasuhiro Takeshima ◽  
Young-Su Park ◽  
Hiroyuki Nakase
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Distal Portion ◽  
Dissecting Aneurysm ◽  
Arterial System ◽  
Left Vertebral Artery ◽  
Retroperitoneal Hemorrhage ◽  
Segmental Arterial Mediolysis ◽  
History Of ◽  
The Right ◽  
Distal Anterior Cerebral Artery

The authors report the rare case of a 58-year-old man with segmental arterial mediolysis (SAM) with associated intracranial and intraabdominal aneurysms, who suffered subarachnoid hemorrhage (SAH) due to rupture of an intracranial aneurysm. This disease primarily involves the intraabdominal arterial system, resulting in intraabdominal and retroperitoneal hemorrhage in most cases. The patient presented with severe headache and vomiting. The CT scans of the head revealed SAH. Cerebral angiography revealed 3 aneurysms: 1 in the right distal anterior cerebral artery (ACA), 1 in the distal portion of the A1 segment of the right ACA, and 1 in the left vertebral artery. The patient had a history of multiple intraabdominal aneurysms involving the splenic, gastroepiploic, gastroduodenal, and bilateral renal arteries. He underwent a right frontotemporal craniotomy and fibrin coating of the dissecting aneurysm in the distal portion of the A1 segment of the right ACA, which was the cause of the hemorrhage. Follow-up revealed no significant changes in the residual intracranial and intraabdominal aneurysms. An SAH due to SAM with associated multiple intraabdominal aneurysms is extremely rare. The authors describe their particular case and review the literature pertaining to SAM with associated intracranial and intraabdominal aneurysms.

scholarly journals Vertebral artery dissecting aneurysm treated by internal trapping via the contralateral vertebral artery: A case report

2015 ◽  
Vol 21 (5) ◽  
pp. 576-579 ◽  
Author(s):  
Atsuhiro Kojima
Keyword(s):  
Vertebral Artery ◽  
Sudden Onset ◽  
Dissecting Aneurysm ◽  
Left Vertebral Artery ◽  
Distal Side ◽  
Consciousness Disturbance ◽  
History Of ◽  
The Right ◽  
Vertebral Artery Dissecting Aneurysm ◽  
Guiding Catheter

A 42-year-old man with a history of sudden onset of severe headache followed by consciousness disturbance was brought to our hospital. Radiological examinations revealed subarachnoid hemorrhage, associated with rupture of a left vertebral artery dissecting aneurysm. Initially, internal trapping was attempted via the ipsilateral vertebral artery. However, the microcatheter could not be navigated through the true lumen to the distal side of the vertebral artery. Subsequently, therefore, the guiding catheter was placed in the right vertebral artery, and the microcatheter was retrogradely navigated successfully through the lesion to the proximal side of the left vertebral artery. Finally, the lesion was completely embolized with electrodetachable coils without complications. However, the patient died after the operation because of deterioration of the general condition. The postmortem examination revealed how an intimal flap had interfered with the antegrade navigation of the microcatheter in the lesion. The present case showed that endovascular treatment for a vertebral artery dissecting aneurysm via the contralateral vertebral artery may be a useful option in cases where antegrade navigation of the microcatheter via the ipsilateral vertebral artery is found to be difficult.

scholarly journals Splenic undifferentiated high grade pleomorphic sarcoma of a small size with fatal tumor rupture

1970 ◽  
Vol 1 (2) ◽  
pp. 151-153 ◽  
Author(s):  
BM Amatya ◽  
M Sawabe ◽  
T Arai ◽  
T Kumakawa ◽  
K Takubo ◽  
...  
Keyword(s):  
Past History ◽  
Distant Metastases ◽  
Tumor Rupture ◽  
Retroperitoneal Hemorrhage ◽  
Undifferentiated Pleomorphic Sarcoma ◽  
Bone Marrow Histology ◽  
Pleomorphic Sarcoma ◽  
Fatal Bleeding ◽  
History Of ◽  
The Right

(The order of authors on this article was changed on 09/01/2012.)Primary undifferentiated pleomorphic sarcoma of the spleen is a rare and highly aggressive neoplasm that usually presents with splenomegaly, constitutional symptoms and frequent distant metastases. We report a case of 77-year old male patient with a past history of dissecting aortic aneurysm that developed acute hemorrhagic shock. Aneurysmal rupture was clinically suspected, but the postmortem examination revealed a 25 mm-sized tumor in an atrophic spleen weighing 65 gram with massive retroperitoneal bleeding. Metastases were found in the right renal hilus, the right adrenal gland and femoral bone marrow. Histology of the tumor showed undifferentiated pleomorphic sarcoma. Tumor rupture with fatal bleeding and systemic metastases had occurred despite the small size of the tumor. Tumor size is not a reliable predictor of systemic metastasis or tumor rupture for splenic undifferentiated pleomorphic sarcoma. Keywords: Undifferentiated pleomorphic sarcoma; Malignant fibrous histiocytoma; Splenic neoplasms; Retroperitoneal hemorrhage DOI: http://dx.doi.org/10.3126/jpn.v1i2.5411 JPN 2011; 1(2): 151-153

scholarly journals Dissecting Aneurysms of Bilateral Anterior Cerebral Artery Complicated by Subarachnoid Hemorrhage after Cerebral Infarction: A Case Report

2008 ◽  
Vol 1 ◽  
pp. CCRep.S833
Author(s):  
Akihiro Kurosu ◽  
Shizuo Hatashita ◽  
Hideo Ueno
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Vascular Reconstruction ◽  
Dissecting Aneurysm ◽  
Vascular Anastomosis ◽  
Left Lower Extremity ◽  
The Right ◽  
Dissecting Aneurysms

Introduction Intracranial dissecting aneurysms have been increased due to recent advancements in diagnostic imaging. However there have been little article with subarachnoid hemorrhage and cerebral infarction occurring almost at the same time. We performed the surgical treatment and obtained good result. Case presentation A 47-year-old male presented to our hospital with chief complaints of sudden headache and mild paralysis of the left lower extremity. Brain imaging at admission revealed cerebral infarction in the right frontal lobe and subarachnoid hemorrhage in the frontal convexy and anterior interhemispheric fissure. The left and right internal carotid angiography showed a bulging cerebral aneurysm at the left A1–A2 junction and stenosis and arterial dissections in the peripheral of the bilateral anterior cerebral artery. Wrapping was performed for the dissecting aneurysm of the left anterior cerebral artery. For the right anterior cerebral artery, trapping was performed at the A2 segment without vascular anastomosis. The patient's postoperative course was uneventful. Conclusion A consensus has not been reached on the treatment for intracranial dissecting aneurysms. Proximal trapping without vascular reconstruction was performed for the right anterior cerebral artery without vascular anastomosis to prevent rebleeding. However no symptoms of neurological deficiency were observed. Proximal trapping of dissecting aneurysm seems to be a good option when patient's functional and life prognosis are taken into account in case that vascular reconstruction will be anticipated difficulty.

Cerebral mycotic aneurysm of fungal origin

1978 ◽  
Vol 49 (1) ◽  
pp. 0107-0110 ◽  
Author(s):  
Gulshan K. Ahuja ◽  
Neeraj Jain ◽  
Malini Vijayaraghavan ◽  
Subimal Roy
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mycotic Aneurysm ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Content Type ◽  
History Of ◽  
The Right ◽  
Internal Carotid Arteries ◽  
Fine Print

✓ A young man who had a long history of sinusitis developed subarachnoid hemorrhage and died. Autopsy showed a mycotic aneurysm of fungal origin at the junction of the right posterior cerebral and internal carotid arteries. Four of five reported cases of fungal aneurysm were due to Aspergillus infection.

scholarly journals Combined reconstructive and deconstructive endovascular approach for bilateral vertebral artery dissection with subarachnoid hemorrhage

2019 ◽  
Vol 46 (Suppl_1) ◽  
pp. V13
Author(s):  
Jacob Cherian ◽  
Thomas P. Madaelil ◽  
Frank Tong ◽  
Brian M. Howard ◽  
C. Michael Cawley ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Left Vertebral Artery ◽  
Artery Dissection ◽  
Critical Flow ◽  
Alternative Strategies ◽  
Potential Alternative ◽  
Endovascular Approach ◽  
The Right

The video highlights a challenging case of bilateral vertebral artery dissection presenting with subarachnoid hemorrhage. The patient was found to have a critical flow-limiting stenosis in his dominant right vertebral artery and a ruptured pseudoaneurysm in his left vertebral artery. A single-stage endovascular treatment with stent reconstruction of the right vertebral artery and coil embolization sacrifice of the left side was performed. The case highlights the rationale for treatment and potential alternative strategies.The video can be found here: https://youtu.be/e0U_JE2jISw.

scholarly journals P1702 Libman-Sacks endocarditis of the mitral valve combined with right atrial thrombus formation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Klappacher ◽  
D Beitzke
Keyword(s):  
Mitral Valve ◽  
Thrombus Formation ◽  
Arterial System ◽  
Right Atrial ◽  
Atrial Thrombus ◽  
Systemic Embolization ◽  
History Of ◽  
Right Atrial Thrombus ◽  
The Right ◽  
The Brain

Abstract Case presentation A 46-years old female with a history of systemic lupus erythematosus (SLE) was admitted to hospital care after the manifestation of a tonic-clonic generalized seizure. Since this had been the first neurological event, a thorough diagnostic work-up was performed. CT- and MRI-imaging of the brain revealed cerebral microangiopathy and two small fresh ischemic lesions in the left frontal and temporobasal regions, respectively. While the microangiopathy could be reconciled with cerebral SLE-vasculitis, the ischemic lesions pointed to thromboembolism whose source could be potentially cardiogenic. Findings. In fact, the transesophageal echocardiogram showed a small vegetation (5x8 mm) on the posteromedial cusp of the posterior mitral leaflet (P3) with moderate regurgitation, likely to represent Libman-Sacks endocarditis and a potential source of systemic embolization. In addition, a mass of was visible protruding from the fossa ovalis into the right atrium, see figure. It represented a thrombus according to MRI which was subsequently performed. Since no interatrial passage of microbubbles occurred, the foramen ovale was unlikely to be patent and to allow for paradoxical embolism into the brain. However, the right atrial thrombus was compatible with a history of repeated deep venous thrombosis and pulmonary embolism in the recent past. Discussion This case exemplifies the combination of Libman-Sacks endocarditis on the mitral valve with right atrial thrombus formation and ensuing embolism both into the venous and arterial system. It demonstrates the importance of closely monitoring and treating coagulopathies in SLE patients which makes them prone to thrombus formation both in the systemic and pulmonary circulation. Abstract P1702 Figure.

Tentorial Dural Arteriovenous Fistula Presenting with Various Visual Symptoms Related to Anterior and Posterior Visual Pathway Dysfunction: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (1) ◽  
pp. 222-227 ◽  
Author(s):  
Goetz Benndorf ◽  
Stefanie Schmidt ◽  
Wolf-Peter Sollmann ◽  
Stefan-Nikolaus Kroppenstedt
Keyword(s):  
Cavernous Sinus ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Visual Pathway ◽  
Sudden Onset ◽  
Left Vertebral Artery ◽  
Visual Symptoms ◽  
Meningeal Arteries ◽  
History Of ◽  
The Right

Abstract OBJECTIVE AND IMPORTANCE Dural arteriovenous fistulae (DAVFs) not directly shunting into the cavernous sinus are an infrequent cause of visual dysfunction. An unusual case of a tentorial DAVF associated with visual symptoms related to dysfunction of the anterior and posterior visual pathway is presented. CLINICAL PRESENTATION A 38-year-old woman with a history of long-standing bilateral proptosis experienced a sudden onset of headache and visual disturbances. Ocular examination revealed bilateral episcleral and retinal venous congestion, optic disc paleness, right superior homonymous quadrantanopsia in both eyes, and concentric narrowing of the visual field of the right eye. Angiography revealed a DAVF supplied by a falx branch arising from the left vertebral artery and both middle meningeal arteries, which drained directly into the markedly dilated vein of Galen via the basal vein of Rosenthal and the cavernous sinus into both superior ophthalmic veins. INTERVENTION Endovascular treatment was performed in two consecutive sessions by transarterial embolization with n-butylcyanoacrylate, which resulted in occlusion of the fistula and complete clinical cure, confirmed at the 6-month follow-up examination. CONCLUSION Various neuro-ophthalmological findings may be caused by an arteriovenous lesion remote from the optic organ as a result of rerouting of venous drainage compromising the visual pathway at different locations. Transarterial embolization of a DAVF may result in complete cure if advantageous arterial anatomy allows for flow control and occlusion of the fistulous connection with liquid adhesives.

Ruptured Dissecting Aneurysm of the Vertebral Artery Revealed by Repeat Angiography

Neurosurgery ◽  
1988 ◽  
Vol 23 (2) ◽  
pp. 225-227 ◽  
Author(s):  
Yasushi Ito ◽  
Ryoji Ishii ◽  
Yasuo Suzuki ◽  
Masahisa Kikuoka ◽  
Kazuhiro Hirano ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Dissecting Aneurysm ◽  
Repeat Angiography ◽  
The Right ◽  
Angiographic Change

ABSTRACT A case of subarachnoid hemorrhage caused by the rupture of a dissecting aneurysm of the vertebral artery is reported. The initial angiogram was normal, and repeat angiography carried out 12 days later revealed a dissecting aneurysm of the right vertebral artery. This angiographic change seems to be due to the progression of minimal dissection that was not found at the time of first angiogram.

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