scholarly journals Subarachnoid hemorrhage due to intradural cerebral aneurysm and simultaneous spinal subdural hematoma: illustrative case

2021 ◽  
Vol 1 (20) ◽  
Author(s):  
Francisco Hernández-Fernández ◽  
Noemí Cámara-González ◽  
María José Pedrosa-Jiménez ◽  
Cristian Alcahut-Rodríguez
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Foramen Magnum ◽  
Dissecting Aneurysm ◽  
Exceptional Case ◽  
Left Vertebral Artery ◽  
Illustrative Case ◽  
Pathophysiological Mechanism ◽  
Stiff Neck ◽  
Spinal Hematoma ◽  
Spinal Subdural Hematoma

BACKGROUND Spontaneous spinal subdural hematomas (SSDHs) are unusual. Among their probable etiologies, an association with ruptured brain aneurysms has been described in an extraordinary way. The underlying pathophysiological mechanism is not conclusively described in the literature. OBSERVATIONS The authors reported an exceptional case of a 59-year-old woman admitted for a condition that included sudden headache, stiff neck, and vomiting associated with pain in the left flank area that radiated to the leg. Computed tomography (CT) of the brain evidenced acute subarachnoid hemorrhage distributed in the bilateral posterior parieto-occipital fossa and occipital horns of the ventricles. CT angiography detected a dissecting aneurysm in the left vertebral artery (V4) that was treated urgently via the endovascular route. In the next hours, the patient’s symptoms worsened, with paraplegia of the lower extremities. Magnetic resonance imaging showed SSDH at T4–6 and extensive associated myelopathy. LESSONS The origin of the spinal hematoma may be the rupture of the aneurysm of the V4 segment in the dura mater of the foramen magnum and subsequent rostrocaudal migration of the hemorrhage to the spinal subdural space, enhanced by an intracranial pressure increase. This hypothesis is discussed, as is a brief literature review.

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.

Motion-related vascular abnormalities at the craniocervical junction: illustrative case series and literature review

2015 ◽  
Vol 38 (4) ◽  
pp. E6 ◽  
Author(s):  
Vijay M. Ravindra ◽  
Jayson A. Neil ◽  
Marcus D. Mazur ◽  
Min S. Park ◽  
William T. Couldwell ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Case Series ◽  
Vascular Anomaly ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Dissecting Aneurysm ◽  
Vascular Pathology ◽  
Illustrative Case ◽  
Vascular Compression ◽  
Elective Resection

The craniocervical junction (CCJ) functions within a complicated regional anatomy necessary to protect and support vital neurovascular structures. In select instances, vascular pathology can be attributed to this complicated interplay of motion and structure found within this narrow space. The authors report 3 cases of complex vascular pathology related to motion at the CCJ and detail the management of these cases. Two cases involved posterior circulation vascular compression syndromes, and one case involved a vascular anomaly and its relation to aneurysm formation and rupture. The patient in Case 1 was a 66-year-old man with a history of syncopal episodes resulting from the bilateral vertebral artery becoming occluded when he rotated his head. Successful microsurgical decompression at the skull base resulted in patent bilateral vertebral artery V3 segments upon head movement in all directions. The patient in Case 2 was a 53-year-old woman who underwent elective resection of a right temporal meningioma and who experienced postoperative drowsiness, dysphagia, and mild right-arm ataxia. Subsequent MRI demonstrated bilateral posterior inferior cerebel-lar artery (PICA) strokes. Cerebral angiography showed a single PICA, of extradural origin, supplying both cerebellar hemispheres. The PICA exhibited dynamic extradural compression when the patient rotated her head; the bilateral PICA strokes were due to head rotation during surgical positioning. In Case 3, a 37-year-old woman found unconscious in her home had diffuse subarachnoid hemorrhage and evidence of a right PICA aneurysm. A right far-lateral craniectomy was performed for aneurysm clipping, and she was found to have a dissecting aneurysm with an associated PICA originating extradurally. There was a shearing phenomenon of the extradural PICA along the dura of the foramen magnum, and this microtraumatic stress imposed on the vessel resulted in a dissecting aneurysm. This series of complex and unusual cases highlights the authors’ understanding of vascular pathology of the CCJ and its management.

Republished: Use of aspirin as sole oral antiplatelet therapy in acute flow diversion for ruptured dissecting aneurysms

2016 ◽  
Vol 9 (5) ◽  
pp. e18-e18 ◽  
Author(s):  
Albert Ho Yuen Chiu ◽  
Rajalakshmi Ramesh ◽  
Jason Wenderoth ◽  
Mark Davies ◽  
Andrew Cheung
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Antiplatelet Therapy ◽  
Antiplatelet Agent ◽  
Dissecting Aneurysm ◽  
Flow Diversion ◽  
Left Vertebral Artery ◽  
World Federation ◽  
First Case ◽  
Grade 5 ◽  
Vertebral Artery Dissecting Aneurysm

Subarachnoid hemorrhage secondary to rupture of a circumferential dissecting aneurysm continues to be a treatment dilemma. Vessel sacrifice, when possible, continues to be the safest option but in certain cases this is not possible due to lack of collateral supply. In such cases, coil assisted endovascular flow diversion has become a potential option but the requirement for dual antiplatelet therapy in an unsecured intracranial aneurysm continues to raise concern.We present a 48-year-old man with a World Federation of Neurological Surgeons grade 5 subarachnoid hemorrhage, secondary to a ruptured intradural left vertebral artery dissecting aneurysm, who was treated successfully with a pipeline embolization device with Shield technology using aspirin and a single intravenous loading dose of abciximab. To our knowledge, this is the first case of an acute flow diversion performed using only aspirin as the sole oral antiplatelet agent.

scholarly journals Rivaroxaban-Induced Nontraumatic Spinal Subdural Hematoma: An Uncommon Yet Life-Threatening Complication

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mazen Zaarour ◽  
Samer Hassan ◽  
Nishitha Thumallapally ◽  
Qun Dai
Keyword(s):  
Subdural Hematoma ◽  
Lower Risk ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Bleeding Events ◽  
Spinal Hematoma ◽  
The Third ◽  
Spinal Subdural Hematoma ◽  
Life Threatening ◽  
Life Threatening Complication

In the last decade, the desire for safer oral anticoagulants (OACs) led to the emergence of newer drugs. Available clinical trials demonstrated a lower risk of OACs-associated life-threatening bleeding events, including intracranial hemorrhage, compared to warfarin. Nontraumatic spinal hematoma is an uncommon yet life-threatening neurosurgical emergency that can be associated with the use of these agents. Rivaroxaban, one of the newly approved OACs, is a direct factor Xa inhibitor. To the best of our knowledge, to date, only two published cases report the incidence of rivaroxaban-induced nontraumatic spinal subdural hematoma (SSDH). Our case is the third one described and the first one to involve the cervicothoracic spine.

scholarly journals Subarachnoid Hemorrhage Caused by Ruptured Dissecting Aneurysm Arising From the Extracranial Distal Posterior Inferior Cerebellar Artery

2010 ◽  
Vol 50 (1) ◽  
pp. 41-44 ◽  
Author(s):  
Homare NAKAMURA ◽  
Toshihide TANAKA ◽  
Takami HIYAMA ◽  
Shinji OKUBO ◽  
Tadashi KUDO ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
Cerebellar Artery

Abstract 2792: Cardiac Complications After Aneurysmal Subarachnoid Hemorrhage Are Associated With Outcome: A Meta-analysis

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ivo A van der Bilt ◽  
Djo Hasan ◽  
W. P Vandertop ◽  
Arthur A Wilde ◽  
Ale Algra ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Delayed Cerebral Ischemia ◽  
Myocardial Damage ◽  
Future Research ◽  
Cardiac Complications ◽  
Pathophysiological Mechanism ◽  
Cardiac Abnormalities

Cardiac complications after subarachnoid hemorrhage (SAH) occur frequently, but their prognostic significance remains unclear. We performed a meta-analysis to assess whether echocardiographic wall motion abnormalities (WMA), electrocardiographic (ECG) changes, or elevated markers for myocardial damage are related to the occurrence of delayed cerebral ischemia (DCI) or death. Methods All articles that reported on cardiac abnormalities after aneurysmal SAH, that met predefined criteria, and were published between 1960 and 2007 were assessed. Data were extracted on predefined methodological criteria, patient characteristics, prevalence of cardiac abnormalities, and DCI or death. We calculated pooled relative risks (RR) with corresponding 95% confidence intervals (CI) for the separate cardiac abnormalities and outcome. Results We included 25 studies (16 prospective), comprising 2690 patients (mean age 53 years; 35% was male). The figure shows the univariable RRs of the determinants for death. For DCI we found a significant association with WMA (RR 2.10 [CI 1.17, 3.78]); Troponin RR 3.15 [CI 2.27, 4.38]; CK-MB RR: 2.90 [CI 1.86, 4.52]; BNP RR: 4.52 [CI 1.79, 11.39]; and ST depression RR: 2.40 [CI 1.2, 4.9]. No significant associations were found for DCI and ST elevation RR: 2.1 [CI 0.7, 5.7]; T wave abnormality RR: 0.9 [CI 0.5, 1.7]; U wave RR: 0.7 [CI 0.4, 1.3] or prolonged QT RR: 1.0 [CI 0.5, 2.3]. Conclusion Cardiac abnormalities increase the risk of DCI and death after SAH. Future research should be directed towards elucidating the multivariable relationship between the cardiac prognosticators, the pathophysiological mechanism and potential treatment options.

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