scholarly journals Coccidioidal meningitis with multiple aneurysms presenting with pseudo–subarachnoid hemorrhage: illustrative case

2021 ◽  
Vol 2 (15) ◽  
Author(s):  
Rohin Singh ◽  
Visish M. Srinivasan ◽  
Joshua S. Catapano ◽  
Joseph D. DiDomenico ◽  
Jacob F. Baranoski ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
External Ventricular Drain ◽  
Severe Case ◽  
Western United States ◽  
Illustrative Case ◽  
Basal Cistern ◽  
Aneurysmal Rupture ◽  
Multiple Aneurysms ◽  
Prompt Treatment

BACKGROUND Coccidioidomycosis is a primarily self-limiting fungal disease endemic to the western United States and South America. However, severe disseminated infection can occur. The authors report a severe case of coccidioidal meningitis that appeared to be a subarachnoid hemorrhage (SAH) on initial inspection. OBSERVATIONS A man in his early 40s was diagnosed with coccidioidal pneumonia after presenting with pulmonary symptoms. After meningeal spread characterized by declining mental status and hydrocephalus, coccidioidal meningitis was diagnosed. The uniquely difficult aspect of this case was the deceptive appearance of SAH due to the presence of multiple aneurysms and blood draining from the patient’s external ventricular drain. LESSONS Coccidioidal infection likely led to the formation of multiple intracranial aneurysms in this patient. Although few reports exist of coccidioidal meningitis progressing to aneurysm formation, patients should be closely monitored for this complication because outcomes are poor. The presence of basal cistern hyperdensities from a coccidioidal infection mimicking SAH makes interpreting imaging difficult. Surgical management of SAH can be considered safe and viable, especially when the index of suspicion is high, such as in the presence of multiple aneurysms. Even if it is unclear whether aneurysmal rupture has occurred, prompt treatment is advisable.

Demographic and clinical predictors of multiple intracranial aneurysms in patients with subarachnoid hemorrhage

2018 ◽  
Vol 128 (4) ◽  
pp. 961-968 ◽  
Author(s):  
Michael M. McDowell ◽  
Yin Zhao ◽  
Christopher P. Kellner ◽  
Sunjay M. Barton ◽  
Eric Sussman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Smoking History ◽  
Relative Risk Ratio ◽  
Base Case ◽  
Black Race ◽  
Multiple Aneurysms ◽  
Female Sex

OBJECTIVEPathophysiological differences that underlie the development and subsequent growth of multiple aneurysms may exist. In this study, the authors assessed the factors associated with the occurrence of multiple aneurysms in patients presenting with aneurysmal subarachnoid hemorrhage (SAH).METHODSConsecutive patients presenting with aneurysmal SAH between 1996 and 2012 were prospectively enrolled in the Subarachnoid Hemorrhage Outcome Project. Patients harboring 1, 2, or 3 or more aneurysms were stratified into groups, and the clinical and radiological characteristics of each group were compared using multivariate logistic regression.RESULTSOf 1277 patients with ruptured intracranial aneurysms, 890 had 1 aneurysm, 267 had 2 aneurysms, and 120 had 3 or more aneurysms. On multinomial regression using the single-aneurysm cohort as base case, risk factors for patients presenting with 2 aneurysms were female sex (relative risk ratio [RRR] 1.80, p < 0.001), higher body mass index (BMI) (RRR 1.02, p = 0.003), more years of smoking (RRR = 1.01, p = 0.004), and black race (RRR 1.83, p = 0.001). The risk factors for patients presenting with 3 or more aneurysms were female sex (RRR 3.10, p < 0.001), higher BMI (RRR 1.03, p < 0.001), aneurysm in the posterior circulation (RRR 2.59, p < 0.001), and black race (RRR 2.15, p = 0.001). Female sex, longer smoking history, aneurysms in the posterior circulation, BMI, and black race were independently associated with the development of multiple aneurysms in our adjusted multivariate multinomial model.CONCLUSIONSSignificant demographic and clinical differences are found between patients presenting with single and multiple aneurysms in the setting of aneurysmal SAH. These predictors of multiple aneurysms likely reflect a predisposition toward inflammation and endothelial injury.

Aneurysmal Subarachnoid Hemorrhage: Neurosurgical Frontiers and Nursing Challenges

1991 ◽  
Vol 2 (4) ◽  
pp. 665-674
Author(s):  
Helen A. Cook
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Seizure Activity ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Treatment Strategies ◽  
Mortality Rates ◽  
Aneurysmal Rupture ◽  
Management Of Complications ◽  
Ruptured Intracranial Aneurysms

Despite increases in survival beyond the initial hemorrhage, the devastating consequences of subarachnoid hemorrhage persist. Ruptured intracranial aneurysms are the most likely cause of subarachnoid hemorrhage, with morbidity and mortality rates approaching 75%. Complications arising from aneurysmal subarachnoid hemorrhage include rebleeding, delayed cerebral ischemia, hydrocephalus, hypothalamic dysfunction, and seizure activity. In order to positively influence outcome after subarachnoid hemorrhage, preservation of an adequate cerebral blood flow and prevention of secondary aneurysmal rupture is essential. This article reviews aneurysmal subarachnoid hemorrhage, relating the management of complications to currently accepted treatment strategies

scholarly journals Association of single and multiple aneurysms with tobacco abuse: an @neurIST risk analysis

2019 ◽  
Vol 47 (1) ◽  
pp. E9 ◽  
Author(s):  
Bawarjan Schatlo ◽  
Oliver P. Gautschi ◽  
Christoph M. Friedrich ◽  
Christian Ebeling ◽  
Max Jägersberg ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
General Population ◽  
Risk Analysis ◽  
Intracranial Aneurysms ◽  
Lifestyle Modification ◽  
Smoking Status ◽  
Reference Population ◽  
Multiple Aneurysms ◽  
Risk Of Rupture ◽  
Tobacco Abuse

OBJECTIVEAlthough several studies have suggested that the incidence of intracranial aneurysms (IAs) is higher in smokers, the higher prevalence of subarachnoid hemorrhage (SAH) in smokers remains uncertain. It is unclear whether smoking additionally contributes to the formation of multiple aneurysms and the risk of rupture. The aim of this study was to determine whether smoking is associated with IA formation, multiplicity, or rupture.METHODSPatients from the prospective multicenter @neurIST database (n = 1410; 985 females [69.9%]) were reviewed for the presence of SAH, multiple aneurysms, and smoking status. The prevalence of smokers in the population of patients diagnosed with at least one IA was compared with that of smokers in the general population.RESULTSThe proportion of smokers was higher in patients with IAs (56.2%) than in the reference population (51.4%; p < 0.001). A significant association of smoking with the presence of an IA was found throughout group comparisons (p = 0.01). The presence of multiple IAs was also significantly associated with smoking (p = 0.003). A trend was found between duration of smoking and the presence of multiple IAs (p = 0.057). However, the proportion of smokers among patients suffering SAH was similar to that of smokers among patients diagnosed with unruptured IAs (p = 0.48).CONCLUSIONSSmoking is strongly associated with IA formation. Once an IA is present, however, smoking does not appear to increase the risk of rupture compared with IAs in the nonsmoking population. The trend toward an association between duration of smoking and the presence of multiple IAs stresses the need for counseling patients with IAs regarding lifestyle modification.

scholarly journals Angiotensin-(1-7) Protects against the Development of Aneurysmal Subarachnoid Hemorrhage in Mice

2015 ◽  
Vol 35 (7) ◽  
pp. 1163-1168 ◽  
Author(s):  
Kenji Shimada ◽  
Hajime Furukawa ◽  
Kosuke Wada ◽  
Yuan Wei ◽  
Yoshiteru Tada ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Protective Effect ◽  
Receptor Antagonist ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Arteries ◽  
Aneurysm Rupture ◽  
Dependent Manner ◽  
Aneurysmal Rupture ◽  
Mas Receptor

Angiotensin-(1-7) (Ang-(1-7)) can regulate vascular inflammation and remodeling, which are processes that have important roles in the pathophysiology of intracranial aneurysms. In this study, we assessed the effects of Ang-(1-7) in the development of intracranial aneurysm rupture using a mouse model of intracranial aneurysms in which aneurysmal rupture (i.e., aneurysmal subarachnoid hemorrhage) occurs spontaneously and causes neurologic symptoms. Treatment with Ang-(1-7) (0.5 mg/kg/day), Mas receptor antagonist (A779 0.5 mg/kg/day or 2.5 mg/kg/day), or angiotensin II type 2 receptor (AT2R) antagonist (PD 123319, 10 mg/kg/day) was started 6 days after aneurysm induction and continued for 2 weeks. Angiotensin-(1-7) significantly reduced the rupture rate of intracranial aneurysms without affecting the overall incidence of aneurysms. The protective effect of Ang-(1-7) was blocked by the AT2R antagonist, but not by the Mas receptor antagonist. In AT2R knockout mice, the protective effect of Ang-(1-7) was absent. While AT2R mRNA was abundantly expressed in the cerebral arteries and aneurysms, Mas receptor mRNA expression was very scarce in these tissues. Angiotensin-(1-7) reduced the expression of tumor necrosis factor-α and interleukin-1β in cerebral arteries. These findings indicate that Ang-(1-7) can protect against the development of aneurysmal rupture in an AT2R-dependent manner.

scholarly journals Endovascular Coiling of Multiple (More Than Four) Intracranial Aneurysms

2004 ◽  
Vol 10 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Y.J. Kim ◽  
K.Y. Song
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Gold Standard ◽  
Intracranial Aneurysms ◽  
Endovascular Procedure ◽  
Endovascular Coiling ◽  
Basal Cistern ◽  
Multiple Intracranial Aneurysms ◽  
Multiple Aneurysms ◽  
Multiple Aneurysm ◽  
Clear Line

The incidence of multiple intracranial aneurysms has been reported from 5% to 35%. But over four multiple aneurysms are extremely rare. Sometimes it is very difficult to draw a clear line between ruptured ones and unruptured others especially in multiple aneurysm cases with even distribution of subarachnoid haemorrhage on basal cistern. We present two cases of multiple aneurysms, more than four, which were successfully treated by endovascular coiling at the same time. Our experience suggests an endovascular procedure would be the gold standard of treatment for ruptured multiple intracranial aneurysms.

scholarly journals Unruptured intracranial aneurysms and the assessment of rupture risk based on anatomical and morphological factors: sifting through the sands of data

2009 ◽  
Vol 26 (5) ◽  
pp. E2 ◽  
Author(s):  
Rohan R. Lall ◽  
Christopher S. Eddleman ◽  
Bernard R. Bendok ◽  
H. Hunt Batjer
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Morphological Characteristics ◽  
Preventive Treatment ◽  
Rupture Risk ◽  
Catastrophic Event ◽  
Aneurysmal Rupture ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms

Aneurysmal subarachnoid hemorrhage continues to have high rates of morbidity and mortality for patients despite optimal medical and surgical management. Due to the fact that aneurysmal rupture can be such a catastrophic event, preventive treatment is desirable for high-risk lesions. Given the variability of the literature evaluating unruptured aneurysms regarding basic patient population, clinical practice, and aneurysm characteristics studied, such as size, location, aspect ratio, relationship to the surrounding vasculature, and the aneurysm hemodynamics, a metaanalysis is nearly impossible to perform. This review will instead focus on the various anatomical and morphological characteristics of aneurysms reported in the literature with an attempt to draw broad inferences and serve to highlight pressing questions for the future in our continued effort to improve clinical management of unruptured intracranial aneurysms.

scholarly journals Sex Difference and Rupture Rate of Intracranial Aneurysms: An Individual Patient Data Meta-Analysis

Stroke ◽  
2022 ◽  
Author(s):  
Charlotte C.M. Zuurbier ◽  
Rob Molenberg ◽  
Liselore A. Mensing ◽  
Marieke J.H. Wermer ◽  
Seppo Juvela ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Sex Difference ◽  
Intracranial Aneurysms ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Aneurysmal Rupture ◽  
Rupture Rate ◽  
Related Risk

Background and Purpose: In previous studies, women had a higher risk of rupture of intracranial aneurysms than men, but female sex was not an independent risk factor. This may be explained by a higher prevalence of patient- or aneurysm-related risk factors for rupture in women than in men or by insufficient power of previous studies. We assessed sex differences in rupture rate taking into account other patient- and aneurysm-related risk factors for aneurysmal rupture. Methods: We searched Embase and Pubmed for articles published until December 1, 2020. Cohorts with available individual patient data were included in our meta-analysis. We compared rupture rates of women versus men using a Cox proportional hazard regression model adjusted for the PHASES score (Population, Hypertension, Age, Size of Aneurysm, Earlier Subarachnoid Hemorrhage From Another Aneurysm, Site of Aneurysm), smoking, and a positive family history of aneurysmal subarachnoid hemorrhage. Results: We pooled individual patient data from 9 cohorts totaling 9940 patients (6555 women, 66%) with 12 193 unruptured intracranial aneurysms, and 24 357 person-years follow-up. Rupture occurred in 163 women (rupture rate 1.04%/person-years [95% CI, 0.89–1.21]) and 63 men (rupture rate 0.74%/person-years [95% CI, 0.58–0.94]). Women were older (61.9 versus 59.5 years), were less often smokers (20% versus 44%), more often had internal carotid artery aneurysms (24% versus 17%), and larger sized aneurysms (≥7 mm, 24% versus 23%) than men. The unadjusted women-to-men hazard ratio was 1.43 (95% CI, 1.07–1.93) and the adjusted women/men ratio was 1.39 (95% CI, 1.02–1.90). Conclusions: Women have a higher risk of aneurysmal rupture than men and this sex difference is not explained by differences in patient- and aneurysm-related risk factors for aneurysmal rupture. Future studies should focus on the factors explaining the higher risk of aneurysmal rupture in women.

Ventriculostomy for the treatment of acute hydrocephalus following subarachnoid hemorrhage

1973 ◽  
Vol 38 (5) ◽  
pp. 591-595 ◽  
Author(s):  
John A. Kusske ◽  
Paul T. Turner ◽  
George A. Ojemann ◽  
A. Basil Harris
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Matched Control ◽  
External Ventricular Drain ◽  
Control Group ◽  
Control Series ◽  
Content Type ◽  
Acute Hydrocephalus ◽  
Definitive Surgery

✓ The role of ventriculostomy in the treatment of acute hydrocephalus following subarachnoid hemorrhage from intracranial aneurysms is evaluated. Eleven patients treated with an external ventricular drain are compared to a matched control series of untreated patients. Improvement occurred in eight of the 11 treated patients and in only one of the nine patients in the control group. Seven of the patients in the ventriculostomy series improved sufficiently to justify definitive surgery. There were no infections. In 50% of the surviving ventriculostomy patients, permanent shunts were unnecessary. Our data emphasize the deleterious effects of hydrocephalus in the acute period following a subarachnoid hemorrhage and suggest that it may be treated effectively by external ventriculostomy.

Cerebral Panangiography in Spontaneous Subarachnoid Hemorrhage from Intracranial Aneurysms

1988 ◽  
Vol 29 (6) ◽  
pp. 633-636 ◽  
Author(s):  
P. Nakstad ◽  
H. Nornes ◽  
H. N. Hauge ◽  
O. Kjartansson
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Angiography ◽  
Intracranial Aneurysms ◽  
Cerebral Arteries ◽  
Multiple Aneurysms ◽  
Middle Cerebral Arteries ◽  
Spontaneous Subarachnoid Hemorrhage

Cerebral panangiography was performed in 594 patients with subarachnoid hemorrhage from intracranial aneurysms. Aneurysm of the middle cerebral arteries was the most frequent location of aneurysms in this material. Multiple aneurysms of the middle cerebral arteries are far more frequent than the combination of other locations. Judged from this material there is a 7 per cent possibility of finding a contralateral aneurysm of the middle cerebral arteries if one is found. Multiple aneurysms were found in 51 (8.6%) of the 594 patients. We conclude that the results of this study are typical for Norwegians, although some selection exists since the patients were first admitted to other hospitals. The frequency of complications with cerebral panangiography in subarachnoid hemorrhage was less than that of cerebral angiography in patients with other diseases.

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