The angiographically occult cerebrovascular malformation

1978 ◽  
Vol 48 (2) ◽  
pp. 292-296 ◽  
Author(s):  
James B. Golden ◽  
Richard A. Kramer
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Vascular Malformation ◽  
Ct Scans ◽  
Cerebral Lesions ◽  
Content Type ◽  
Surgical Exploration ◽  
Diagnostic Possibility ◽  
Cerebrovascular Malformation ◽  
Fine Print

✓ Three cases presenting with hemiparesis, headache, or seizures gave no history suggestive of subarachnoid or intracerebral hemorrhage. Carotid arteriograms were performed, and in each case failed to demonstrate a vascular malformation. In all three cases cerebral lesions were shown by either computerized tomographic (CT) scan, radionuclide scan, or both. Surgical exploration and biopsy revealed a vascular malformation in each case. The CT scans in two of the cases showed dense lesions that could suggest vascular malformation as a diagnostic possibility.

Ultra-early evaluation of intracerebral hemorrhage

1990 ◽  
Vol 72 (2) ◽  
pp. 195-199 ◽  
Author(s):  
Joseph P. Broderick ◽  
Thomas G. Brott ◽  
Thomas Tomsick ◽  
William Barsan ◽  
Judith Spilker
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Symptom Onset ◽  
Ct Scans ◽  
Content Type ◽  
Early Evaluation ◽  
Hemorrhage Volume ◽  
The Mean ◽  
Fine Print

✓ The authors evaluate eight patients with intracerebral hemorrhage (ICH) who underwent computerized tomography (CT) within 2½ hours after symptom onset and then again several hours later. The second CT scan was performed within 12 hours after onset for seven of the patients and 100 hours after onset for the eighth patient. In four patients, the second CT scan was obtained prospectively. The mean percentage of increase in the volume of hemorrhage between the first and second CT scans was 107% (range 1% to 338%). In each of the six patients with a greater than 40% increase in hemorrhage volume, neurological deterioration occurred soon after the first CT. A systolic blood pressure of 195 mm Hg or greater was recorded during the first 6 hours in five of the same six patients. The data from this study indicate that, in ICH, bleeding may continue after the 1st hour post-hemorrhage, particularly in patients with early clinical deterioration.

Lobar intracerebral hemorrhage

1992 ◽  
Vol 76 (2) ◽  
pp. 231-238 ◽  
Author(s):  
Susumu Wakai ◽  
Nahomi Kumakura ◽  
Masakatsu Nagai
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cerebral Amyloid Angiopathy ◽  
Vascular Malformation ◽  
Cavernous Malformation ◽  
Ct Scans ◽  
Amyloid Angiopathy ◽  
Content Type ◽  
Negative Angiography ◽  
Cerebral Amyloid ◽  
Fine Print

✓ The authors operated consecutively on 50 patients with lobar intracerebral hemorrhage during a prospectively designed study period from January, 1986, to March, 1990. They investigated the correlations between the underlying causes and the clinicoradiographic features in 29 patients who showed no angiographic vascular abnormalities, in order to elucidate the operative indication for such cases. Patients with ruptured saccular aneurysm or trauma were not included in this study. There were 15 males and 14 females, ranging in age from 7 to 76 years (mean 52.4 years). Histological diagnoses of the surgical specimens were as follows: vascular malformation in nine cases (arteriovenous malformation (AVM) in six and cavernous malformation in three), microaneurysm in 11, cerebral amyloid angiopathy in six, and brain tumor in two; in the remaining case the cause was not verified histologically. The underlying cause was determined in 96.5% of cases. The mean patient age was lowest in the cavernous malformation group (27.0 years), followed by the AVM (45.8 years), microaneurysm (59.8 years), and cerebral amyloid angiopathy (70.0 years) groups. Four patients with vascular malformation (three AVM's and one cavernous malformation) had previous episodes of bleeding at the same site, whereas none of those with microaneurysms or cerebral amyloid angiopathy had such episodes. On computerized tomography (CT) scans, the round to oval hematoma was related to the presence of an AVM or cavernous malformation in contrast to microaneurysms and cerebral amyloid angiopathy. Upon infusion of contrast material, variable enhancement was seen in five (two AVM's and three cavernous malformations) of the nine vascular malformations while no enhancement was noted in any patient with microaneurysm or cerebral amyloid angiopathy at the acute stage. Subarachnoid extension of the hematoma was associated with cerebral amyloid angiopathy significantly more frequently than with AVM's (p < 0.05) and microaneurysms (p < 0.01). The results suggest that clinicoradiographic pictures in cases with negative angiography are quite different among the three major pathological categories; namely, vascular malformation (AVM and cavernous malformation), microaneurysm, and cerebral amyloid angiopathy. It is suggested that the underlying etiology of a given lobar intracerebral hemorrhage with negative angiography may be predicted by a combination of patient age, history of previous bleeding at the same site, hematoma shape, and subarachnoid extension of the hematoma on CT scans. Based upon these findings, the authors discuss operative indications for such cases.

Matrix metalloproteinase—9 concentration after spontaneous intracerebral hemorrhage

2003 ◽  
Vol 99 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Sònia Abilleira ◽  
Joan Montaner ◽  
Carlos A. Molina ◽  
Jasone Monasterio ◽  
José Castillo ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Neurological Diseases ◽  
Neurological Status ◽  
Acute Stage ◽  
Ct Scans ◽  
Enzyme Linked Immunosorbent Assay ◽  
Content Type ◽  
Blood Brain Barrier Disruption ◽  
Brain Barrier Disruption ◽  
Fine Print

Object. Matrix metalloproteinases (MMPs) are overexpressed in the presence of some neurological diseases in which blood—brain barrier disruption exists. The authors investigated the MMP-9 concentration in patients after acute intracerebral hemorrhage (ICH) and its relation to perihematomal edema (PHE). Methods. Concentrations of MMP-9 and related proteins were determined in plasma by performing an enzyme-linked immunosorbent assay of samples drawn after hospital admission (< 24 hours after stroke) from 57 patients with ICH. The diagnosis of ICH was made on the basis of findings on computerized tomography (CT) scans. The volumes of ICH and PHE were measured on baseline and follow-up CT scans at the same time that the patient's neurological status was assessed using the Canadian Stroke Scale and the Glasgow Coma Scale. Increased expression of MMP-9 was found among patients with ICH. In cases of deep ICH, MMP-9 was significantly associated with PHE volume (r = 0.53; p = 0.01) and neurological worsening (237.4 compared with 111.3 ng/ml MMP-9; p = 0.04). A logistic regression model focusing on the study of absolute PHE volume showed ICH volume as an independent predictor (odds ratio [OR] 3.37; 95% confidence interval [CI] 1.1–10.3; p = 0.03). A second analysis of relative PHE volume (absolute PHE volume/ICH volume) in patients with deep ICH demonstrated that the only factor related to it was MMP-9 concentration (OR 11.6; 95% CI 1.5–89.1; p = 0.018). Conclusions. Expression of MMP-9 is raised after acute spontaneous ICH. Among patients with deep ICH this increase is associated with PHE and the development of neurological worsening within the acute stage.

Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy

1998 ◽  
Vol 89 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
Abhijit Guha ◽  
Andres Lozano ◽  
Mark Bernstein
Keyword(s):  
Ct Scan ◽  
Neurological Deficit ◽  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Ct Scanning ◽  
Ct Scans ◽  
Stereotactic Brain Biopsy ◽  
Content Type ◽  
Fine Print

Object. Many neurosurgeons routinely obtain computerized tomography (CT) scans to rule out hemorrhage in patients after stereotactic procedures. In the present prospective study, the authors investigated the rate of silent hemorrhage and delayed deterioration after stereotactic biopsy sampling and the role of postbiopsy CT scanning. Methods. A subset of patients (the last 102 of approximately 800 patients) who underwent stereotactic brain biopsies at the Toronto Hospital prospectively underwent routine postoperative CT scanning within hours of the biopsy procedure. Their medical charts and CT scans were then reviewed. A postoperative CT scan was obtained in 102 patients (aged 17–87 years) who underwent stereotactic biopsy between June 1994 and September 1996. Sixty-one patients (59.8%) exhibited hemorrhages, mostly intracerebral (54.9%), on the immediate postoperative scan. Only six of these patients were clinically suspected to have suffered a hemorrhage based on immediate postoperative neurological deficit; in the remaining 55 (53.9%) of 102 patients, the hemorrhage was clinically silent and unsuspected. Among the clinically silent intracerebral hemorrhages, 22 measured less than 5 mm, 20 between 5 and 10 mm, five between 10 and 30 mm, and four between 30 and 40 mm. Of the 55 patients with clinically silent hemorrhages, only three demonstrated a delayed neurological deficit (one case of seizure and two cases of progressive loss of consciousness) and these all occurred within the first 2 postoperative days. Of the neurologically well patients in whom no hemorrhage was demonstrated on initial postoperative CT scan, none experienced delayed deterioration. Conclusions. Clinically silent hemorrhage after stereotactic biopsy is very common. However, the authors did not find that knowledge of its existence ultimately affected individual patient management or outcome. The authors, therefore, suggest that the most important role of postoperative CT scanning is to screen for those neurologically well patients with no hemorrhage. These patients could safely be discharged on the same day they underwent biopsy.

CT infusion scanning for the detection of cerebral aneurysms

1989 ◽  
Vol 71 (2) ◽  
pp. 175-179 ◽  
Author(s):  
David W. Newell ◽  
Peter D. LeRoux ◽  
Ralph G. Dacey ◽  
Gary K. Stimac ◽  
H. Richard Winn
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Cerebral Aneurysms ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Spontaneous Hemorrhage ◽  
Fine Print

✓ Computerized tomography (CT) infusion scanning can confirm the presence or absence of an aneurysm as a cause of spontaneous intracerebral hemorrhage. Eight patients who presented with spontaneous hemorrhage were examined using this technique. In five patients the CT scan showed an aneurysm which was later confirmed by angiography or surgery; angiography confirmed the absence of an aneurysm in the remaining three patients. This method is an easy effective way to detect whether an aneurysm is the cause of spontaneous intracerebral hemorrhage.

Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury

2002 ◽  
Vol 96 (1) ◽  
pp. 109-116 ◽  
Author(s):  
Matthias Oertel ◽  
Daniel F. Kelly ◽  
David McArthur ◽  
W. John Boscardin ◽  
Thomas C. Glenn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ct Scan ◽  
Ct Scanning ◽  
Older Age ◽  
Ct Scans ◽  
Female Ratio ◽  
Content Type ◽  
Male Sex ◽  
Time From Injury ◽  
Fine Print

Object. Progressive intracranial hemorrhage after head injury is often observed on serial computerized tomography (CT) scans but its significance is uncertain. In this study, patients in whom two CT scans were obtained within 24 hours of injury were analyzed to determine the incidence, risk factors, and clinical significance of progressive hemorrhagic injury (PHI). Methods. The diagnosis of PHI was determined by comparing the first and second CT scans and was categorized as epidural hematoma (EDH), subdural hematoma (SDH), intraparenchymal contusion or hematoma (IPCH), or subarachnoid hemorrhage (SAH). Potential risk factors, the daily mean intracranial pressure (ICP), and cerebral perfusion pressure were analyzed. In a cohort of 142 patients (mean age 34 ± 14 years; median Glasgow Coma Scale score of 8, range 3–15; male/female ratio 4.3:1), the mean time from injury to first CT scan was 2 ± 1.6 hours and between first and second CT scans was 6.9 ± 3.6 hours. A PHI was found in 42.3% of patients overall and in 48.6% of patients who underwent scanning within 2 hours of injury. Of the 60 patients with PHI, 87% underwent their first CT scan within 2 hours of injury and in only one with PHI was the first CT scan obtained more than 6 hours postinjury. The likelihood of PHI for a given lesion was 51% for IPCH, 22% for EDH, 17% for SAH, and 11% for SDH. Of the 46 patients who underwent craniotomy for hematoma evacuation, 24% did so after the second CT scan because of findings of PHI. Logistic regression was used to identify male sex (p = 0.01), older age (p = 0.01), time from injury to first CT scan (p = 0.02), and initial partial thromboplastin time (PTT) (p = 0.02) as the best predictors of PHI. The percentage of patients with mean daily ICP greater than 20 mm Hg was higher in those with PHI compared with those without PHI. The 6-month postinjury outcome was similar in the two patient groups. Conclusions. Early progressive hemorrhage occurs in almost 50% of head-injured patients who undergo CT scanning within 2 hours of injury, it occurs most frequently in cerebral contusions, and it is associated with ICP elevations. Male sex, older age, time from injury to first CT scan, and PTT appear to be key determinants of PHI. Early repeated CT scanning is indicated in patients with nonsurgically treated hemorrhage revealed on the first CT scan.

Volumetric quantification of Fisher Grade 3 aneurysmal subarachnoid hemorrhage: a novel approach to predict symptomatic vasospasm on admission computerized tomography scans

2002 ◽  
Vol 97 (2) ◽  
pp. 401-407 ◽  
Author(s):  
Jonathan A. Friedman ◽  
Stephan J. Goerss ◽  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
Mark A. Pichelmann ◽  
...  
Keyword(s):  
Ct Scan ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Ct Scans ◽  
Content Type ◽  
Fisher Grade ◽  
Volumetric Quantification ◽  
Hemorrhage Volume ◽  
Grade 3 ◽  
Fine Print ◽  
New Onset

Object. Predicting which patients with aneurysmal subarachnoid hemorrhage (SAH) will develop delayed ischemic neurological deficit (DIND) due to vasospasm remains subjective and unreliable. The authors analyzed the utility of a novel software-based technique to quantify hemorrhage volume in patients with Fisher Grade 3 aneurysmal SAH. Methods. Patients with aneurysmal SAH in whom a computerized tomography (CT) scan was performed within 72 hours of ictus and demonstrated Fisher Grade 3 SAH were analyzed. Severe DIND was defined as new onset complete focal deficit or coma. Moderate DIND was defined as new onset partial focal deficit or impaired consciousness without coma. Fifteen consecutive patients with severe DIND, 13 consecutive patients with moderate DIND, and 12 consecutive patients without DIND were analyzed. Software-based volumetric quantification was performed on digitized admission CT scans by a single examiner blinded to clinical information. There was no significant difference in age, sex, admission Hunt and Hess grade, or time to admission CT scan among the three groups (none, moderate, or severe DIND). Patients with severe DIND had a significantly higher cisternal volume of hemorrhage (median 30.5 cm3) than patients with moderate DIND (median 12.4 cm3) and patients without DIND (median 10.3 cm3; p < 0.001). Intraparenchymal hemorrhage and intraventricular hemorrhage were not associated with DIND. All 13 patients with cisternal volumes greater than 20 cm3 developed DIND, compared with 15 of 27 patients with volumes less than 20 cm3 (p = 0.004). Conclusions. The authors developed a simple and potentially widely applicable method to quantify SAH on CT scans. A greater volume of cisternal hemorrhage on an admission CT scan in patients with Fisher Grade 3 aneurysmal SAH is highly associated with DIND. A threshold of cisternal hemorrhage volume (> 20 cm3) may exist above which patients are very likely to develop DIND. Prospective application of software-based volumetric quantification of cisternal SAH may predict which patients will develop DIND.

Vascular malformation simulating a glioma on computerized tomography

1981 ◽  
Vol 54 (1) ◽  
pp. 125-127 ◽  
Author(s):  
Patrick M. Foy ◽  
Leandro Lozada ◽  
Malcolm D. Shaw
Keyword(s):  
Arteriovenous Malformation ◽  
Computerized Tomography ◽  
Vascular Malformation ◽  
Ct Scans ◽  
Venous Aneurysm ◽  
Content Type ◽  
Fine Print

✓ A patient with an arteriovenous malformation and giant venous aneurysm was erroneously diagnosed as having an oligodendroglioma on computerized tomography (CT). This case highlights some of the problems of interpretation of CT scans and the dangers of misinterpretation, particularly in the surgical context.

Localization of brain tumors with a simple scalp-mounted fiducial device

1989 ◽  
Vol 70 (2) ◽  
pp. 280-281 ◽  
Author(s):  
Henry Hirschberg
Keyword(s):  
Brain Tumors ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Ct Images ◽  
Ct Scans ◽  
Content Type ◽  
Varying Length ◽  
Fine Print

✓ A method is described for marking the site of a tumor on the scalp based on information from computerized tomography (CT) scans. The technique employs a syrinx-shaped array of radiopaque catheters of varying length taped to the patient's scalp for visualization on the CT scan. Fiducial markings on the CT images allow the transfer of the tumor's location directly onto the scalp. The device can be placed anywhere on the scalp, including in a parasagittal position.

Low-grade gliomas in children: tumor volume response to radiation

1998 ◽  
Vol 88 (6) ◽  
pp. 969-974 ◽  
Author(s):  
Barbara J. Fisher ◽  
Glenn S. Bauman ◽  
Christopher E. Leighton ◽  
Larry Stitt ◽  
J. Gregory Cairncross ◽  
...  
Keyword(s):  
Ct Scan ◽  
Tumor Volume ◽  
Residual Tumor ◽  
Ct Scans ◽  
Low Grade ◽  
Tumor Shrinkage ◽  
Content Type ◽  
Low Grade Gliomas ◽  
Fine Print

Object. The authors conducted a retrospective review to examine and document the frequency, degree, and timing of the radiologically confirmed response to radiotherapy of low-grade gliomas in children. Methods. Between 1963 and 1995, 80 patients 17 years of age or younger were referred to the London Regional Cancer Centre in London, Ontario after diagnosis of a low-grade glioma. All patients underwent surgical resection or biopsy procedures and 47 underwent radiotherapy (40 postoperatively and seven at the time of tumor progression). Nineteen patients with residual measurable lesions who received radiation therapy were selected for volumetric analysis of tumor response to this treatment. The extent and timing of response to radiation were determined by the process of comparing postoperative, preirradiation computerized tomography (CT) scans with postirradiation, follow-up CT scans. For one patient the comparison was made by using serial magnetic resonance images. Residual tumor was found on postoperative CT scans in all cases. The mean preradiotherapy tumor volume was 17.1 cm3, and the postradiotherapy volume was reduced to a mean of 11.5 cm3. A reduction in tumor volume was demonstrated in eight patients by the time of their first postirradiation follow-up CT scan and in two patients a slower reduction in volume over time was shown, bringing the total number of “responders” to 10. In five of these 10 patients the tumor had shown a maximum response by the time of the first postirradiation CT scan; the median time to response was 3.3 months. A 25% or greater reduction in tumor volume was seen in eight (42%) of the 19 patients. A 50% or greater reduction was noted in five (26%) of the patients. A complete response was demonstrated at 7, 12, and 15 months, and 5 years, respectively, in four patients (21%). One responder's tumor eventually increased in size after radiotherapy and he died of his disease. The magnitude of the radiographically demonstrated response to radiation did not correlate significantly with clinical outcome (that is, survival or symptom improvement). Conclusions. On the basis of this CT scan analysis of the response of low-grade gliomas in children to radiotherapy, the authors suggest that these lesions respond to radiation, as demonstrated by tumor shrinkage on serial imaging. Major or complete responses occur occasionally. However, low-grade gliomas in children mimic other benign brain tumors such as pituitary adenomas and meningiomas in that, although growth is frequently arrested after radiotherapy, residual tumor can persist for many years, illustrating that tumor shrinkage may not be a good measure of treatment efficacy. Nevertheless, radiation therapy can result in improvement of clinical symptomatology in association with or independent of visible tumor reduction. As radiation treatment techniques become increasingly conformal and because studies indicate that lower doses of radiation may be equally effective, improvement of symptoms may be an important consideration when weighing treatment options, particularly in patients with residual or unresectable disease.

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