Subarachnoid hemorrhage from intracranial dissecting aneurysm

1984 ◽  
Vol 60 (2) ◽  
pp. 325-334 ◽  
Author(s):  
Allan H. Friedman ◽  
Charles G. Drake
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Arterial Occlusion ◽  
Dissecting Aneurysm ◽  
Content Type ◽  
Vertebrobasilar Circulation ◽  
Intracranial Dissecting Aneurysm ◽  
Fine Print

✓ Rupture of an intracranial dissecting aneurysm is a rare but dangerous event. The authors' experience with 14 cases of these lesions on the vertebrobasilar circulation suggests that these aneurysms have typical angiographic silhouettes and that, at least in the vertebral artery, they are treatable by proximal arterial occlusion.

Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysms

1991 ◽  
Vol 74 (3) ◽  
pp. 393-398 ◽  
Author(s):  
Armand Aymard ◽  
Y. Pierre Gobin ◽  
Jonathan E. Hodes ◽  
Siegfried Bien ◽  
Daniel Rüfenacht ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Mass Effect ◽  
Content Type ◽  
Vertebral Arteries ◽  
Endovascular Occlusion ◽  
Vertebrobasilar Circulation ◽  
Partial Thrombosis ◽  
Vertebrobasilar Aneurysms ◽  
Fine Print

✓ Twenty-one patients with aneurysms of the vertebrobasilar circulation underwent unilateral or bilateral endovascular occlusion of the vertebral artery. Six patients presented with subarachnoid hemorrhage (SAH), 10 with mass effect, four with mass effect and SAH, and one with ischemic symptoms. Thirteen patients had good outcomes with complete clinical and angiographic cure. Six patients had partial thrombosis of their aneurysms. There was one death and one treatment failure. One patient suffered transient stroke. It is concluded that endovascular occlusion of the vertebral artery following test occlusion is a safe and effective treatment for proximal aneurysms of the vertebrobasilar circulation.

Dissecting aneurysm of the vertebral artery

1984 ◽  
Vol 61 (6) ◽  
pp. 1038-1046 ◽  
Author(s):  
Takeyoshi Shimoji ◽  
Kuniaki Bando ◽  
Keiji Nakajima ◽  
Kazufumi Ito
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Vertebral Artery ◽  
Arterial Wall ◽  
Dissecting Aneurysm ◽  
Content Type ◽  
Venous Phase ◽  
Dissecting Aneurysms ◽  
Angiographic Findings ◽  
Fine Print

✓ Seven cases of dissecting aneurysm of the vertebral artery, all appearing to be of fusiform type, are reported. Clinically, all seven cases initially showed symptoms of subarachnoid hemorrhage; however, three of these were associated with Wallenberg's syndrome. The characteristic angiographic findings in these cases were: 1) retention of contrast medium in the aneurysm; 2) the presence of a true (vertebral artery) and false (arterial wall) lumen in the late arterial and/or venous phase; and 3) irregular arterial narrowing proximal and/or distal to the aneurysm. Autopsy findings of one patient supported the angiographic findings. Recently, reports of fusiform aneurysms associated with subarachnoid hemorrhage have been increasing. As dissecting aneurysms are found in the fusiform group, it is very important to analyze serial angiograms in order to choose a method of surgical treatment.

Nontraumatic dissecting aneurysm of the vertebral artery

1982 ◽  
Vol 56 (1) ◽  
pp. 128-130 ◽  
Author(s):  
Howard J. Senter ◽  
Mohammad Sarwar
Keyword(s):  
Differential Diagnosis ◽  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Vascular Malformation ◽  
Dissecting Aneurysm ◽  
Content Type ◽  
Fine Print

✓ A case is described of a nontraumatic dissecting aneurysm of the vertebral artery, which presented as a subarachnoid hemorrhage (SAH). Differentiation from vasospasm and from atherosclerosis is critical. Dissection between the adventitia and media should be noted in the differential diagnosis of SAH when an aneurysm or vascular malformation is not demonstrated angiographically.

Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients

2004 ◽  
Vol 101 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Masaru Yamada ◽  
Takao Kitahara ◽  
Akira Kurata ◽  
Kiyotaka Fujii ◽  
Yoshio Miyasaka
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Conservative Treatment ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Delayed Diagnosis ◽  
Acute Stage ◽  
Artery Dissection ◽  
Content Type ◽  
String Structure ◽  
Fine Print

Object. Intracranial vertebral artery (VA) dissection with subarachnoid hemorrhage is notorious for frequent rebleeding and a poor prognosis. Nevertheless, some patients survive with a good final outcome. The factors associated with the prognosis of this disease are not fully understood and appropriate treatment strategies continue to be debated. The authors retrospectively evaluated the clinical features of conservatively treated patients to elucidate the relationship between the clinical and angiographic characteristics of the disease and final outcomes. Methods. This study includes 24 patients who were treated by conservative methods between 1990 and 2000. Conservative treatment was chosen because of delayed diagnosis, poor clinical condition, or anatomical features such as bilateral lesions and contralateral VA hypoplasia. Of nine patients with an admission Hunt and Kosnik Grade I or II, eight had good outcomes (mean follow-up period 8 years and 4 months). All 15 patients with Grade III, IV, or V died and in 10 of these the cause of death was rebleeding. Among the 24 patients, 14 suffered a total of 35 rebleeding episodes; in 10 (71.4%) of these 14 patients rebleeding occurred within 6 hours and in 13 (93%) within 24 hours. Compared with the survivors, there was a female preponderance (0.022) among patients who died. These patients also had significantly shorter intervals between onset and hospital admission (p = 0.0067), a higher admission Hunt and Kosnik grade (p = 0.0001), a higher incidence of prehospitalization (p = 0.0296) and postadmission (p = 0.0029) rebleeding episodes, and a higher incidence of angiographically confirmed pearl-and-string structure of the lesion (p = 0.0049). Conclusions. In our series of preselected patients, poor admission neurological grade, rebleeding episode(s), and lesions with a pearl-and-string structure were predictive of poor outcomes. Our findings indicate that patients with these characteristics may be candidates for aggressive attempts to prevent rebleeding during the acute stage. Patients without these characteristics may be good candidates for conservative treatment, especially those who survive the acute phase without rebleeding.

Intracranial dissecting aneurysm

1971 ◽  
Vol 35 (4) ◽  
pp. 483-487 ◽  
Author(s):  
Osamu Sato ◽  
James F. Bascom ◽  
John Logothetis
Keyword(s):  
Middle Cerebral Artery ◽  
Age Distribution ◽  
Acute Onset ◽  
Dissecting Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Content Type ◽  
Relative Rarity ◽  
Intracranial Dissecting Aneurysm ◽  
Left Middle ◽  
Fine Print

✓ The case of a 6-year-old boy who died 4 days after the acute onset of a left middle cerebral artery aneurysmal dissection is described. A review of the 30 reported cases with similar lesions reveals their relative rarity. The age distribution, sex incidence, intracranial vessels affected, and postulated causes of the dissection are discussed.

Intracranial vertebral arteriovenous fistula

1993 ◽  
Vol 79 (4) ◽  
pp. 589-591 ◽  
Author(s):  
Andrea L. Halliday ◽  
Christopher S. Ogilvy ◽  
Robert M. Crowell
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Surgical Management ◽  
Surgical Approach ◽  
Venous System ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Open Surgical Approach ◽  
Fine Print

✓ True intracranial arteriovenous fistulas are rare. The authors report a case of a direct fistula between the intracranial portion of the vertebral artery and the lateral medullary venous system. The patient initially presented with a subarachnoid hemorrhage. An open surgical approach with clip obliteration of the lesion was used. The anatomy of this lesion and its surgical management are described.

Endovascular management of dissecting vertebrobasilar artery aneurysms in patients presenting with acute subarachnoid hemorrhage

2005 ◽  
Vol 103 (4) ◽  
pp. 649-655 ◽  
Author(s):  
Ichiro Yuki ◽  
Yuichi Murayama ◽  
Fernando Viñuela
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Dissecting Aneurysm ◽  
Endovascular Techniques ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Vertebrobasilar Artery ◽  
Acute Subarachnoid Hemorrhage ◽  
Grade Ii ◽  
Dissecting Aneurysms ◽  
Fine Print

Object. The authors report on a series of 29 patients presenting with acute subarachnoid hemorrhage (SAH) related to the rupture of a vertebrobasilar dissecting aneurysm. Special attention was focused on embolization techniques and immediate and midterm anatomical and clinical outcomes. Methods. Between March 1994 and January 2003, 29 patients presented with acute SAH caused by the rupture of a vertebrobasilar dissecting aneurysm. Eleven patients (37.9%) had Hunt and Hess Grade I SAH, four (13.8%) Grade II, six (20.7%) Grade III, five (17.2%) Grade IV, and three (10.3%) Grade V. Aneurysms were classified into five groups based on lesion location, and treatment courses were decided. All patients except two were treated by endovascular trapping of the aneurysm with concomitant occlusion of the involved vertebral artery (VA). No technical or clinical complication was observed in 28 patients (97%). Aneurysm perforation occurred during the procedure in one patient (3%). There was evidence of aneurysm recanalization in one patient. One patient with Hunt and Hess Grade IV SAH and two patients with Grade V SAH died. One patient died of respiratory infection 1 year after aneurysm trapping. One patient presented with a recurrent hemorrhage 1 month after treatment and died. Overall morbidity and mortality rates were 13.8 and 17.2%, respectively. Conclusions. Twenty-nine patients with acute SAH due to rupturing of vertebrobasilar dissecting aneurysms were treated using endovascular techniques. In most cases, endovascular trapping of the aneurysm and concomitant occlusion of the VA was technically and clinically successful.

Subarachnoid hemorrhage caused by a fungal aneurysm of the vertebral artery as a complication of intracranial aneurysm clipping

1990 ◽  
Vol 73 (6) ◽  
pp. 962-964 ◽  
Author(s):  
Wolfgang Peter Piotrowski ◽  
Peter Pilz ◽  
I-Hsing Chuang
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Fungal Infection ◽  
Vertebral Artery ◽  
Immunosuppressive Therapy ◽  
Intracranial Aneurysms ◽  
Content Type ◽  
Aneurysm Clipping ◽  
Long Period ◽  
Fine Print

✓ Intracranial aneurysms are an uncommon manifestation of fungal infection. A case is described in which the formation of an aneurysm followed an intracranial intraoperative Aspergillus infection attributable to a long period of preoperative antibiotic medication and immunosuppressive therapy with steroids.

Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation

1995 ◽  
Vol 82 (1) ◽  
pp. 137-139 ◽  
Author(s):  
Quentin J. Durward
Keyword(s):  
Blood Flow ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
Normal Blood ◽  
Content Type ◽  
Cerebellar Artery ◽  
Normal Blood Flow ◽  
Vertebral Artery Dissecting Aneurysm ◽  
Fine Print

✓ The author presents the case of a patient with a ruptured vertebral artery dissecting aneurysm in which the posterior inferior cerebellar artery (PICA) arose from the wall of the aneurysm. The aneurysm was treated by trapping and the PICA was anastomosed to the vertebral artery proximal to the dissection. This technique allows intraoperative obliteration of the aneurysm while maintaining normal blood flow to the PICA.

Cerebral artery spasm

1978 ◽  
Vol 48 (4) ◽  
pp. 515-525 ◽  
Author(s):  
J. Trevor Hughes ◽  
Pietro M. Schianchi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Histological Examination ◽  
Cerebral Vasospasm ◽  
Arterial Wall ◽  
Arterial Occlusion ◽  
Intimal Thickening ◽  
Content Type ◽  
Small Arteries ◽  
Acute Changes ◽  
Fine Print

✓ From a larger series of autopsies with subarachnoid hemorrhage (SAH), 20 cases were selected for the known complication of cerebral vasospasm. Evidence for vasospasm was radiological and pathological in 17 cases and pathological alone in three. A systematic histological examination of the large arteries in places known formerly to have been in spasm showed that, in the 12 early cases (death before 3 weeks), there were relevant changes in all the layers of the arterial wall, the most significant being evidence of necrosis in the tunica media. In the eight late cases (death after 3 weeks), in addition to the sequelae of the earlier acute changes, there was marked concentric intimal thickening by subendothelial fibrosis, again located in the segments of arteries formerly in spasm. Changes were also found in the small arteries, capillaries, and veins, both in the early and late cases but these changes, although striking, were thought to be caused by the ischemia due to the vasospasm; similar changes were also seen in the control cases with ischemia from arterial occlusion.

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