Computerized tomography angiography in isolated third nerve palsies

1998 ◽  
Vol 88 (4) ◽  
pp. 679-684 ◽  
Author(s):  
Robert M. McFadzean ◽  
Evelyn M. Teasdale
Keyword(s):  
Cerebral Aneurysm ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Cerebral Angiography ◽  
Diagnostic Tool ◽  
Nerve Palsy ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Third Nerve ◽  
Fine Print

Object. The goal of this study was to assess the value of computerized tomography (CT) angiography as a diagnostic tool in isolated oculomotor nerve palsies. Methods. One hundred consecutive patients who presented with an isolated third nerve palsy were examined by CT angiography. This procedure was followed by conventional cerebral angiography in most patients in whom a vascular abnormality was noted on the CT angiography. Thus, all patients whose symptoms were caused by a compressive aneurysm were identified. The remaining patients were observed clinically to exclude the possibility that a missed cerebral aneurysm caused the isolated third nerve palsy. Eighteen patients harbored a cerebral aneurysm responsible for causing the isolated third nerve palsy. Most of the remaining patients experienced some degree of spontaneous recovery. There was no clinical evidence to indicate that a case of compressive cerebral aneurysm causing the isolated third nerve palsy had been missed on CT angiography. Conclusions. Computerized tomography angiography is a reliable diagnostic tool for use in the assessment of patients with an isolated third nerve palsy; it can identify the minority of patients in whom conventional cerebral angiography may be required.

Aneurysm-induced third nerve palsy

1972 ◽  
Vol 36 (5) ◽  
pp. 548-551 ◽  
Author(s):  
Iftikhar A. Raja
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Functional Recovery ◽  
Poor Prognosis ◽  
Nerve Palsy ◽  
Nerve Function ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Carotid Ligation ◽  
Third Nerve ◽  
Fine Print

✓ Forty-two patients with aneurysm-induced third nerve palsy are described. After carotid ligation, 58% showed satisfactory and 42% unsatisfactory functional recovery. In some patients the deficit continued to increase even after carotid ligation. Early ligation provided a better chance of recovery of third nerve function. Patients in whom third nerve palsy began after subarachnoid hemorrhage had a poor prognosis. No relationship was noted between the size of the aneurysm and the recovery of third nerve function.

Symptoms of pituitary apoplexy rapidly reversed with bromocriptine

1996 ◽  
Vol 85 (6) ◽  
pp. 1153-1155 ◽  
Author(s):  
Michael H. Brisman ◽  
Gillian Katz ◽  
Kalmon D. Post
Keyword(s):  
Emergency Surgery ◽  
Visual Function ◽  
Prolactin Level ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Rapid Progression ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Third Nerve ◽  
Fine Print

✓ Macroprolactinomas rarely present with apoplexy. The authors describe a patient with a macroprolactinoma who presented with apoplexy and rapid progression of a third nerve palsy. The patient was managed expectantly with bromocriptine, and within 48 hours, the patient's third nerve palsy had completely resolved. The authors suggest that all patients who present with pituitary apoplexy in the presence of a pituitary tumor receive an immediate course of bromocriptine and steroid therapy until the prolactin level can be determined. Emergency surgery is indicated if visual function is abnormal and the tumor is not a prolactinoma.

Aberrant regeneration in idiopathic oculomotor nerve palsy

1980 ◽  
Vol 52 (6) ◽  
pp. 854-856 ◽  
Author(s):  
Jose F. Laguna ◽  
Michael S. Smith
Keyword(s):  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Aberrant Regeneration ◽  
Oculomotor Function ◽  
Third Nerve ◽  
Fine Print

✓ Aberrant regeneration of the oculomotor nerve usually follows injury to the nerve by posterior communicating artery aneurysms or trauma. A case of idiopathic third nerve palsy with pupillary involvement occurred in an otherwise healthy 38-year-old man. Follow-up examination 32 months later showed evidence of oculomotor function with aberrant regeneration.

Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions

1978 ◽  
Vol 49 (5) ◽  
pp. 635-649 ◽  
Author(s):  
Gérard Debrun ◽  
Pierre Lacour ◽  
Jean-Pierre Caron ◽  
Michel Hurth ◽  
Jean Comoy ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Vascular Lesions ◽  
Detachable Balloon ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Third Nerve ◽  
Fine Print ◽  
Cerebral Vascular

✓ Of the cerebral vascular lesions that can be treated with intravascular detachable balloon techniques, carotid-cavernous sinus fistulas and vertebro-vertebral fistulas have the best results. The great advantage of this technique is that the cerebral blood flow can usually be preserved after the occlusion of the fistula. The authors report 17 posttraumatic carotid-cavernous sinus fistulas successfully treated with preservation of the carotid blood flow in 12 cases. None of the patients died, and the morbidity was limited to one case of third nerve palsy. The treatment of aneurysms by this method is, however, much more difficult and dangerous. Of 14 cases treated, seven good results were obtained. Two patients died and two had a poor outcome. The embolization of certain brain angiomas with calibrated-leak balloons using bucrylate promises to be important in the future.

Direct embolectomy of the basilar artery bifurcation

1992 ◽  
Vol 77 (3) ◽  
pp. 463-465 ◽  
Author(s):  
Michael K. Morgan ◽  
Michael T. Biggs
Keyword(s):  
Basilar Artery ◽  
Surgical Approach ◽  
Nerve Palsy ◽  
Therapeutic Embolization ◽  
Good Recovery ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Neurologically Normal ◽  
Third Nerve ◽  
Fine Print

✓ The case is presented of a 27-year-old man who developed a basilar artery bifurcation embolus encompassing Hilal microcoil as a complication following therapeutic embolization. An immediate direct surgical approach to the basilar artery bifurcation enabled the microcoil and associated thrombus to be removed and flow to be restored in the basilar artery and its distal branches. Postoperatively, the patient made a good recovery and on discharge was neurologically normal with the exception of a right third nerve palsy. This case suggests that in selected patients a direct surgical approach to the top of the basilar artery may be possible for treatment of emboli.

Three-dimensional computerized tomography angiography in patients with hyperacute intracerebral hemorrhage

1999 ◽  
Vol 91 (3) ◽  
pp. 424-431 ◽  
Author(s):  
Yasuo Murai ◽  
Ryo Takagi ◽  
Yukio Ikeda ◽  
Yasuhiro Yamamoto ◽  
Akira Teramoto
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Three Dimensional ◽  
Ct Scanning ◽  
3D Ct ◽  
Content Type ◽  
Hematoma Enlargement ◽  
3D Ct Angiography ◽  
Fine Print

Object. The authors confirm the usefulness of extravasation detected on three-dimensional computerized tomography (3D-CT) angiography in the diagnosis of continued hemorrhage and establishment of its cause in patients with acute intracerebral hemorrhage (ICH).Methods. Thirty-one patients with acute ICH in whom noncontrast and 3D-CT angiography had been performed within 12 hours of the onset of hemorrhage and in whom conventional cerebral angiographic studies were obtained during the chronic stage were prospectively studied. Noncontrast CT scanning was repeated within 24 hours of the onset of ICH to evaluate hematoma enlargement.Findings indicating extravasation on 3D-CT angiography, including any abnormal area of high density on helical CT scanning, were observed in five patients; three of these demonstrated hematoma enlargement on follow-up CT studies. Thus, specificity was 60% (three correct predictions among five positives) and sensitivity was 100% (19 correct predictions among 19 negatives). Evidence of extravasation on 3D-CT angiography indicates that there is persistent hemorrhage and correlates with enlargement of the hematoma.Regarding the cause of hemorrhage, five cerebral aneurysms were visualized in four patients, and two diagnoses of moyamoya disease and one of unilateral moyamoya phenomenon were made with the aid of 3D-CT angiography. Emergency surgery was performed without conventional angiography in one patient who had an aneurysm, and it was clipped successfully.Conclusions. Overall, 3D-CT angiography was found to be valuable in the diagnosis of the cause of hemorrhage and in the detection of persistent hemorrhage in patients with acute ICH.

Aneurysms of the posterior circulation: detection and treatment planning using volume-rendered three-dimensional helical computerized tomography angiography

2005 ◽  
Vol 103 (6) ◽  
pp. 1018-1029 ◽  
Author(s):  
J. Pablo Villablanca ◽  
Adina Achiriolaie ◽  
Parizad Hooshi ◽  
Neil Martin ◽  
Gary Duckwiler ◽  
...  
Keyword(s):  
Treatment Planning ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Treatment Options ◽  
Significant Proportion ◽  
Posterior Circulation ◽  
Content Type ◽  
Computerized Tomography Angiography ◽  
Posterior Circulation Aneurysms ◽  
Fine Print

Object. The aim of this study was to determine whether computerized tomography (CT) angiography could be used to identify and characterize aneurysms of the posterior circulation and guide optimal treatment selection, and how data obtained using this method compared with intraoperative findings. Methods. Patients suspected of harboring brain aneurysms underwent CT angiography and digital subtraction (DS) angiography; the results were prospectively interpreted by blinded independent evaluators. All patients with posterior circulation aneurysms were consecutively enrolled in the study. After treatment, neurosurgeons and endovascular therapists evaluated the ability of CT and DS angiography to demonstrate features of the lesions important for triage between treatment options (Wilcoxon signed-rank test) and to allow for coil or clip preselection and complete treatment planning (McNemar test of proportions), while using intraoperative findings as the basis of truth. In 242 patients overall, CT angiography detected 38 aneurysms and two aneurysmal blisters in 32 patients. The sensitivity of CT angiography in revealing posterior circulation aneurysms was 100% compared with DS angiography, with no false-positive results. Furthermore, CT angiography was sufficient as the sole study at triage for 65% of the posterior circulation aneurysms (26 of 40 lesions; p < 0.001), including 62% of the complex lesions (p < 0.001), and permitted coil or clip preselection in 74% of treated cases (20 of 27 cases; p < 0.002). Results of CT angiography revealed information about mural calcification and intraluminal thrombus not available on DS angiography, which affected patient care. Conclusions. In this study population, CT angiography was comparable to DS angiography in the detection and characterization of aneurysms of the posterior circulation. Computerized tomography angiography was used successfully to triage patients between endovascular and neurosurgical treatment options in a significant proportion of cases and permitted treatment planning in more than 70% of treated cases.

Three-dimensional helical computerized tomography angiography in the diagnosis, characterization, and management of middle cerebral artery aneurysms: comparison with conventional angiography and intraoperative findings

2002 ◽  
Vol 97 (6) ◽  
pp. 1322-1332 ◽  
Author(s):  
J. Pablo Villablanca ◽  
Parizad Hooshi ◽  
Neil Martin ◽  
Reza Jahan ◽  
Gary Duckwiler ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Treatment Planning ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Cerebral Artery ◽  
Three Dimensional ◽  
Content Type ◽  
Computerized Tomography Angiography ◽  
Fine Print

Object. Middle cerebral artery (MCA) aneurysms can be difficult to detect and characterize. The authors describe the utility and impact of helical computerized tomography (CT) angiography for the evaluation of aneurysms in this location, and compare this modality with digital subtraction (DS) angiography and intraoperative findings. Methods. Two hundred fifty-one patients with suspected cerebral aneurysms underwent CT angiography. Two-dimensional multiplanar reformatted images and three-dimensional CT angiograms were examined by two independent readers in a blinded fashion. Results were compared with findings on DS angiograms to determine the relative efficacy of these modalities in the detection and characterization of aneurysms. Questionnaires completed by neurosurgeons and endovascular therapists were used to determine the impact of CT angiograms on aneurysm management. Twenty-eight patients harboring 31 MCA aneurysms and 26 patients without aneurysms were identified using CT angiography. The sensitivity of CT angiography and DS angiography for MCA aneurysms was 97%; both techniques showed 100% specificity. In 76% of evaluations, the CT angiography studies provided information not available on DS angiography examinations. For the characterization of aneurysms, CT angiography was rated superior (72%) or equal (20%) to DS angiography in 92% of cases evaluated (p < 0.001). Computerized tomography angiography was evaluated as the only study needed for patient triage in 82% of cases (p < 0.001), and as the only study needed for treatment planning in 89% of surgically treated (p < 0.001) and in 63% of endovascularly treated cases (p < 0.001). The information acquired on CT angiograms changed the initial treatment plan in 24 (67%) of these 36 complex lesions (p < 0.01). The aneurysm appearance intraoperatively was identical or nearly identical to that seen on CT angiograms in 17 (89%) of 19 of the surgically treated cases. Conclusions. Computerized tomography angiography has unique advantages over DS angiography and is a viable alternative to the latter modality in the diagnosis, triage, and treatment planning in patients with MCA aneurysms.

Cerebral air embolism occurring at angiography and diagnosed by computerized tomography

1984 ◽  
Vol 60 (1) ◽  
pp. 177-178 ◽  
Author(s):  
Rand M. Voorhies ◽  
Richard A. R. Fraser
Keyword(s):  
High Resolution ◽  
Computerized Tomography ◽  
Cerebral Angiography ◽  
Air Embolism ◽  
Cerebral Air Embolism ◽  
Content Type ◽  
Fine Print

✓ A case of air embolism complicating cerebral angiography is presented. The presence of the embolism was confirmed with high-resolution computerized tomography scans using appropriate window settings.

Three-dimensional computerized tomography angiography—guided surgery of acutely ruptured cerebral anuerysms

2001 ◽  
Vol 94 (5) ◽  
pp. 718-727 ◽  
Author(s):  
Masato Matsumoto ◽  
Masanori Sato ◽  
Masayuki Nakano ◽  
Yuji Endo ◽  
Youichi Watanabe ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Computerized Tomography ◽  
Three Dimensional ◽  
Artery Aneurysm ◽  
3D Ct ◽  
Conventional Angiography ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
3D Ct Angiography ◽  
Fine Print

Object. The aim of this study was to assess whether aneurysm surgery can be performed in patients with ruptured cerebral aneurysms by using three-dimensional computerized tomography (3D-CT) angiography alone, without conventional catheter angiography. Methods. In a previous study, 60 patients with subarachnoid hemorrhage (SAH) from ruptured aneurysms were prospectively evaluated using both 3D-CT and conventional angiography, which resulted in a 100% accuracy for 3D-CT angiography in the diagnosis of ruptured aneurysms, and a 96% accuracy in the identification of associated unruptured aneurysms. The results led the authors to consider replacing conventional angiography with 3D-CT angiography for use in diagnosing ruptured aneurysms, and to perform surgery aided by 3D-CT angiography alone without conventional angiography. Based on the results, 100 consecutive patients with SAH who had undergone surgery in the acute stage based on 3D-CT angiography findings have been studied since December 1996. One hundred ruptured aneurysms, including 41 associated unruptured lesions, were detected using 3D-CT angiography. In seven of 100 ruptured aneurysms, which included four dissecting vertebral artery aneurysms, two basilar artery (BA) tip aneurysms, and one BA—superior cerebellar artery aneurysm, 3D-CT angiography was followed by conventional angiography to acquire diagnostic confirmation or information about the vein of Labbé, which was needed to guide the surgical approach for BA tip aneurysms. All of the ruptured aneurysms were confirmed at surgery and treated successfully. Ninety-three patients who underwent operation with the aid of 3D-CT angiography only had no complications related to the lack of information gathered by conventional angiography. The 3D-CT angiography studies provided the authors with the aneurysm location as well as surgically important information on the configuration of its sac and neck, the presence of calcification in the aneurysm wall, and its relationship to the adjacent vessels and bone structures. Conclusions The authors believe that 3D-CT angiography can replace conventional angiography in the diagnosis of ruptured aneurysms and that surgery can be performed in almost all acutely ruptured aneurysms by using only 3D-CT angiography without conventional angiography.

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