Treatment and outcome in 30 patients with posterior cerebral artery aneurysms

2003 ◽  
Vol 99 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Christopher L. Taylor ◽  
Thomas A. Kopitnik ◽  
Duke S. Samson ◽  
Phillip D. Purdy
Keyword(s):  
Visual Field ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Underlying Disease ◽  
Neurological Deficits ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
The Mean ◽  
Poor Outcomes ◽  
Fine Print

Object. The records of 30 patients with posterior cerebral artery (PCA) aneurysms treated during a 12-year period were reviewed to determine outcome and the risk of visual field deficit associated with PCA sacrifice. Methods. Clinical data and treatment summaries for all patients were maintained in an electronic database. The Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) scores were determined by an independent registrar. Visual field changes were determined by review of medical records. Twenty-eight patients were treated with open surgery, one of them after an attempt at detachable coil embolization failed. Two patients underwent successful endovascular PCA sacrifice. The mean GOS and mRS scores in 18 patients with unruptured aneurysms were 4 and 2, respectively, at discharge. Subarachnoid hemorrhage (SAH) from other aneurysms and neurological deficits caused by the PCA lesion or underlying disease contributed to poor outcomes in this group. The mean GOS and mRS scores in 12 patients with ruptured aneurysms were 4 and 4, respectively, at discharge. One patient died of severe vasospasm. Neurological deficits secondary to SAH and, in one patient, treatment of a concomitant arteriovenous malformation contributed to poor outcomes in the patients with ruptured aneurysms. Seven patients with normal visual function preoperatively underwent PCA occlusion. One patient (14%) developed a new visual field deficit. Conclusions. Optimal treatment of PCA aneurysms is performed via one of several surgical approaches or by endovascular therapy. The approach is determined, in part, by the anatomical location and size of the aneurysm and the presence of underlying disease and neurological deficits.

Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients

2002 ◽  
Vol 96 (1) ◽  
pp. 64-70 ◽  
Author(s):  
Bryce Weir ◽  
Lew Disney ◽  
Theodore Karrison
Keyword(s):  
Cerebral Artery ◽  
Patient Age ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Patient Âgé ◽  
Risk Of Rupture ◽  
Mean Size ◽  
The Mean ◽  
Fine Print

Object. The authors explore the risk of rupture in aneurysms categorized by size. Methods. A computerized database of 945 patients with aneurysms treated between 1967 and 1987 was retrospectively established. All available clinical and radiological studies were abstracted. Because of the recent interest in the size of intracranial aneurysms in relation to their likelihood of rupture, the database was searched with respect to this parameter. In 390 patients representing 41% of all cases, aneurysms were measured by neuroradiologists at the time of diagnosis. In 78% of the 945 patients there was only one aneurysm, and of the 507 aneurysms that were measured, 60% were solitary. Of all patients, 86% had ruptured aneurysms. The average age of all patients was 47 years, and for those with ruptured aneurysms it was 46 years. Of the ruptured aneurysms, 77% were 10 mm or smaller, compared with 85% of the unruptured aneurysms. It was found that 40.3% of the ruptured aneurysms were on the anterior cerebral artery or anterior communicating artery, compared with 13% of the unruptured aneurysms. None of the cavernous internal carotid artery (ICA) aneurysms were ruptured and 65% of the ophthalmic artery (OphA) aneurysms were. Of the unruptured aneurysms, 15% were located in the cavernous ICA or the OphA. Of the ruptured aneurysms, 29% were on the middle cerebral artery, compared with 36% of the unruptured aneurysms. The mean size of ruptured and unruptured aneurysms showed no statistically significant increase with patient age, although the difference in size between the ruptured and unruptured aneurysms decreased with increasing age. The mean size of all ruptured aneurysms (10.8 mm) was significantly larger than the mean size of all unruptured aneurysms (7.8 mm, p < 0.001); the median sizes were 10 mm and 5 mm, respectively. The size of ruptured aneurysms in patients who died in the hospital was significantly larger than those in the patients who survived (12 mm compared with 9.9 mm, p = 0.004). Symptomatic unruptured aneurysms were significantly larger than incidental unruptured aneurysms (14.6 mm compared with 6.9 mm, p = 0.032), which were, in turn, larger than aneurysms that were unruptured and part of a multiple aneurysm constellation. Both ruptured and unruptured aneurysms were larger in male than in female patients, but not significantly. Conclusions. Site and patient age, as well as lesion size, may affect the chance of rupture.

Cerebral revascularization using omental transplantation for childhood moyamoya disease

1993 ◽  
Vol 79 (2) ◽  
pp. 192-196 ◽  
Author(s):  
Jun Karasawa ◽  
Hajime Touho ◽  
Hideyuki Ohnishi ◽  
Susumu Miyamoto ◽  
Haruhiko Kikuchi
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Cerebral Arteries ◽  
Neurological Deficits ◽  
Content Type ◽  
Collateral Vessels ◽  
Neurological State ◽  
Fine Print

✓ Between January, 1986, and October, 1990, 30 children with moyamoya disease, aged from 2 to 17 years, underwent omental transplantation to either the anterior or the posterior cerebral artery territory. The mean follow-up period was 3.8 years, ranging from 1.6 to 6.4 years. Seventeen patients had symptoms of monoparesis, paraparesis, and/or urinary incontinence and were treated using unilateral or bilateral omental transplantation to the anterior cerebral artery territory. Eleven patients had visual symptoms and were treated with unilateral or bilateral omental transplantation to the posterior cerebral artery territory. Two patients had symptoms associated with both the anterior and the posterior cerebral arteries, and were treated with dual omental transplantations. All 19 patients treated with omental transplantation to the anterior cerebral artery and 11 (84.6%) of the 13 treated with omental transplantation to the posterior cerebral artery showed improvement in their neurological state. Patients with more collateral vessels via the omentum had more rapid and complete improvement in their neurological state. Patients with severe preoperative neurological deficits associated with the posterior cerebral artery had persistence of their symptoms.

Split spinal cord malformations in children

1998 ◽  
Vol 88 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Yusuf Ersşahin ◽  
Saffet Mutluer ◽  
Sevgül Kocaman ◽  
Eren Demirtasş
Keyword(s):  
Spinal Cord ◽  
Neurological Deficits ◽  
Single Type ◽  
Type I ◽  
Type Ii ◽  
Content Type ◽  
Spinal Lesion ◽  
The Mean ◽  
Fine Print

Object. The authors reviewed and analyzed information on 74 patients with split spinal cord malformations (SSCMs) treated between January 1, 1980 and December 31, 1996 at their institution with the aim of defining and classifying the malformations according to the method of Pang, et al. Methods. Computerized tomography myelography was superior to other radiological tools in defining the type of SSCM. There were 46 girls (62%) and 28 boys (38%) ranging in age from less than 1 day to 12 years (mean 33.08 months). The mean age (43.2 months) of the patients who exhibited neurological deficits and orthopedic deformities was significantly older than those (8.2 months) without deficits (p = 0.003). Fifty-two patients had a single Type I and 18 patients a single Type II SSCM; four patients had composite SSCMs. Sixty-two patients had at least one associated spinal lesion that could lead to spinal cord tethering. After surgery, the majority of the patients remained stable and clinical improvement was observed in 18 patients. Conclusions. The classification of SSCMs proposed by Pang, et al., will eliminate the current chaos in terminology. In all SSCMs, either a rigid or a fibrous septum was found to transfix the spinal cord. There was at least one unrelated lesion that caused tethering of the spinal cord in 85% of the patients. The risk of neurological deficits resulting from SSCMs increases with the age of the patient; therefore, all patients should be surgically treated when diagnosed, especially before the development of orthopedic and neurological manifestations.

scholarly journals Early Recognition of Stroke by Confrontation Visual Field Test – Is It Possible?

2020 ◽  
Keyword(s):  
Case Report ◽  
Visual Field ◽  
Cerebral Artery ◽  
Vision Loss ◽  
Posterior Cerebral Artery ◽  
Early Recognition ◽  
Past History ◽  
Neurological Deficits ◽  
Visual Field Defects ◽  
Axial Tomography

Introduction: Visual field loss is often the first sign of lesion of the anterior or posterior visual pathways. Screening for visual field defects should be a part of all routine eye examinations, mainly when neurological lesions are suspected. A confrontation visual field (CVF) test provide a rapid and practical method of visual field assessment, allowing the recognition of major neurological deficits. Materials and Research Methods: To report a case of posterior cerebral artery (PCA) stroke early suspected by CVF test. Case-Report: A 77 year-old male presented to our emergency department with vision blurring complaints and a strange sensation of a vision loss on one side on the left eye (OS), for the previous 15 days. He explained that symptoms initiated after an episode of dizziness followed by lipothymia. He denied diplopia or headaches. Past history revealed hypertension and diabetes as cardiovascular risk factors. The best corrected visual acuity was 20/25 on right eye (OD) and 20/60 on OS and pupillary reflexes were normal. CVF test was performed and showed a decrease on left hemicampus of OS. The biomicroscopy was normal and the fundus examination showed optic nerve edema bilaterally, also documented by Optical Coherence Tomography. Considering the findings and the history, neuroimaging and a neurological observation were requested. Computerized axial tomography revealed a hypodense lesion in right occipital posterior region, with hematic density. He was hospitalized for proper treatment with the diagnosis of posterior cerebral artery ischemic stroke, with further hemorrhagic transformation. Discussion: In acute stroke, visual disorders may form all or part of the initial presentation. Homonymous visual field deficits are well-known almost universal characteristics of PCA ischemia, however, due to the absent of cognitive impairment or speech problems associated to many cases, the diagnosis can be challenging at early stages. Our case-report highlights the importance of using CVF test to an immediate inspection of the peripheral visual field, in order to detect acute major defects, including homonymous deficits, to understand if a further prompt neurological examination is mandatory.

Proximal occlusion of the middle cerebral artery in C57Black6 mice: relationship of patency of the posterior communicating artery, infarct evolution, and animal survival

2004 ◽  
Vol 100 (1) ◽  
pp. 97-105 ◽  
Author(s):  
Kazuhide Furuya ◽  
Nobutaka Kawahara ◽  
Kensuke Kawai ◽  
Tomikatsu Toyoda ◽  
Keiichiro Maeda ◽  
...  
Keyword(s):  
Survival Rate ◽  
Infarct Size ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Focal Cerebral Ischemia ◽  
Infarct Volume ◽  
Posterior Communicating Artery ◽  
Neurological Deficits ◽  
Content Type ◽  
Fine Print

Object. The intraluminal suture model for focal cerebral ischemia is increasingly used, but not without problems. It causes hypothalamic injury, subarachnoid hemorrhage, and inadvertent premature reperfusion. The patency of the posterior communicating artery (PCoA) potentially affects the size of the infarct. In addition, survival at 1 week is unstable. The authors operated on C57Black6 mice to produce proximal middle cerebral artery occlusion (MCAO) so that drawbacks with the suture model could be circumvented. Methods. The MCA segment just proximal to the olfactory branch was occluded either permanently or temporarily. After 1 hour of MCAO the infarct volume was significantly smaller than that found after 2 hours or in instances of permanent MCAO. The differences were assessed at 24 hours and 7 days after surgery (p < 0.05 and p < 0.001, respectively). The patency of the PCoA, as visualized using carbon black solution, did not correlate with the infarct size. Neurologically, the 1- and 2-hour MCAO groups displayed significantly less severe deficits than the permanent MCAO group on Days 1, 4, and 7 (p < 0.005 and p < 0.01, respectively). Although the infarct size, neurological deficits, and body weight loss were more severe in the permanent MCAO group, the survival rate at Day 7 was 80%. Conclusions. This model provides not only a robust infarct size (which is not affected by the patency of the PCoA), but also a better survival rate.

Ruptured aneurysms of the proximal middle cerebral artery

1973 ◽  
Vol 39 (4) ◽  
pp. 498-502 ◽  
Author(s):  
Matej Lipovšek
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Bed Rest ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
Carotid Ligation ◽  
Angiographic Evidence ◽  
Proximal Middle Cerebral Artery ◽  
Middle Cerebral Artery Aneurysms ◽  
Fine Print

✓ In 57 patients with proximal middle cerebral artery aneurysms, two forms of treatment are reviewed, namely, bed rest and common carotid ligation. Patients who had no angiographic evidence of spasm or accompanying hematoma did better with carotid ligation than with bed rest if they were treated within the first week of the onset of subarachnoid hemorrhage.

Characterization of perioperative seizures and epilepsy following aneurysmal subarachnoid hemorrhage

2003 ◽  
Vol 99 (6) ◽  
pp. 978-985 ◽  
Author(s):  
Chih-Lung Lin ◽  
Aaron S. Dumont ◽  
Ann-Shung Lieu ◽  
Chen-Po Yen ◽  
Shiuh-Lin Hwang ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Predictive Factors ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Neurological Deficits ◽  
Loss Of Consciousness ◽  
Content Type ◽  
Fisher Grade ◽  
The Mean ◽  
Fine Print

Object. The reported incidence, timing, and predictive factors of perioperative seizures and epilepsy after subarachnoid hemorrhage (SAH) have differed considerably because of a lack of uniform definitions and variable follow-up periods. In this study the authors evaluate the incidence, temporal course, and predictive factors of perioperative seizures and epilepsy during long-term follow up of patients with SAH who underwent surgical treatment. Methods. Two hundred seventeen patients who survived more than 2 years after surgery for ruptured intracranial aneurysms were enrolled and retrospectively studied. Episodes were categorized into onset seizures (≤ 12 hours of initial hemorrhage), preoperative seizures, postoperative seizures, and late epilepsy, according to their timing. The mean follow-up time was 78.7 months (range 24–157 months). Forty-six patients (21.2%) had at least one seizure post-SAH. Seventeen patients (7.8%) had onset seizures, five (2.3%) had preoperative seizures, four (1.8%) had postoperative seizures, 21 (9.7%) had at least one seizure episode after the 1st week postoperatively, and late epilepsy developed in 15 (6.9%). One (3.8%) of 26 patients with perioperative seizures (onset, preoperative, or postoperative seizure) had late epilepsy at follow up. The mean latency between the operation and the onset of late epilepsy was 8.3 months (range 0.3–19 months). Younger age (< 40 years old), loss of consciousness of more than 1 hour at ictus, and Fisher Grade 3 or greater on computerized tomography scans proved to be significantly related to onset seizures. Onset seizure was also a significant predictor of persistent neurological deficits (Glasgow Outcome Scale Scores 2–4) at follow up. Factors associated with the development of late epilepsy were loss of consciousness of more than 1 hour at ictus and persistent postoperative neurological deficit. Conclusions. Although up to one fifth of patients experienced seizure(s) after SAH, more than half had seizure(s) during the perioperative period. The frequency of late epilepsy in patients with perioperative seizures (7.8%) was not significantly higher than those without such seizures (6.8%). Perioperative seizures did not recur frequently and were not a significant predictor for late epilepsy.

Endovascular occlusion of intracranial vessels for curative treatment of unclippable aneurysms: report of 16 cases

1991 ◽  
Vol 75 (5) ◽  
pp. 694-701 ◽  
Author(s):  
Jonathan E. Hodes ◽  
Armand Aymard ◽  
Y. Pierre Gobin ◽  
Daniel Rüfenacht ◽  
Siegfried Bien ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Neurological Deficits ◽  
Parent Vessel ◽  
Content Type ◽  
Fine Print

✓ Among 121 intracerebral aneurysms presenting at one institution between 1984 and 1989, 16 were treated by endovascular means. All 16 lesions were intradural and intracranial, and had failed either surgical or endovascular attempts at selective exclusion with parent vessel preservation. The lesions included four giant middle cerebral artery (MCA) aneurysms, one giant anterior communicating artery aneurysm, six giant posterior cerebral artery aneurysms, one posterior inferior cerebellar artery aneurysm, one giant mid-basilar artery aneurysm, two giant fusiform basilar artery aneurysms, and one dissecting vertebral artery aneurysm. One of the 16 patients failed an MCA test occlusion and was approached surgically after attempted endovascular selective occlusion. Treatment involved pretreatment evaluation of cerebral blood flow followed by a preliminary parent vessel test occlusion under neuroleptic analgesia with vigilant neurological monitoring. If the test occlusion was tolerated, it was immediately followed by permanent occlusion of the parent vessel with either detachable or nondetachable balloon or coils. The follow-up period ranged from 1 to 8 years. Excellent outcomes were obtained in 12 cases with complete angiographic obliteration of the aneurysm and no new neurological deficits and/or improvement of the pre-embolization symptoms. Four patients died: two related to the procedure, one secondary to rupture of another untreated aneurysm, and the fourth from a postoperative MCA thrombosis after having failed endovascular test occlusion. The angiographic, clinical, and cerebral blood flow criteria for occlusion tolerance are discussed.

Subarachnoid hemorrhage secondary to ruptured aneurysms in infants

1978 ◽  
Vol 49 (6) ◽  
pp. 898-902 ◽  
Author(s):  
Marshall L. Grode ◽  
Myles Saunders ◽  
Charles A. Carton
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Case Histories ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
Detailed Case ◽  
Subarachnoid Bleeding ◽  
Middle Cerebral Artery Aneurysms ◽  
Fine Print

✓ Two infants with subarachnoid bleeding from middle cerebral artery aneurysms are presented, with detailed case histories.

Foramen magnum syndrome caused by a giant aneurysm of the posterior inferior cerebral artery

1978 ◽  
Vol 48 (4) ◽  
pp. 639-641 ◽  
Author(s):  
Donald Judice ◽  
Edward S. Connolly
Keyword(s):  
Cerebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Giant Aneurysm ◽  
Foramen Magnum ◽  
Neurological Deficits ◽  
Content Type ◽  
Cerebellar Artery ◽  
Fine Print

✓ The authors present a case of giant aneurysm of the posterior inferior cerebellar artery. It was successfully excised with reversal of neurological deficits.

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