Multiple ruptured cerebral aneurysms in a child with Takayasu arteritis

2008 ◽  
Vol 1 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Suresh N. Magge ◽  
H. Isaac Chen ◽  
Michael F. Stiefel ◽  
Linda Ernst ◽  
Ann Marie Cahill ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysm ◽  
Takayasu Arteritis ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Rare Presentation ◽  
Anterior Communicating Artery Aneurysm ◽  
Clip Application

✓The authors report the case of an 18-month-old girl who presented with a ruptured anterior communicating artery aneurysm, and who was later diagnosed with Takayasu arteritis. Her initial aneurysm was successfully treated with clip application. However, over a 6-month period she had multiple ruptures from new and rapidly recurring aneurysms adjacent to the clips. These aneurysms were treated with repeated craniotomy and clip application and then with endovascular coil placement. Aneurysmal subarachnoid hemorrhage is a rare presentation of Takayasu arteritis. To the authors' knowledge, this is the youngest reported patient with Takayasu arteritis to present with a ruptured cerebral aneurysm.

STENT REMODELING TECHNIQUE FOR COILING OF RUPTURED WIDE-NECK CEREBRAL ANEURYSMS: CASE REPORT

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E1007-E1008 ◽  
Author(s):  
Demetrius K. Lopes ◽  
Kalani Wells
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Acute Subarachnoid Hemorrhage ◽  
The Right ◽  
Wide Neck ◽  
Cordis Corporation

Abstract OBJECTIVE To describe a novel stent remodeling technique for the coiling of ruptured wide-neck cerebral aneurysms. CLINICAL PRESENTATION A 46-year-old man presented with acute subarachnoid hemorrhage (Hunt and Hess grade IV), intracerebral hemorrhage, and hydrocephalus. Cerebral angiography revealed a wide-neck small anterior communicating artery aneurysm. Conventional coiling was not successful because of coil instability and compromise of the dominant anterior cerebral artery. TECHNIQUE A 6-French shuttle sheath (Cook Medical, Indianapolis, IN) was advanced from a right femoral approach into the right common carotid artery. To protect the parent vessel during coiling without compromising blood flow, a Prowler Select Plus catheter (Cordis Corporation, Bridgewater, NJ) was navigated across the aneurysm neck. Subsequently, an Enterprise stent (22-mm length; Cordis Corporation) was partially deployed across the aneurysm's wide neck. It was very important to watch the distal markers of the stent and lock the stent delivery wire to the Prowler Select Plus with a hemostatic valve once the stent was halfway deployed. This maneuver was essential to prevent further deployment of the stent. The SL-10 microcatheter and Synchro 14 wire (Boston Scientific, Natick, MA) were carefully navigated to the aneurysm passing through the partially deployed stent. Coils were then delivered to the aneurysm using the stent as a scaffold. After coiling, the SL-10 microcatheter was removed and the stent was recaptured into the Prowler Select Plus catheter. During the recapture, there was initial resistance. This was easily overcome after deploying the stent a little more before resheathing. During the procedure, the patient received 2000 U of heparin after the first coil was detached in the aneurysm. CONCLUSION The stent remodeling technique is a novel endovascular technique that can be used to treat ruptured wide-neck aneurysms and maintain patency of parent vessels, avoiding the use of antiplatelet therapy in acute subarachnoid hemorrhage.

Management of Intraprocedural Arterial Thrombus in Cerebral Aneurysm Embolization with Abciximab: Technical Case Report

Neurosurgery ◽  
2002 ◽  
Vol 50 (4) ◽  
pp. 899-902 ◽  
Author(s):  
Michael J. Alexander ◽  
Gary R. Duckwiler ◽  
Y. Pierre Gobin ◽  
Fernando Viñuela
Keyword(s):  
Cerebral Aneurysm ◽  
Coil Embolization ◽  
Artery Aneurysm ◽  
Neurological Deficits ◽  
Anterior Communicating Artery ◽  
Thromboembolic Complications ◽  
Anterior Communicating Artery Aneurysm ◽  
Guglielmi Detachable Coil ◽  
Aneurysm Embolization ◽  
Arterial Thrombus

Abstract OBJECTIVE AND IMPORTANCE: Thromboembolic complications after cerebral aneurysm treatment with Guglielmi detachable coils (Boston Scientific/Target, Fremont, CA) are not infrequent; in a University of California, Los Angeles institutional review of 720 treated aneurysms, thromboembolic complications occurred in 2.5% of cases. The development of intraluminal thrombus during the embolization procedure, however, may be diagnosed promptly and treated effectively with appropriate therapy. This report describes the use of intravenously administered abciximab for the treatment of intraprocedural arterial thrombus encountered during the coil embolization of a recently ruptured anterior communicating artery aneurysm. CLINICAL PRESENTATION: A 45-year-old man presented with severe headache 12 days before transfer to our institution. He had no neurological deficits at admission. Previous computed tomography of the brain demonstrated subarachnoid hemorrhage, and magnetic resonance angiography from the other institution demonstrated a 4-mm anterior communicating artery aneurysm. INTERVENTION: The patient underwent Guglielmi detachable coil embolization of the aneurysm under systemic heparinization. During the embolization, however, a thrombus developed in the proximal left A2 segment. The patient was given an intravenous infusion (20 mg) of abciximab for 10 minutes, and within 15 minutes dissolution of the thrombus was observed with no angiographic evidence of distal emboli. After reversal of general anesthesia, the patient exhibited minimal right leg weakness, which resolved within 1 hour. CONCLUSION: Abciximab may be a useful adjunct for endovascular treatment of patients with cerebral aneurysms in whom intraprocedural arterial thrombus is encountered.

scholarly journals Xanthochromia: yellow color is a red flag

QJM ◽  
2021 ◽  
Author(s):  
Takuhiro Hashiyama ◽  
Nobuaki Mori ◽  
Yu Tsuruyama
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
World Federation ◽  
Anterior Communicating Artery ◽  
Low Grade ◽  
Presenting Symptoms ◽  
Csf Analysis ◽  
Yellow Color ◽  
Fisher Grade

Abstract A 72-year-old previously healthy man consulted in our hospital for persistent moderate headache, accompanied by flexor pain of both thighs and low-grade fever for five days. Although the symptoms were worsened by motion, he noticed the flexor pain was most severe when taking a bow. On physical examination, he was fully alert and oriented to person, place, and time. His body temperature, blood pressure, pulse, and respiratory rate were 37.6 °C, 126/81 mmHg, 67 beats/min, and 16 breaths/min, respectively. His neck was supple. Kernig’s and Brudzinski’s signs were negative. There was a positive jolt accentuation test. No other neurologic findings were remarkable. Head computed tomography (CT) was normal; therefore, a lumbar puncture was performed, following suspicion of meningitis. Cerebrospinal fluid (CSF) analysis revealed 14 cells per microliter (mononucleosis was dominant), protein 185 mg/dL, and glucose 34 mg/dL. The opening pressure was 13 cmH2O. The CSF had an orange-yellow appearance (Figure 1a). This was suggestive of xanthochromia. Contrast-enhanced head CT and head magnetic resonance imaging were performed, and a ruptured anterior communicating artery aneurysm was detected (Figure 1 b). He was diagnosed with aneurysmal subarachnoid hemorrhage (SAH), which was classified as Grade 1 and Group 1, according to the World Federation of Neurological Surgeons subarachnoid hemorrhage grading scale and Fisher grade of cerebral vasospasm risk, respectively. Regarding the presenting symptoms, thigh flexor pain and low-grade fever were symptoms of breakdown of blood products within the CSF, which led to aseptic meningitis, also called meningismus. He was admitted to the intensive care unit for neurological and hemodynamic monitoring. Aneurysm repair with surgical clipping was performed, and after 4 weeks of rehabilitation, he was discharged ambulatory.

Paradoxical aggravation of vasospasm with papaverine infusion following aneurysmal subarachnoid hemorrhage

1996 ◽  
Vol 84 (4) ◽  
pp. 690-695 ◽  
Author(s):  
Brent L. Clyde ◽  
Andrew D. Firlik ◽  
Anthony M. Kaufmann ◽  
MichaelP. Spearman ◽  
Howard Yonas
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Xenon Ct ◽  
Content Type ◽  
Symptomatic Vasospasm ◽  
Fine Print

✓ Reports of intraarterial papaverine infusion as treatment for cerebral vasospasm are few and documented complications are uncommon. The authors report the case of a patient with paradoxical aggravation of cerebral arterial narrowing during selective intraarterial papaverine infusion intended to treat vasospasm following aneurysmal subarachnoid hemorrhage (SAH). A 48-year-old man presented to the authors' service with symptomatic vasospasm 10 days after experiencing an SAH. The ruptured anterior communicating artery aneurysm was surgically obliterated the following day, and thereafter maximum hypervolemic and hypertensive therapies were used. However, the patient remained lethargic, and a stable xenon—computerized tomography (CT) cerebral blood flow (CBF) study revealed CBF to be 15 cc/100 g/minute in the left anterior cerebral artery (ACA) and 25 cc/100 g/minute in the right ACA territories. Cerebral arteriography demonstrated diffuse severe left ACA and mild left middle cerebral artery (MCA) vasospasm. In response intraarterial papaverine was infused into the internal carotid artery just proximal to the ophthalmic artery. During the infusion the patient became aphasic and exhibited right hemiplegia. Arteriography performed immediately after the intraarterial papaverine infusion revealed diffuse exacerbation of vasospasm in the distal ACA and MCA territories. A repeat xenon—CT CBF study showed that CBF in the left ACA and the MCA had drastically decreased (2 cc/100 g/minute and 10 cc/100 g/minute, respectively). Despite aggressive management, infarction ultimately developed. This is the first clinical case to illustrate a paradoxical effect of intraarterial papaverine treatment for vasospasm following aneurysmal SAH. The possible mechanisms of this paradoxical response and potential therapeutic reactions are reviewed.

scholarly journals Spontaneous Disappearance of an Intracranial Aneurysm After Subarachnoid Hemorrhage

1992 ◽  
Vol 19 (3) ◽  
pp. 389-391 ◽  
Author(s):  
Mark G. Hamilton ◽  
Oliver N.R. Dold
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Complete Disappearance ◽  
Slow Recovery ◽  
Spontaneous Thrombosis ◽  
Grade 5 ◽  
Spontaneous Disappearance

ABSTRACT:Spontaneous disappearance of an intracranial aneurysm after subarachnoid hemorrhage is an uncommon event and usually associated with severe cerebral vasospasm, giant aneurysms or the use of antifibrinolytics. We present a young woman who suffered a grade 5 subarachnoid hemorrhage with severe vasospasm caused by a small anterior communicating artery aneurysm. The patient underwent a slow recovery and two years later requested surgery. Angiography demonstrated complete disappearance of the aneurysm. The neurosurgeon should be aware that spontaneous thrombosis of cerebral aneurysms can occur and ensure that angiography is repeated when surgery is significantly delayed.

scholarly journals A patient with neurofibromatosis type 1 presenting with bilateral frontal lobe infarctions following anterior communicating artery aneurysm rupture

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984115
Author(s):  
HMMTB Herath ◽  
Nilukshana Yogendranathan ◽  
Aruna Kulatunga
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Neurofibromatosis Type ◽  
Frontal Lobes ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Sri Lankan ◽  
Vascular Abnormalities ◽  
Anterior Communicating Artery Aneurysm ◽  
First Case

Neurofibromatosis is a neurocutaneous genetic condition with dysplasia of the mesodermal and ectodermal tissues. Vascular abnormalities are well recognized in neurofibromatosis and cerebral aneurysms are rarely reported in literature. Here, we present a 20-year-old Sri Lankan female presented with headache, altered personality, disinhibited behaviour, and urinary incontinence. On imaging, she was found to have infarctions of both frontal lobes and evidence of a ruptured anterior communicating artery aneurysm with a small subarachnoid haemorrhage. Another small middle cerebral artery aneurysm was also seen in the angiogram. She was managed conservatively and gradually recovered. Because aneurysms in neurofibromatosis are usually asymptomatic and as rupture of such an aneurysm is rare, regular vascular screening is not recommended to all patients with neurofibromatosis. This is the first case report in literature in which a patient with neurofibromatosis presented with infarctions of both frontal lobes due to rupture of an anterior communicating artery aneurysm.

Hemodynamics Analysis of Several Stent Treatments of a Patient Specific Anterior Communicating Artery Aneurysm

2012 ◽  
Author(s):  
S. Cito ◽  
J. Pallarés ◽  
A. Vernet ◽  
A. J. Geers ◽  
I. Cuesta
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
The Other ◽  
Patient Specific ◽  
Anterior Communicating Artery ◽  
Flow Conditions ◽  
Real Patient ◽  
Open Cell ◽  
Anterior Communicating Artery Aneurysm ◽  
Closed Cell

CFD predictions of the flow in cerebral aneurysms can help to analyze the mechanisms of growth and rupture and the degree of stress for a given flow conditions and to compare and to propose different stenting treatments. In this work we simulated the flow in a model of cerebral aneurysms of a real patient in six different conditions. One case corresponds to the flow conditions in the aneurysm without treatment and the other five cases correspond to different options or strategies of treatment with open cell stents (OCS) and closed cell stents (CCS) to hold the coil. The aneurysm is located in the anterior communicating artery (AComA). The effect of the treatment on the hemodynamics is quantified and reported.

scholarly journals Posterior ischemic optic neuropathy with acute monocular vision loss following clipping of anterior communicating artery aneurysm. A case report and review of literature

2021 ◽  
Vol 12 ◽  
pp. 471
Author(s):  
Amit Kumar Sharma ◽  
Binita Dholakia ◽  
Anita Jagetia ◽  
Ghanshyam Das Singhal ◽  
Shaam Bodeliwala ◽  
...  
Keyword(s):  
Optic Neuropathy ◽  
Vision Loss ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Monocular Vision ◽  
Anterior Communicating Artery ◽  
Ischemic Optic Neuropathy ◽  
Rare Presentation ◽  
Anterior Communicating Artery Aneurysm ◽  
Posterior Ischemic Optic Neuropathy

Background: The acute postoperative monocular vision loss following anterior communicating artery aneurysm clipping secondary to posterior ischemic optic neuropathy (PION) a rare presentation. Case Description: A 32-year old patient presented with a spontaneous holocranial thunderclap headache for 7 days, associated with vomiting. The SAH was diagnosed with a tiny saccular aneurysm arising from the anterior communicating artery. A left pterional craniotomy and clipping of aneurysm were done. On the 3rd postoperative day, he complained of left-sided complete blindness, and on the 5th postoperative day, his GCS dropped to E4V1M5 with right-sided hemiplegia. MRI brain showed normal optic apparatus with bilateral ACA and left MCA territory infarct. Conclusion: The PION must be kept in the differential diagnosis of post-clipping sudden visual deterioration, especially following anterior communicating artery aneurysm rupture.

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