scholarly journals Risk Factors and Morphological Differences of Ruptured Saccular Aneurysm in Different Sites of Anterior Circulation in Patients Presenting with Subarachnoid Haemorrhage

2018 ◽  
Vol 3 (1) ◽  
pp. 21-28
Author(s):  
Reaz Mahmud ◽  
Mansur Habib ◽  
Sharif Uddin Khan ◽  
Asma Khan
Keyword(s):  
Risk Factors ◽  
Subarachnoid Haemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Aneurysm Rupture ◽  
Digital Subtraction ◽  
Anterior Circulation ◽  
College Hospital ◽  
Medical College ◽  
The Mean

Background: All sites of intracranial aneurysms have always been considered together in most of the studies of risk factors of aneurysm rupture. Therefore, it is not known whether some risk factors predispose to aneurysm rupture at a particular location. Morphologies also vary in accordance to different sites of the aneurysm.Objective: The purpose of the present study was to observe the differences in the risk factors, the size, aspect ratio and size ratio among the anterior circulation aneurysms.Methodology: This hospital based cross-sectional study carried out in the Department of Neurology at Dhaka Medical College Hospital (DMCH), Dhaka during July 2013 to June 2015 for a period of two (02) years. Patients with subarachnoid haemorrhage caused by ruptured anterior circulation saccular aneurysms admitted in the Departments of Neurology, Internal Medicine and Neurosurgery Departments at Dhaka Medical College Hospital (DMCH), Dhaka and the Department of Neurointervention at National Institute of Neurosciences and Hospital, Dhaka were enrolled in this study. Patients’ ≥18 years of age with subarachnoid haemorrhage caused by anterior circulation aneurysm which was confirmed by computed tomogram (CT-scan) and/or CSF study and digital subtraction angiography were included in this study. The risk factors were identified by interviewing the patients and the morphology were measured from the digital subtraction angiogram.Results: A total number of 85 patients with ruptured saccular anterior circulation aneurysm were enrolled in this study. In this study anterior communicating artery aneurysm (ACom) was the most frequent site of aneurysm (42%). The mean age of the patients with ACom aneurysm (51.72 ± 9.26 years) was significantly higher than posterior communicating artery (47.5 ± 8.2 years) aneurysm and middle cerebral artery (MCA) (43.41 ± 8.0 years) aneurysm. Above the age of 50 ACom aneurysm was the most frequent aneurysm (OR 5.5, p<0.05). Among the female Posterior communicating artery (PCom) aneurysm (46.7%) was the most frequent aneurysm and among the male ACom aneurysm (37.5%) was the most frequent aneurysm. Family history was exclusive in MCA aneurysm (3.5%). The mean size of MCA (7.79 ± 0.71 cm) was higher than ACom (6.12 ± 2.7cm) aneurysm and PCom (6.5 ± 2.4 cm) aneurysm and proportion of aneurysm >10 mm was also higher among the middle cerebral artery (35.6%) aneurysms. The size ratio was significantly higher in ACom (3.08±1.23) and MCA (3.04±0.97) aneurysm. ACom (76.4%) and MCA (83.3%) had also more frequent high risk size ratio.Conclusion: In conclusion anterior circulation aneurysms differ in respects of risk factors and morphology.Journal of National Institute of Neurosciences Bangladesh, 2017;3(1): 21-28

scholarly journals Clinical and digital subtraction angiographic (DSA) evaluation of patients of subarachnoid haemorrhage (SAH) in a tertiary level hospital

2016 ◽  
Vol 44 (3) ◽  
pp. 125-129 ◽  
Author(s):  
Md Nazmul Hasan ◽  
Md Azharul Hoque ◽  
Kazi Mohibur Rahman ◽  
Md Harisul Hoque ◽  
Md Rasul Amin ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Arteries ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Digital Subtraction ◽  
Eligibility Criteria ◽  
College Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
Male Preponderance

The present study was undertaken to evaluate the morphological anatomy of cerebral vessels in patients of aneurysmal subarachnoid hemorrhage. The cross-sectional observational study was carried out in the Department of Neurology, Dhaka Medical College Hospital, Dhaka from January 2013 to June 2013. Adult patients of spontaneous subarachnoid haemorrhage (SAH), diagnosed clinically and confirmed by CT scan of the head were included in the study. However, patients who are not capable financially of undergoing Digital Subtraction Angiography (DSA), traumatic subarachnoid haemorrhage, intracerebral haemorrhage and patients taking antiplatelet and anticoagulant drugs and with comorbidities were excluded. A total of 30 subjects meeting the above eligibility criteria were selected consecutively from the study population. The present study demonstrated that 80% of the patients were 50 or younger than 50 years old (mean age 45.0 ± 9.4 years) with a male preponderance (60%). Sudden headache accompanied by vomiting was invariably complained by the patients at onset of Athe disease. On admission two-thirds (66.7%) of the patients were unconscious. 4 out of 30(16.65%) patients exhibited neurological deficit. Of the risk factors, hypertension and smoking demonstrated their significant presence (around 45%) among the patients studied. Based on Glasgow Coma Scale, 7(23.3%) patients out of 30 in the present study were in grade-v. Our data showed that the common site of aneurysm was anterior communication artery (36.7%) followed by middle cerebral artery (26.7%) and posterior communicating artery (23.3%). Saccular aneurysms formed the main bulk (93%) of the cases irrespective of anatomical distribution of aneurysm. In aneurysmal subarachnoid haemorrhage, aneurysms are mainly located in anterior communicating and middle cerebral arteries and of medium-sized. Majority are saccular type and narrow-necked.Bangladesh Med J. 2015 Sep; 44 (3): 125-129

Change of Positional Blood Pressure and Indication of Ephedrine in Hypotension During Spinal Anesthesia for Cesarean Delivery

2013 ◽  
Vol 21 (Number 2) ◽  
pp. 18-23
Author(s):  
Md. A Matin ◽  
J Banu ◽  
K Sultana ◽  
S M Shahana
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Clinical Practice ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Lateral Position ◽  
College Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
The Mean

Hypotension during spinal anaesthesia for caesarean section remains a common scenario in clinical practice. Certain risk factors play a role in altering the incidence of hypotension. A cross sectional observational study was done on sixty patients undergone cesarean delivery spinal anesthesia in Holy Family Red Crescent Medical College Hospital to evaluate the correlation between pre-anesthetic change of positional blood pressure and predictive necessity of Ephedrine to mange per-operative hypotension. The mean age of the patients included in the study was 25.85 ± 4.24 years and weighted 63.60 ± 6.91 kg (Mean ± sco. The haemodynamic outcomes of the patients are summarized in Table-I as mean systolic blood pressure increased (118 ± 12.02 and 132 ± 14.11 mm of Hg) after change of position from baseline (supine position) to right lateral position. The positional blood pressure varied from 2 to 32 mm of Hg and was observed in 54 patients. But only 35 patients were hypotensive (58.33%) after spinal anesthesia among them only 28 patients required Ephedrine (46.6%). But there was no significant correlation was observed in patients needed Ephedrine who hypotension but not obvious with positional change of pre-anesthetic blood pressure.

A CASE OF MIDDLE CEREBRAL ARTERY INFARCT FOLLOWING UNEVENTFUL CLIPPING OF ANTERIOR COMMUNICATING ARTERY ANEURYSM

2021 ◽  
pp. 6-7
Author(s):  
T S Vasan ◽  
Rahul Vyas ◽  
Karan Mathur
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Middle Cerebral Artery Infarction ◽  
Anterior Communicating Artery Aneurysm ◽  
Ct Angiogram

Background: Aneurysms of the anterior communicating artery are the most frequently encountered intracerebral aneurysms in routine neurosurgical practice. Management of intracerebral aneurysm involves aneurysm clipping or endovascular coil aneurysm embolisation. However, to the best of our knowledge, there is no reported case of an isolated ipsilateral middle cerebral artery infarction following clipping of anterior communicating artery aneurysm. Case Description: A 65-year-old female with hypertension presented with a history of giddiness, fall and altered sensorium. The patient had a Glasgow Coma Scale (GCS) score of 12, and further investigation of the magnetic resonance imaging on suspicion of stroke revealed subarachnoid haemorrhage in the bilateral parietal sulcus, left Sylvain ssure, left ambient and quadrigeminal cisterns with intra-ventricular extension. The patient was subsequently referred for neurosurgery consultation. Computed tomography (CT) angiogram conrmed the presence of a ruptured anterior communicating artery aneurysm. The neurological assessment showed reduced responsiveness to verbal commands, with a Hunt and Hess score of 3. The patient underwent uneventful clipping of the aneurysm. Postoperatively, the patient did not wake up from anaesthesia and had persistently elevated blood pressure and right-sided hemiplegia. On the third day of postoperative care, a CT head scan revealed a left middle cerebral artery infarction with a midline shift. Decompressive craniotomy was performed, and following this procedure, the patient improved in sensorium with residual right-sided hemiplegia Conclusion: This case report presents an undetected new micro embolism or postoperative cerebral vasospasm as possible causes for the development of cerebral infarct in patients with subarachnoid haemorrhage following an aneurysm rupture.

scholarly journals Twin Middle Cerebral Artery with Aneurysm: A Variant of Early Bifurcation or a Discrete Entity

2017 ◽  
Vol 08 (S 01) ◽  
pp. S114-S116
Author(s):  
Sushant Sahoo ◽  
Sunil Singh ◽  
Anit Parihar
Keyword(s):  
Computed Tomography ◽  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Arterial Wall ◽  
Distinct Pattern ◽  
Branching Pattern ◽  
Digital Subtraction ◽  
Anterior Circulation ◽  
Computed Tomography Angiogram

ABSTRACTThe middle cerebral artery (MCA) usually bifurcates into a superior or frontal and inferior or temporal branch. However, it may have various branching pattern, and there may be additional arteries from the anterior circulation supplying its territory. The majority of them remain asymptomatic. Some cases may have aneurismal dilatation due to turbulent blood flow or the weak arterial wall. The surgical approach in these cases may be challenging due to complex anatomical pattern of MCA. In this report, we have described a distinct pattern of left MCA with an aneurysm which was not clear in computed tomography angiogram and further confirmed on digital subtraction angiography. The different anatomical patterns of MCA and their surgical implications have also been discussed.

scholarly journals A retrospective study on the risk factors for retinopathy of prematurity in NICU of tertiary care hospital

2018 ◽  
Vol 5 (4) ◽  
pp. 1447
Author(s):  
Sundar K. C. ◽  
Devi Meenakshi K. ◽  
Aruna B. Patil
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Birth Weight ◽  
Retinopathy Of Prematurity ◽  
Oxygen Therapy ◽  
Tertiary Care ◽  
Care Hospital ◽  
College Hospital ◽  
Medical College ◽  
The Mean

Background: Retinopathy of prematurity (ROP) affects developing retinal vasculature in premature infants. The risk factors for ROP are prematurity, low birth weight, oxygenation, respiratory distress, infection and frequent blood transfusion. Identification of risk factors leading to ROP may help in planning preventive strategies.Methods: A retrospective analysis of records of preterm babies less than 34 weeks of gestation or birth weight less than 1750 grams and between 34 -36 weeks gestation or 1750-2000 grams birth weight associated with risk factors for ROP admitted to NICU of Kilpauk Medical college hospital from August 2015 to July 2016 were evaluated.Results: Out of a total of 166 babies who were screened for ROP, 37 babies were detected to have ROP (22.3 %). Of these 20 (54%) were female and 17 (46%) were male. The mean birth weight of babies with ROP identified in our study was 1480 grams. The mean gestational age of babies with ROP was 32 weeks. By logistic regression analysis for mode of oxygen therapy as a risk factor for ROP it was found that prongs alone showed the strong risk factor towards ROP which was statistically significant. Sepsis, transfusion and shock requiring inotropes individually and statistical significantly contributed to the risk of ROP.Conclusions: ROP was more common in babies <34 weeks. Sepsis, transfusion and shock requiring inotropes significantly contributed to the risk of ROP. Analysis of the mode of oxygen therapy showed that use of prongs significantly increased the risk of ROP.

scholarly journals A comparative study of computed Tomographic Angiography and digital subtraction Angiography in evaluation of Aneurysmal Subarachnoid Haemorrhage

2015 ◽  
Vol 22 (2) ◽  
pp. 195-200
Author(s):  
Mahmudul Islam ◽  
Ahmed Hossain Chowdhury ◽  
Md Shah Jahirul Hoque Chowdhury ◽  
Md Nahidul Islam ◽  
Abu Nayeem ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Digital Subtraction Angiography ◽  
Computed Tomographic Angiography ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Digital Subtraction ◽  
College Hospital ◽  
Female Ratio ◽  
Medical College ◽  
Computed Tomographic ◽  
Tomographic Angiography

Context: The aim of the study was to retrospectively analyze the performance of Computed Tomographic Angiography (CTA) in detecting, localizing and sizing intracranial aneurysms in patients of aneurysmal subarachnoid haemorrhage using Digital Subtraction Angiography (DSA) as standard. Methods: The study was carried out from December 2009 to November 2010 in the Dept. of Neurology of Dhaka Medical College Hospital, Dhaka. Among 81 patients of SAH admitted in the above mentioned period, 30 were enrolled in the study as they met the inclusion criteria. Patient’s age range was 26 to 70 years; male female ratio was 1.5: 1. All the study patients underwent both DSA and CTA examinations. The findings of both procedures were recorded and compared. Results: A total of 30 aneurysms in 30 patients were identified on DSA. Among 10 small sized aneurysms (<4 mm) detected by DSA, CTA incorrectly diagnosed 2 and overlooked 2 aneurysms. Out of 14 medium sized (5- 12 mm) identified on DSA, CTA missed 2 aneurysms. But CTA correctly diagnosed all 6 large (e”13 mm) aneurysms. The overall sensitivity of CTA was 60% for small, 85.7% for medium and 100% for large aneurysm. Regarding identification of aneurysmal sites, CTA correctly localized 22 (73.4%), incorrectly localized 4 (13.3%) and missed 4 (13.3%) cases. Sensitivity of CTA in identification of aneurysmal site was 73.3%. Conclusion: CTA is less sensitive than DSA in detecting small and medium sized aneurysms. However it correlated perfectly with DSA in detection of large aneurysms. The performance of CTA in identification of aneurysmal site is also lesser than DSA. So, DSA remains the standard technique for evaluation of aneurysmal SAH. DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21542 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 195-200

Chest Trauma Evaluation and Outcome of Management in a Tertiary Hospital - One Year Experience

2020 ◽  
Vol 22 (2) ◽  
pp. 110-117
Author(s):  
Md Mahmudul Islam ◽  
Khondkar AK Azad ◽  
Md Aminul Islam ◽  
Rivu Raj Chakraborty
Keyword(s):  
Road Traffic Accident ◽  
Traffic Accident ◽  
Chest Trauma ◽  
Road Traffic ◽  
Tube Thoracostomy ◽  
Rib Fracture ◽  
Medical College Hospital ◽  
College Hospital ◽  
Medical College ◽  
The Mean

Background: Chest trauma is responsible for 50% of deaths due to trauma. This kind of death usually occurs immediately after the trauma has occurred. Various therapeutic options have been reported for management of chest injuries like clinical observation, thoracocentesis, tube thoracostomy and open thoracotomy. Objective: To observe the pattern and outcome of management in chest trauma Methods: This is an observational study carried out in Casualty department of Chittagong Medical College Hospital (CMCH), Chittagong, between April 2015 to March 2016. Our study was included all patients, both sexes, following chest injury at Casualty units of Chittagong Medical College Hospital. All the data were recorded through the preformed data collection sheet and analyzed. Result: The mean age was found 37.7±18.1 years with range from 12 to 80 years. Male female ratio was 11.8:1. The mean time elapsed after trauma was found 6.1±3.1 hours with range from 1 to 72 hours. Almost one third (35.7%) patients was affecting road traffic accident followed by 42(27.3%) assault, 35(22.7%) stab injury, 15(9.7%) fall and 7(4.5%) gun shot . More than three fourth (80.5%) patients were managed by tube thoracostomy followed by 28(18.2%) observation and 2(1.3%) ventilatory support. No thoracotomy was done in emergency department. 42(27.2%) patients was found open pneumothorax followed by 41(26.6%) rib fracture, 31(20.1%) haemopneumothorax, 14(9%) simple pneumothorax, 12(7.8%) haemothorax, 6(3.9%) chest wall injury, 5(3.2%) tension pneumothorax, and 3(1.9%) flail chest. About the side of tube 60(39.0%) patients were given tube on left side followed by 57(37.0%) patients on right side, 9(5.8%) patients on both (left & right) side and 28(18.2%) patients needed no tube. Regarding the complications, 13(30%) patients had persistent haemothorax followed by 12(29%)tubes were placed outside triangle of safety, 6(13.9%) tubes were kinked, 6(13.9%) patients developed port side infection, 2(4.5%)tube was placed too shallow, 2(4.5%) patients developed empyema thoracis and 2(4.5%) patients developed bronchopleural fistula. The mean ICT removal information was found 8.8±3.6 days with range from 4 to 18 days. Reinsertion of ICT was done in 6(4.7%) patients. More than two third (68.2%) patients were recovered well, 43(27.9%) patients developed complication and 6(3.9%)patients died. More than two third (66.9%) patients had length of hospital stay 11-20 days. Conclusion: Most of the patients were in 3rd decade and male predominant. Road traffic accident and tube thoracostomy were more common. Open pneumothorax, rib fracture and haemopneumothorax were commonest injuries. Nearly one third of the patients had developed complications. Re-insertion of ICT needed almost five percent and death almost four percent. Journal of Surgical Sciences (2018) Vol. 22 (2) : 110-117

scholarly journals Aneurysm Arising at the Origin of a Duplicated Middle Cerebral Artery

2021 ◽  
pp. 446-450
Author(s):  
Jean Roch Alliez ◽  
Luis Manera
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Haemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
World Federation ◽  
Treatment Procedure ◽  
3D Computed Tomography ◽  
Ruptured Aneurysms ◽  
Tomography Reconstruction ◽  
Computed Tomography Reconstruction

A duplicated middle cerebral artery (DMCA) is a common anomaly. However, aneurysms arising from the origin of a DMCA are extremely rare. A 22-year-old female was admitted to our hospital with a World Federation of Neurosurgical Societies grade 2 subarachnoid haemorrhage. Four-vessel angiography revealed a DMCA and an aneurysm arising from the origin of this artery. The aneurysm was successfully treated by embolization, and the patient was discharged 2 weeks later. Ruptured aneurysms arising from the origin of a DMCA can be successfully treated by embolization. These aneurysms are small and 3D-computed tomography reconstruction is mandatory to detect them. It is important to preserve the DMCA during the treatment procedure.

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