scholarly journals Symptomatic bilateral isolated perforator infarction following aneurysmal subarachnoid hemorrhage

2013 ◽  
Vol 04 (01) ◽  
pp. 45-47 ◽  
Author(s):  
Pravin Salunke ◽  
Sunil K Gupta
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Animal Studies ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Neurological Status ◽  
Major Vessel ◽  
Perforator Vessels ◽  
Triple H ◽  
Cerebral Artery Aneurysm ◽  
The Brain

ABSTRACTVasospasm following aneurysmal subarachnoid hemorrhage (SAH) occurs in the extraparenchymal vessels in the subarachnoid space at the base of the brain. Ischemia/ Infarction affecting primarily the perforator vessels in isolation, following aneurysmal SAH is uncommon. A 28-year-old man with a ruptured middle cerebral artery aneurysm underwent clipping of the aneurysm. He developed delayed bilateral deep seated infarcts involving both internal capsular regions, the thalamus and basal ganglia without any major vessel infarct. The patient was managed with triple H (hypertensive hypervolemic hemodilutional) therapy and calcium channel antagonists but did not show any improvement and remained in poor neurological status. Perforator vasospasm occurring secondary to aneurysmal SAH, though documented in experimental animal studies, has rarely been reported in humans in a clinical setting. The present case provides evidence, albeit indirect, of isolated perforator vasospasm, which possibly should be the target of future therapeutic strategies.

scholarly journals Clinical characteristics and outcome of aneurysmal subarachnoid hemorrhage with intracerebral hematoma

2016 ◽  
Vol 125 (6) ◽  
pp. 1344-1351 ◽  
Author(s):  
Anthony Wan ◽  
Blessing N. R. Jaja ◽  
Tom A. Schweizer ◽  
R. Loch Macdonald
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Early Treatment ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Neurological Status ◽  
Aneurysm Rupture ◽  
Study Data ◽  
Intracerebral Hematoma ◽  
Pia Mater ◽  
Proportional Odds Models ◽  
The Brain

OBJECTIVE Intracerebral hematoma (ICH) with subarachnoid hemorrhage (SAH) indicates a unique feature of intracranial aneurysm rupture since the aneurysm is in the subarachnoid space and separated from the brain by pia mater. Broad consensus is lacking regarding the concept that ultra-early treatment improves outcome. The aim of this study is to determine the associative factors for ICH, ascertain the prognostic value of ICH, and investigate how the timing of treatment relates to the outcome of SAH with concurrent ICH. METHODS The study data were pooled from the SAH International Trialists repository. Logistic regression was applied to study the associations of clinical and aneurysm characteristics with ICH. Proportional odds models and dominance analysis were applied to study the effect of ICH on 3-month outcome (Glasgow Outcome Scale) and investigate the effect of time from ictus to treatment on outcome. RESULTS Of the 5362 SAH patients analyzed, 1120 (21%) had concurrent ICH. In order of importance, neurological status, aneurysm location, aneurysm size, and patient ethnicity were significantly associated with ICH. Patients with ICH experienced poorer outcome than those without ICH (OR 1.58; 95% CI 1.37–1.82). Treatment within 6 hours of SAH was associated with poorer outcome than treatment thereafter (adjusted OR 1.67; 95% CI 1.04–2.69). Subgroup analysis with adjustment for ICH volume, location, and midline shift resulted in no association between time from ictus to treatment and outcome (OR 0.99; 95% CI 0.94–1.07). CONCLUSIONS The most important associative factor for ICH is neurological status on admission. The finding regarding the value of ultra-early treatment suggests the need to more robustly reevaluate the concept that hematoma evacuation of an ICH and repair of a ruptured aneurysm within 6 hours of ictus is the most optimal treatment path.

The neutrophil enzyme myeloperoxidase directly modulates neuronal response after subarachnoid hemorrhage, a sterile injury model

2020 ◽  
Author(s):  
Aminata P. Coulibaly ◽  
Pinar Pezuk ◽  
Paul Varghese ◽  
William Gartman ◽  
Danielle Triebwasser ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cognitive Deficits ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Neuronal Response ◽  
Neutrophil Infiltration ◽  
Brain Parenchyma ◽  
Biologically Active ◽  
Cns Injury ◽  
And Function ◽  
The Brain

Abstract Background: Aneurysmal subarachnoid hemorrhage (SAH) is associated with the development of delayed cognitive deficits. Neutrophil infiltration into the central nervous system (CNS) is linked to the development of these deficits after SAH. It is however unclear how neutrophil activity, direct or indirect, influences CNS function in SAH. As such, the present project aims to elucidate neutrophil factors and mechanisms mediating CNS injury and cognitive deficits after SAH. Methods: Using a murine model of SAH and mice deficient in neutrophil effector functions, we determined which neutrophil effector function is critical to the development of deficits after SAH. Also, in vitro techniques were used to elucidate whether neutrophils directly or indirectly affect neuronal function after SAH. Results: Our results show that following SAH, neutrophils infiltrate the meninges, and not the brain parenchyma. Mice lacking functional myeloperoxidase (MPO KO), a neutrophil enzyme, lack both the meningeal neutrophil infiltration and the cognitive deficits associated with SAH. The re-introduction of biologically active MPO, and its substrate hydrogen peroxide, to the cerebrospinal fluid of MPO KO mice at the time of hemorrhage restores the spatial memory deficit observed after SAH. Furthermore, MPO directly affects the function of both primary neurons and astrocytes in culture. Neurons exposed to MPO and its substrate show decreased calcium activity at baseline and after stimulation with potassium chloride. In addition, MPO and its substrate lead to significant astrocyte loss in culture, phenocopying a result observed in the brain after SAH. Conclusions: These results implicate MPO as a mediator of neuronal dysfunction in SAH through direct effect on both neurons and astrocytes. Finally, these results show that, in SAH, the activity of innate immune cells in the meninges can modulate the activity and function of the underlying brain tissue.

scholarly journals Pediatric Moyamoya Presenting as a Subarachnoid Hemorrhage from a Ruptured Anterior Cerebral Artery Aneurysm

2020 ◽  
Vol 134 ◽  
pp. 123-127 ◽  
Author(s):  
Mohammad Hassan A. Noureldine ◽  
Ibrahim Saikali ◽  
Anis Nassif ◽  
Rita Chahinian ◽  
Ahmad Sweid ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Anterior Cerebral Artery Aneurysm ◽  
Cerebral Artery Aneurysm

Conus Perimedullary Arteriovenous Fistula with Intracranial Drainage: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 457-462 ◽  
Author(s):  
G. Edward Vates ◽  
Alfredo Quiñones-Hinojosa ◽  
Van V. Halbach ◽  
Michael T. Lawton
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Venous Drainage ◽  
Sudden Onset ◽  
Clinical Findings ◽  
Left Middle Cerebral Artery ◽  
Lower Extremity Weakness ◽  
Posterior Laminectomy ◽  
Cerebral Artery Aneurysm ◽  
Left Middle

Abstract OBJECTIVE AND IMPORTANCE Perimedullary arteriovenous fistulae (AVFs) do not commonly present with subarachnoid hemorrhage or intracranial venous drainage causing neurological symptoms. We present a case with both of these features. The patient was inadvertently treated for an unruptured intracranial aneurysm before his true problem was recognized. CLINICAL PRESENTATION A 65-year-old man presented with sudden-onset lower-extremity weakness, diplopia, nausea, and dysarthria on the day of admission. A lumbar puncture documented subarachnoid hemorrhage, and imaging studies revealed a left middle cerebral artery aneurysm. It was noted during surgery that this aneurysm was unruptured, and the patient did not exhibit improvement after surgery. INTERVENTION Spinal angiography demonstrated a spinal perimedullary AVF feeding from the left T12 radicular artery; venous drainage extended rostrally into the posterior fossa venous system. The AVF was surgically occluded via a posterior laminectomy at the level of the AVF. After surgery, the patient's symptoms began to abate. CONCLUSION Conus perimedullary AVFs can have venous drainage that extends as far as intracranial veins, which can lead to confusing clinical findings because the symptoms may suggest an intracranial process, although the lesion is in the spine. Surgeons must be aware of this confusing presentation.

Seizures after Aneurysmal Subarachnoid Hemorrhage Treated with Coil Embolization

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 545-552 ◽  
Author(s):  
James V. Byrne ◽  
Philip Boardman ◽  
Ioannis Ioannidis ◽  
Jane Adcock ◽  
Zoe Traill
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Coil Embolization ◽  
De Novo ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Motor Vehicles ◽  
Single Operator ◽  
Surgical Data ◽  
History Of ◽  
Low Incidence

Abstract OBJECTIVE We sought to determine the incidence of seizures among patients treated with endovascular coil embolization for ruptured intracranial aneurysms because data on which to base antiepileptic drug (AED) prescriptions and advice to patients regarding driving motor vehicles and other high-risk activities are currently lacking. METHODS We conducted a single-institute, single-operator observational study of 243 patients referred for endovascular treatment after aneurysmal subarachnoid hemorrhage. Prospective data collection was performed, and all successfully treated patients were followed. The incidence of seizures was compared with published surgical data, and logistic regression analysis of potential clinical associations was performed. Patients were followed for up to 7.7 years (mean follow-up period, 21.9 mo). RESULTS Ictal seizures occurred at the time of subarachnoid hemorrhage in 26 (11%) of 243 patients and correlated with middle cerebral artery aneurysm location, loss of consciousness at ictus, and AED prescription. No patients experienced periprocedural seizures during their hospitalization. Seven of 233 successfully treated patients (3%) experienced seizures more than 30 days after treatment: late seizures occurred de novo in four patients (1.7%) and in three patients (1.4%) were caused by preexisting epilepsy. Two patients (0.85%) who had de novo seizures developed epilepsy. Late seizures correlated with a history of previous seizures, the presence of a cerebrospinal fluid shunt, and the use of AEDs. CONCLUSION The low incidence of seizures does not justify the use of prophylactic AED therapy after aneurysmal subarachnoid hemorrhage in patients treated solely with coil embolization, nor does it justify subsequent restrictions on the driving of motor vehicles if the patient is otherwise fit to drive.

High-Dose Nadroparin Following Endovascular Aneurysm Treatment Benefits Outcome After Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2017 ◽  
Vol 83 (2) ◽  
pp. 281-287 ◽  
Author(s):  
Rene Post ◽  
IJsbrand A.J Zijlstra ◽  
Rene van den Berg ◽  
Bert A Coert ◽  
Dagmar Verbaan ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Dose Group ◽  
Low Dose ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Controlled Trial ◽  
Delayed Cerebral Ischemia ◽  
Neurological Status ◽  
High Dose ◽  
Aneurysm Treatment ◽  
Significant Difference

Abstract BACKGROUND Delayed cerebral ischemia (DCI) is one of the major causes of delayed morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE To evaluate the effect of high-dose nadroparin treatment following endovascular aneurysm treatment on the occurrence of DCI and clinical outcome. METHODS Medical records of 158 adult patients with an aSAH were retrospectively analyzed. Those patients treated endovascularly for their ruptured aneurysm were included in this study. They received either high-dose (twice daily 5700 AxaIE) or low-dose (once daily 2850 AxaIE) nadroparin treatment after occlusion of the aneurysm. Medical charts were reviewed and imaging was scored by 2 independent neuroradiologists. Data with respect to in-hospital complications, peri-procedural complications, discharge location, and mortality were collected. RESULTS Ninety-three patients had received high-dose nadroparin, and 65 patients prophylactic low-dose nadroparin. There was no significant difference in clinical DCI occurrence between patients treated with high-dose (34%) and low-dose (31%) nadroparin. More patients were discharged to home in patients who received high-dose nadroparin (40%) compared to low-dose (17%; odds ratio [OR] 3.13, 95% confidence interval [95% CI]: 1.36-7.24). Furthermore, mortality was lower in the high-dose group (5%) compared to the low-dose group (23%; OR 0.19, 95% CI: 0.07-0.55), also after adjusting for neurological status on admission (OR 0.21, 95% CI: 0.07-0.63). CONCLUSION Patients who were treated with high-dose nadroparin after endovascular treatment for aneurysmal SAH were more often discharged to home and showed lower mortality. High-dose nadroparin did not, however, show a decrease in the occurrence of clinical DCI after aSAH. A randomized controlled trial seems warranted.

RELATIONSHIP OF THE MET ALLELE OF THE BRAIN-DERIVED NEUROTROPHIC FACTOR VAL66MET POLYMORPHISM TO MEMORY AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

Neurosurgery ◽  
2008 ◽  
Vol 63 (2) ◽  
pp. 198-203 ◽  
Author(s):  
Juhani Vilkki ◽  
Jaakko Lappalainen ◽  
Seppo Juvela ◽  
Katarzyna Kanarek ◽  
Juha A. Hernesniemi ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Neurotrophic Factor ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Brain Derived Neurotrophic Factor ◽  
Val66met Polymorphism ◽  
Relationship Of ◽  
The Brain

scholarly journals Gasserian ganglion radiofrequency thermoablation in a patient with aneurysm of the anterior communicating artery

2021 ◽  
Author(s):  
Yong Ho Lee ◽  
Ji Hee Hong ◽  
Hye Kyung Shin
Keyword(s):  
Trigeminal Neuralgia ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Gasserian Ganglion ◽  
Inferior Aspect ◽  
Molar Teeth ◽  
Anterior Cerebral Artery Aneurysm ◽  
Good Treatment Option ◽  
Cerebral Artery Aneurysm ◽  
The Brain

BackgroundGasserian ganglion radiofreqeucy thermoablation is a good treatment option for the management of pain in trigeminal neuralgia. We report a case in which the patient of trigeminal neuralgia combined with anterior cerebral artery aneurysm was treated successfully by gasserian ganglion thermoablation without any complication.CaseAn 85-year-old female presenting with electric shock like sensation in the gum and molar teeth was diagnosed as trigeminal neuralgia. Carbamazepine medication and trigeminal nerve blockade relieved her pain partially, but severe side effects of carbamazepine occurred. Magnetic resonance angiography of the brain showed saccular aneurysm in inferior aspect of the anterior communicating artery. Gasserian ganglion thermoablation under sedation anesthesia using nicardipine was performed carefully without any rupture of the cerebral aneurysm.ConclusionsGasserian ganglion thermoablation could be performed safely in a patient with cerebral aneurysm without any inadvertent event.

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