Intracraniaal infectieus aneurysma: belang van vroegtijdige diagnose

2021 ◽  
Author(s):  
M. OVERSTIJNS ◽  
F. VAN CALENBERGH
Keyword(s):  
Myeloid Leukemia ◽  
Posterior Inferior Cerebellar Artery ◽  
Mri Scan ◽  
Left Posterior ◽  
Cerebellar Artery ◽  
Level Of Consciousness ◽  
Respiration Pattern ◽  
Antimycotic Treatment ◽  
The Brain ◽  
Intracranial Vasculature

Intracranial aneurysm: importance of early detection A 45-year old woman presented at the emergency department with a decreased level of consciousness. She was under treatment for acute myeloid leukemia. An MRI scan of the brain showed diffuse vasoconstriction of the intracranial vasculature, suggestive for vasculitis. Aspergillus fumigatus was discovered in the cerebrospinal fluid (CSF), for which antimycotic treatment was initiated. Because of further neurological decline (acute decreased consciousness, unilateral gaze impairment and irregular obstructive respiration pattern) a CT scan was performed which showed diffuse subarachnoid and intraventricular hemorrhaging. CT-angiography showed an aneurysm at the left posterior inferior cerebellar artery. Because of the severe clinical condition of the patient, there was no indication for invasive therapy.

scholarly journals Reversible Parinaud Syndrome Following Intraventricular Thrombolysis

2009 ◽  
Vol 36 (1) ◽  
pp. 95-97
Author(s):  
Robert Laforce ◽  
Hélène Khuong ◽  
Jean-Luc Gariépy ◽  
Geneviève Milot ◽  
Martin Savard
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Endovascular Embolization ◽  
Severe Headache ◽  
Laboratory Studies ◽  
Fisher Grade ◽  
Glascow Coma Scale ◽  
Left Posterior ◽  
Cerebellar Artery ◽  
Level Of Consciousness ◽  
History Of

A 57-year-old daycare educator presented as a drowsy but oriented individual with a history of sudden and severe headache associated with vomiting. She had no previous medical or neurological history. Examination showed no focal signs and routine laboratory studies were unremarkable. Head computed tomogram (CT) revealed a Fisher grade IV subarachnoid hemorrhage in the posterior fossa with extensive intraventricular hemorrhage (Graeb 8/12, see Figures 1A and 1B) which was shown to originate from a left Posterior Inferior Cerebellar Artery (PICA) aneurysm on CT angiography and treated successfully with endovascular embolization. Five days later she deteriorated her level of consciousness (Glascow coma scale [GCS] 8/15). The CT scan showed moderate hydrocephalus and a ventricular drain was placed. She improved clinically but remained disoriented with slowed information processing skills.

scholarly journals Microsurgical treatment of distal aneurysms of the posterior inferior cerebellar artery

2019 ◽  
Vol 21 (4) ◽  
pp. 12-23
Author(s):  
V. G. Dashyan ◽  
I. V. Senko
Keyword(s):  
Informed Consent ◽  
Brain Stem ◽  
Postoperative Period ◽  
Conflict Of Interest ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Pica Aneurysms ◽  
The Brain ◽  
Perforating Arteries ◽  
Suboccipital Approach

The study objective is to analyze characteristics of distal aneurysms of the posterior inferior cerebellar artery (PICA) using the results of surgical treatment of 11 patients with this disorder.Materials and methods. Eleven patients with distal PICA aneurysms (7 men and 4 women aged between 32 and 57 years (mean age 44 years)) were operated in N.V. Sklifosovsky Research Institute for Emergency Medicine. Aneurysms were visualized using cerebral angiography in 2 patients and using computed angiography in 9 patients. The aneurysms were classified using the classification system developed by J.R. Lister and A.L. Rhoton. Aneurysms located in the tonsillomedullary segment were most common. Saccular aneurysms were found in 7 (64 %) patients, whereas fusiform aneurysms were observed in 4 (36 %) patients. Two saccular aneurysms had a large neck. The size of aneurysms varied between 2 and 9 mm. The majority of patients (70 %) had aneurysms less than 7 mm.Results. Five patients were operated via median suboccipital approach, while the remaining 6 patients were operated via lateral suboccipital approach. We performed either reconstructive (n = 9) or deconstructive (n = 2) aneurysm clipping depending on the possibility of preserving the PICA lumen and presence of damage to the perforating arteries of the brain stem. Nine patients (82 %) had Glasgow Outcome Score of 5; two patients (18 %) died (one of them was admitted in sopor with occlusive hydrocephalus; another one had grade III–IV obesity and developed purulent septic respiratory complications and secondary purulent meningitis). Two patients (18 %) developed dysarthria and dysphagia in the postoperative period, but these symptoms disappeared by the moment of discharge.Conclusion. Distal PICA aneurysms are quite rare and require tailored approach to treatment. A surgeon should bear in mind specific anatomical characteristics of aneurysms, control arterial patency when isolating the aneurysm from the bloodstream, and use revascularizing methods whenever possible. In addition to that, a surgeon should be extremely careful during manipulations with perforating arteries of the brain stem and distal cranial nerves, because their damage result in a more difficult postoperative period.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study and to the publication of their data. 

scholarly journals Laceration of the posterior inferior cerebellar artery by suboccipital puncture of the cisterna magna: case report

2004 ◽  
Vol 62 (3b) ◽  
pp. 882-884 ◽  
Author(s):  
Luiz Antonio Pezzi Portela ◽  
Valéria Souza ◽  
Félix Hendrick Pahl ◽  
Alberto Cappel Cardoso ◽  
Eduardo de Arnaldo Silva Vellutini ◽  
...  
Keyword(s):  
Emergency Room ◽  
Ct Scan ◽  
Blood Cells ◽  
Posterior Inferior Cerebellar Artery ◽  
Surgical Clipping ◽  
Cranial Ct ◽  
Anxious Patient ◽  
Left Posterior ◽  
Cerebellar Artery ◽  
Neurological Exam

We report the case of a 27 year old man who presented to the emergency room of a hospital with headache, vomiting and an episode of loss of conciousness. A cranial CT scan was normal and the patient discharged. Ten hours later he came to the emergency room of our hospital with the same complaints. A technically difficult cisternal puncture in an anxious patient who moved during the needle introduction was done. The CSF sample showed 1600 intact red blood cells without other alterations. His headache worsened and after 6 hours he became drowsy, numb and exhibited decerebration signs. A new CT scan showed diffuse subarachnoid and intraventricular blood. An emergency angiogram demonstrated laceration of a left posterior-inferior cerebellar artery in its retrobulbar loop with a pseudoaneurysm. He was succesfully treated by surgical clipping without injury. Sixteen days later he was discharged with a normal neurological exam.

Outcome of Endoscope-Assisted Microvascular Decompression in Patients With Hemifacial Spasm Caused by Severe Indentation of the Brain Stem at the Pontomedullary Sulcus by the Posterior Inferior Cerebellar Artery

2021 ◽  
Author(s):  
Ehab El Refaee ◽  
Steffen Fleck ◽  
Marc Matthes ◽  
Sascha Marx ◽  
Joerg Baldauf ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Transitional Zone ◽  
Effective Treatment Option ◽  
Cerebellar Artery ◽  
The Brain

Abstract BACKGROUND Microvascular decompression (MVD) is the most effective treatment option for hemifacial spasm (HFS). However, deeply located forms of compression would require proper identification to allow for adequate decompression. OBJECTIVE To describe the usefulness of endoscopic visualization in one of the most challenging compression patterns in HFS, where the posterior inferior cerebellar artery (PICA) loop is severely indenting the brain stem at the proximal root exit zone of facial nerve along the pontomedullary sulcus. METHODS Radiological and operative data were checked for all patients in whom severe indentation of the brainstem by PICA at pontomedullary sulcus was recorded and endoscope-assisted MVD was performed. Clinical correlation and outcome were analyzed. RESULTS A total of 58 patients with HFS were identified with radiological and surgical evidence proving brainstem indentation at the VII transitional zone. In 31 patients, PICA was the offending vessel to the facial nerve. In 3 patients, the PICA loop was mobilized under visualization of a 45° endoscope. A total of 31 patients had a mean follow-up duration of 52.1 mo. The mean duration between start of complaints and surgery was 7.2 yr. In the last follow-up, all patients had remarkable spasm improvement. A total of 5 patients had more than 90% disappearance of spasms and 26 patients experienced spasm-free outcome. CONCLUSION Although severe indentation of brain stem implies morphological damage, outcome after MVD is excellent. A 45° endoscope is extremely helpful to identify compression down at the pontomedullary sulcus. Deeply located compression site can easily be missed with microscopic inspection alone.

End-to-End Suture of the Posterior Inferior Cerebellar Artery after the Excision of a Large Aneurysm: Case Report

Neurosurgery ◽  
1982 ◽  
Vol 11 (5) ◽  
pp. 690-693 ◽  
Author(s):  
Vinko Dolenc
Keyword(s):  
Case Report ◽  
Neurological Deficit ◽  
Posterior Inferior Cerebellar Artery ◽  
Postoperative Neurological Deficit ◽  
Left Posterior ◽  
Cerebellar Artery ◽  
End To End ◽  
Large Aneurysm

Abstract A case of a large aneurysm of the left posterior inferior cerebellar artery (PICA) is presented. The ectasia of the PICA was excised, and the artery was reconstructed by end-to-end suture. The PICA proved to be patent. The patient had neither pre- nor postoperative neurological deficit.

scholarly journals Lateral Medullary Syndrome (Wallenberg's Syndrome) - A Case Report

1970 ◽  
Vol 5 (1) ◽  
pp. 35-36 ◽  
Author(s):  
R Saha ◽  
S Alam ◽  
MA Hossain
Keyword(s):  
Case Report ◽  
Ischaemic Stroke ◽  
Posterior Inferior Cerebellar Artery ◽  
Sudden Onset ◽  
Appropriate Treatment ◽  
Cerebellar Artery ◽  
Lateral Medullary Syndrome ◽  
Great Vessels ◽  
History Of ◽  
The Brain

The Lateral medullary syndrome is not a very common stroke. Sometimes it is under diagnosed. Mr. Ibrahim Mollah, 50 years old male person, non diabetic, non hypertensive but smoker presented with the history of sudden onset of dysphagia, dysarthria and ataxia of the gait. He is clinically and radiologically diagnosed as a case of Lateral medullary syndrome (Ischaemic stroke). With treatment this patient improved significantly. It is commonly caused by occlusion of the cranial segment of the vertebral artery or the posterior inferior cerebellar artery. The occlusion may be due to thrombosis or embolism. The emboli are coming from the heart or the great vessels. We can diagnose Lateral medullary syndrome with expert clinical eye and CT/MRI of the brain. It should be managed with appropriate treatment and physiotherapy. DOI: 10.3329/fmcj.v5i1.6813Faridpur Med. Coll. J. 2010;5(1):35-36

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