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Ruptured cerebral aneurysm

Muhammad AlMatter, Pervinder Bhogal, Marta Aguilar Pérez, Victoria Hellstern, Hansjörg Bäzner, Oliver Ganslandt, Hans Henkes
INTRODUCTION: The endovascular treatment (EVT) of ruptured cerebral aneurysms has been widely adopted after publication of the ISAT. In this study we sought to evaluate the safety and efficacy of the EVT for ruptured aneurysms based on 10-year series from a single centre with coil-first strategy. METHODS: All patients with aneurysmal subarachnoid haemorrhage (aSAH) treated between 2007 and 2016 were retrospectively reviewed and divided according to initial treatment into an EVT and a microsurgical clipping (MSC) group...
March 12, 2018: Journal of Neuroradiology. Journal de Neuroradiologie
T Cesak, J Adamkov, J Habalova, P Poczos, M Kanta, M Bartos, T Hosszu
AIM: The aim of this study was to analyse the relationship between intracranial pressure (intracranial pressure monitoring) and lactate pyruvate ratio (cerebral microdialysis) in patients with ruptured intracranial aneurysms. METHODS: In a group of fifteen patients, intracranial pressure and lactate/pyruvate ratios were measured and logged in hourly intervals. The relationship between these two variables was subsequently analysed in two ways. 1) Intracranial hypertension (ICP > 20 mmHg) in the presence of energy deprivation (L/P ratio > 30) was noted...
2018: Bratislavské Lekárske Listy
Stephan A Munich, Marshall C Cress, Leonardo Rangel-Castilla, Ashish Sonig, Christopher S Ogilvy, Giuseppe Lanzino, Ondra Petr, J Mocco, Peter J Morone, Kenneth V Snyder, L Nelson Hopkins, Adnan H Siddiqui, Elad I Levy
BACKGROUND: Neck remnants are not uncommon after endovascular treatment of cerebral aneurysms. Critics of endovascular treatments for cerebral aneurysms cite neck remnants as evidence in favor of microsurgical clipping. However, studies have failed to evaluate the true clinical significance of aneurysm neck remnants following endovascular therapies. OBJECTIVE: To assess the clinical significance of residual aneurysm necks and to determine the rate of subsequent rupture following coiling or stent-assisted coiling of cerebral aneurysms...
March 8, 2018: Neurosurgery
Pius Kim, Suk Jung Jang
OBJECTIVE: Surgical clipping of the cerebral aenurysm is considered as a standard therapy with endovascular coil embolization. The surgical clipping is known to be superior to the endovascular coil embolization in terms of recurrent rate. However, a recurrent aneurysm which is initially treated by surgical clipping is difficult to handle. The purpose of this study was to research the management of the recurrent cerebral aneurysm after a surgical clipping and how to overcome them. METHODS: From January 1996 to December 2015, medical records and radiologic findings of 14 patients with recurrent aneurysm after surgical clipping were reviewed retrospectively...
March 2018: Journal of Korean Neurosurgical Society
Won-Sang Cho, Jeong Eun Kim, Sukh Que Park, Jun Kyeung Ko, Dae-Won Kim, Jung Cheol Park, Je Young Yeon, Seung Young Chung, Joonho Chung, Sung-Pil Joo, Gyojun Hwang, Deog Young Kim, Won Hyuk Chang, Kyu-Sun Choi, Sung Ho Lee, Seung Hun Sheen, Hyun-Seung Kang, Byung Moon Kim, Hee-Joon Bae, Chang Wan Oh, Hyeon Seon Park
Despite advancements in treating ruptured cerebral aneurysms, an aneurysmal subarachnoid hemorrhage (aSAH) is still a grave cerebrovascular disease associated with a high rate of morbidity and mortality. Based on the literature published to date, worldwide academic and governmental committees have developed clinical practice guidelines (CPGs) to propose standards for disease management in order to achieve the best treatment outcomes for aSAHs. In 2013, the Korean Society of Cerebrovascular Surgeons issued a Korean version of the CPGs for aSAHs...
March 2018: Journal of Korean Neurosurgical Society
Ramazan Jabbarli, Thiemo Florin Dinger, Marvin Darkwah Oppong, Daniela Pierscianek, Philipp Dammann, Karsten H Wrede, Klaus Kaier, Martin Köhrmann, Michael Forsting, Christoph Kleinschnitz, Ulrich Sure
BACKGROUND AND PURPOSE: Multiple intracranial aneurysms (MIAs) are common findings of cerebral angiographies; however, MIA prevalence varies in different patient cohorts. We sought to elucidate risk factors influencing MIA prevalence and the clinical consequences. METHODS: We systematically searched PubMed, Scopus, Embase, and Cochrane Library databases for publications before January 15, 2017, reporting MIA prevalence and risk factors. We used random-effects meta-analysis and multivariate regression analysis to assess the impacts of individual, study, and population characteristics...
March 6, 2018: Stroke; a Journal of Cerebral Circulation
Virendra R Desai, Alejandro L Rosas, Gavin W Britz
Cerebral aneurysms have a high mortality rate when ruptured. Endovascular techniques have improved substantially in treating this pathology. However, surgical clip ligation remains the preferred option for some aneurysms. Various techniques are used intraoperatively to assist the surgeon in dissecting the aneurysmal dome free of surrounding tissue and placing a clip around the neck safely and effectively so that no nearby perforating vessels are affected and no residual remains. These techniques include temporary clip ligation, endovascular balloon occlusion and cardiac standstill...
December 2017: Stroke and Vascular Neurology
Tomohiko Ozaki, Takeo Nishida, Yuya Fujita, Haruhiko Kishima, Manabu Kinoshita
Ruptured dissecting aneurysms located at the middle cerebral artery (MCA) are rare, and its standard treatment has not been defined. Furthermore, lenticulostriate artery involvement in the dissecting segment makes the treatment extremely difficult, and no previous reports have described successful treatment for such conditions. We herein report the case of a 74-year-old woman who presented with sudden severe headache from subarachnoid hemorrhage due to dissection in the proximal M1 segment of left MCA involving LSA...
February 27, 2018: World Neurosurgery
Jeewaka E Mohotti, Nicole S Carter, Victor Jia Wei Zhang, Leon T Lai, Christopher Xenos, Hamed Asadi, Ronil V Chandra
Intracranial aneurysms in the neonate, presenting in the first 4 weeks of life, are exceedingly rare. They appear to have characteristics, including presentation and location, that vary from those found in adults. The authors present a case of a 28-day-old neonate with a ruptured distal middle cerebral artery (MCA) aneurysm. Initial noninvasive imaging with transfontanelle ultrasound and CT confirmed intraparenchymal and subarachnoid hemorrhage. Contrast-enhanced MRI revealed a 14-mm ruptured fusiform MCA aneurysm that was not identified on time-of-flight magnetic resonance angiography (MRA)...
March 2, 2018: Journal of Neurosurgery. Pediatrics
Ben A Strickland, Robert C Rennert, Joshua Bakhsheshian, Sebina Bulic, Adrian J Correa, Arun Amar, Joseph Carey, Jonathan J Russin
Surgical revascularization continues to play an important role in the management of complex intracranial aneurysms and ischemic cerebrovascular disease. Graft spasm is a common complication of bypass procedures and can result in ischemia or graft thrombosis. The authors here report on the first clinical use of botulinum toxin to prevent graft spasm following extracranial-intracranial (EC-IC) bypass. This technique was used in 3 EC-IC bypass surgeries, 2 for symptomatic carotid artery occlusions and 1 for a ruptured basilar tip aneurysm...
March 2, 2018: Journal of Neurosurgery
Jong Young Lee, Jong-Hwa Park, Hong Jun Jeon, Dae Young Yoon, Seoung Woo Park, Byung Moon Cho
PURPOSE: A complicated course of the femoral route for neurointervention can prevent approaching the target. Thus, we determined whether transcervical access in the hybrid angiosuite is applicable and beneficial in real practice. METHODS: From January 2014 to March 2017, this approach was used in 17 of 453 (3.75%) cases: 11 cerebral aneurysms (4 ruptured, 7 unruptured), 4 acute occlusions of the large cerebral artery, 1 proximal internal carotid artery (ICA) stenosis, and 1 direct carotid cavernous fistula (CCF)...
March 1, 2018: Neuroradiology
Dipanker Singh Mankotia, Sumit Sinha, Bhawani Shankar Sharma
Mycotic cerebral aneurysms are rare inflammatory aneurysms associated with high mortality and morbidity reaching up to 80% after rupture. We report a case of incidentally diagnosed infective endocarditis presenting with rupture of distal middle cerebral artery mycotic aneurysm and intracerebral hematoma. Aneurysmectomy with clip ligation of the terminal cortical branch and hematoma evacuation was done with good surgical outcome.
January 2018: Asian Journal of Neurosurgery
Hecheng Ren, Lin Ma, Ming Wei, Jialin Li, Mingsheng Yu, Long Yin
RATIONALE: Middle cerebral artery (MCA) anomalies are relatively rare and often related to aneurysms. Familiarity with these anomalies is important in resolving problems that arise in the complex angioarchitecture. Reports often describe that aneurysms that are related to accessory or duplicated MCA are often located at its origin. PATIENT CONCERNS: A 59-year-old man presented with a headache for 10 days, without nausea and vomiting. The physical examination was negative...
March 2018: Medicine (Baltimore)
Ravi N Srinivasa, Rajiv N Srinivasa, Sara Zhao, Joseph J Gemmete, Jacob Bundy, Jeffrey F B Chick
Mycotic aneurysms, which may occur anywhere in the body, may be prone to spontaneous rupture. Antibiotic therapy combined with surgical debridement without or with revascularization has been described as potential treatment options. This report describes a combined balloon occlusion technique with the injection of ethylene-vinyl alcohol copolymer for the treatment of a mycotic aneurysm of the pulmonary artery secondary to infective endocarditis. Similar techniques have been described in the cerebral circulation and may obviate concerns for coil erosion, non-target embolization, or superinfection...
February 2018: Radiology Case Reports
Toshio Baba, Kiyofumi Morishita, Tooru Mawatari, Masami Shingaki, Tsuyoshi Shibata, Kouhei Narayama, Koudai Tsuruta
A 19-year-old male patient was admitted to our hospital after developing infectious endocarditis associated with methicillin-sensitive bovine Staphylococcus aureus septicemia. Brain magnetic resonance imaging confirmed occipital lobe cerebral bleeding. An echocardiogram showed severe mitral regurgitation with vegetation on the posterior mitral leaflet. We performed mitral valve replacement. However, a hepatic artery aneurysm and a ruptured splenic artery aneurysm was found on the 5th postoperative day and coil embolization was accordingly performed...
February 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
J Walter, A W Unterberg, K Zweckberger
Approximately 1% of all patients surviving rupture of a cerebral aneurysm suffer from a second aneurysmatic subarachnoid hemorrhage (aSAH) later on in their lives, 61% of which are caused by rupture of a de-novo aneurysm. Latency between bleedings is usually many years and younger patients tend to achieve better outcomes from a second SAH. We report an unusual case of lethal ultra-early rupture of a de-novo aneurysm of the anterior communicating artery only five months after the initial hemorrhage in a young and healthy male patient...
February 23, 2018: World Neurosurgery
Aziz Waseem, Ismael Ahmed, Shihan Hadeel
BACKGROUND: The neurosurgical management of microcerebral aneurysms with diameter smaller than 3 mm remains a great challenge as many complications can occur. AIM: Our target was to assess the efficacy and usefulness of endovascular treatment of these lesions. METHODS: We did a prospective and retrospective gathering of the results of endovascular treatments for a group of 16 patients with 16 microcerebral aneurysms. Four patients were treated by direct coil embolization, and 12 patients were managed by remodeling techniques...
February 20, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Muhammad AlMatter, Marta Aguilar Péreza, Pervinder Bhogal, Victoria Hellstern, Oliver Ganslandt, Hans Henkes
OBJECTIVES: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high rates of morbidities and fatalities. The continuous evolution of neurosurgical, endovascular and neuro-intensive cares has improved the overall mortality. In this study we sought to evaluate the clinical outcome after aSAH from a single tertiary center. PATIENTS AND METHODS: We retrospectively identified and reviewed all consecutive patients with aSAH treated at our center between 2007 and 2016...
February 13, 2018: Clinical Neurology and Neurosurgery
Alejandro Santillan, Srikanth Boddu, Justin Schwarz, Ning Lin, Y Pierre Gobin, Jared Knopman, Athos Patsalides
Background and purpose This retrospective study evaluates the safety, effectiveness, and long-term clinical and angiographic follow-up of intracranial aneurysms treated with the Low-Profile Visualized Intraluminal Support Junior (LVIS Jr.) stent and parent vessels of diameter equal to or less than 2.5 mm. Materials and methods We included all patients treated with the LVIS Jr. stent in aneurysms with small parent vessel diameter between March 2015 and July 2017. Periprocedural adverse events, immediate aneurysm occlusion rates, and clinical and angiographic follow-up are reported...
January 1, 2018: Interventional Neuroradiology
A V Sergeev
Differential diagnosis of migraine, can be difficult, especially of migraine with aura. On the one hand, some diseases can produce symptoms similar to migraine (cerebral aneurysm before rupture, reversible cerebral vasoconstriction syndrome). On the other hand, migraine with aura and some other disorders are conditions that have common pathophysiological mechanisms (e.g., CADASIL and MELAS syndrome, antiphospholipid syndrome). Thirdly, clinical presentations of migraine are often difficult to distinguish from features of other headache conditions (migraine with aura - transient ischemic attack, migraine with visual aura - occipital epilepsy)...
2018: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
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