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Vaner Koksal, Selim Kayaci
INTRODUCTION: The treatment of giant intracranial aneurysms is one of the most challenging cerebrovascular problems of neurosurgery. We report the rupture of a giant, lobulated, and almost completely thrombosed middle cerebral artery (MCA) aneurysm that is the ninth such report in the literature. We also investigated additional solutions used in the treatment of this patient. CASE PRESENTATION: A 58-year-old man had been admitted with headache 8 years previously (in 2005), and a giant MCA aneurysm was detected...
August 2016: Iranian Red Crescent Medical Journal
Sandeep Kandregula, Amey R Savardekar, B N Nandeesh, A Arivazhagan, Malla Bhaskar Rao
Giant hypothalamic hamartomas (GHH) are extremely rare lesions in infants and usually intrinsically epileptogenic. We present the case of a 10-month-old girl child presenting with drug-resistant seizures and a giant hypothalamic lesion that was confirmed as hamartoma on histopathology. Surgical decompression and disconnection from the hypothalamus was performed with the intent of controlling her seizures. Unfortunately, the patient developed right middle cerebral artery and posterior cerebral artery territory infarction, possibly due to vasospasm or thrombosis of the vessels...
October 26, 2016: Pediatric Neurosurgery
Mohammad Ali Ostovan, Mahdi Sajedi Khanian, Sahand Hamidi, Mostafa Fattahi, Pooyan Dehghani
Spontaneous coronary artery vasospasm is one of the important causes of acute chest pain syndromes. The diagnosis of diffuse multifocal spasm can be quite challenging and it could be easily mistaken for diffuse coronary artery disease. The use of intracoronary nitroglycerin can relieve spasm and reveal the real extent of coronary artery disease. Herein we present a case presenting with acute myocardial infarction due to severe coronary artery spasm that had even received fibrinolytic therapy. Multiple narrowing was shown during coronary angiography and the patient was scheduled for percutaneous coronary intervention (PCI)...
2016: Journal of Cardiovascular and Thoracic Research
Apar S Patel, Christoph J Griessenauer, Raghav Gupta, Nimer Adeeb, Paul M Foreman, Hussain Shallwani, Justin M Moore, Mark R Harrigan, Adnan H Siddiqui, Christopher S Ogilvy, Ajith J Thomas
INTRODUCTION: Cerebral vasospasm following subarachnoid hemorrhage (SAH) is the single most important cause of neurological decline following successful treatment of the ruptured aneurysm. Here, we report safety and efficacy of non-compliant balloon angioplasty for the treatment of cerebral vasospasm. METHODS: Three major academic institutions in the United States provided data on cerebral vasospasm treated with non-compliant balloon angioplasty between October 2004 and February 2016...
October 21, 2016: World Neurosurgery
Daniel Dubinski, Sae-Yeon Won, Jürgen Konczalla, Jan Mersmann, Christof Geisen, Eva Herrmann, Volker Seifert, Christian Senft
OBJECTIVE: Rupture of an intracranial aneurysm usually presents with an acute onset, requires multidisciplinary intensive care treatment, and the overall death and disability rates are high. The ABO blood type is known to play an important role in hemostasis, thrombosis and vascular NO response. The aspect of ABO blood type in onset, clinical progress and outcome after SAH are to date largely unexplored. We conducted this study to elucidate the association of ABO blood type on the occurrence and outcome of aneurysmal SAH...
October 21, 2016: World Neurosurgery
Zenghui Qian, Xin Feng, Huibin Kang, Xiaolong Wen, Wenjuan Xu, Fei Zhao, Chuhan Jiang, Zhongxue Wu, Youxiang Li, Aihua Liu
BACKGROUND: Recent studies have reported the use of stent-assisted coiling (SAC) for wide-necked aneurysms in patients with acute subarachnoid hemorrhage (SAH). This study attempted to determine whether it is safe and efficient to use SAC for wide-necked aneurysms during post-SAH days 4-10. METHODS: We reviewed 126 consecutive patients with ruptured wide-necked aneurysms who underwent SAC. The patients were classified into the early cohort (SAC was performed within post-SAH days 0-3) and late cohort (SAC was performed within post-SAH days 4-10)...
October 21, 2016: World Neurosurgery
Kristin L Garlanger, Elena J Jelsing, Jonathan T Finnoff
A 33-year-old elite female runner presented to a tertiary care sports medicine clinic with a 2-year history of progressive anterior thigh and circumferential leg pain with associated foot paresthesias brought on by high-intensity running. She had both external iliac artery vasospasm and chronic exertional compartment syndrome. External iliac artery vasospasm is a rare cause of exertional leg pain, particularly in the running population. This case highlights the unique features of this condition, addresses the multidisciplinary approach that led to the accurate diagnoses, and demonstrates that more than 1 etiology for exertional leg pain can coexist in an athlete...
October 19, 2016: Sports Health
Davide Croci, Edin Nevzati, Hiroki Danura, Salome Schöpf, Javier Fandino, Serge Marbacher, Carl Muroi
BACKGROUND: In subarachnoid hemorrhage (SAH), occurrence of cerebral vasospasm (CVS) mediated by endothelin (ET)-1 might be a result of a compartmental inflammatory response with interleukin (IL)-6 release. We aim to investigate the relationship between ET-1 and IL-6 in association of CVS. METHODS: A total of 24 New Zealand white rabbits where randomly allocated into 3 groups: SAH (n=10), IL-6 (n=10), and sham (n=4). SAH was induced by a closed cranium extracranial-intracranial shunt model...
October 19, 2016: Journal of Neurosurgical Sciences
Yarelis Alvarado Reyes, Alexandra Perez, Gloria Rodriguez-Vega
OBJECTIVE: Vitamin D deficiency has been associated with increased risk and adverse outcomes in many clinical settings including cardiovascular disease, stroke, and critically ill patients. Therefore we aimed to determine whether vitamin D deficiency had any effect in aneurysmal subarachnoid hemorrhage (aSAH) clinical outcomes. METHODS: A retrospective record review was conducted in a tertiary community hospital in Puerto Rico. Adult patients admitted to the neurosurgical intensive care unit (NICU) with a diagnosis of aSAH from January 2013 to July 2014, who had a 25-hydroxyvitamin-D level drawn, were included...
October 15, 2016: World Neurosurgery
Pedro A Villablanca, David F Briceno, Anand D Jagannath, Martin Cohen, Robert Pyo
Coronary vasospasm is uncommon during pregnancy and the postpartum period. We present a very rare case of an acute coronary vasospasm in a 36-year-old woman who was two weeks postpartum. The coronary arteriograms showed a coronary vasospasm in the distal left anterior descending and circumflex coronary arteries. Electrocardiogram (ECG) presentation was atypical, with T-wave inversions in leads I, aVL, and V2 to V6. To our knowledge, this is the first case with a well-documented coronary artery vasospasm in a postpartum woman without the classic ST elevation on ECG...
October 18, 2016: Acute Cardiac Care
Harvey J Woehlck, Brent T Boettcher, Kathryn K Lauer, David C Cronin, Johnny C Hong, Michael A Zimmerman, Joohyun Kim, Motaz Selim
Systemic vasoplegia is common in patients undergoing liver transplantation. In this report, we present a case in which treatment with conventional vasopressors caused peripheral arterial spasm, rendering arterial blood pressure monitoring impossible. Administration of methylene blue resolved the vasospasm; however, concern for toxic dose requirements limited its use. Hydroxocobalamin administration resolved the vasospasm and increased blood pressure without the potential adverse effects seen with methylene blue...
October 5, 2016: A & A Case Reports
Timo-Benjamin Baumeister, Ingo Wickenbrock, Christian A Perings
Methylphenidate (Ritalin(®)) is an increasingly used medication in the treatment of attention-deficit hyperactivity disorder (ADHD). Cardiovascular adverse effects like vasospasm or myocardial infarction are described as very rare adverse effects. We present the case of a 21-year-old man diagnosed with ADHD who recently started therapy with Ritalin(®) Adult 20 mg for at least 3 days. Afterwards he presented with chest pain, elevated troponin and creatine kinase, and posterolateral ST elevations. A myocarditis was initially supposed...
December 2016: Drug Saf Case Rep
Laurence Ducharme-Crevier, Michele G Mills, Priya M Mehta, Craig M Smith, Mark S Wainwright
BACKGROUND: The primary objective of this study was to characterize changes in cerebral blood flow measured using transcranial Doppler in children with central nervous system infections. We hypothesized that children with central nervous system infections have abnormal cerebral blood flow, associated with a greater frequency of complications and poor neurological outcome. METHODS: We conducted a single-center, retrospective study of children admitted to the neonatal or pediatric intensive care unit with central nervous system infection and undergoing transcranial Doppler as part of routine care between March 2011 and July 2015...
September 4, 2016: Pediatric Neurology
Michael A Bohl, James Forseth, Peter Nakaji
BACKGROUND: Arginine vasopressin (AVP) is a common second-line or third-line vasopressor used in critically ill neurosurgical patients. Neurosurgical indications include hyperdynamic therapy for vasospasm, maintenance of cerebral perfusion pressure in patients with intracranial hypertension, and prevention of hypotension in patients with sepsis. CASE DESCRIPTION: A series of six neurosurgical patients receiving AVP infusions developed severe but transient diabetes insipidus (tDI) after cessation of AVP...
October 11, 2016: World Neurosurgery
Qiang Li, Yujie Chen, Xuan Zhang, Shilun Zuo, Hongfei Ge, Yanyan Chen, Xin Liu, John H Zhang, Huaizhen Ruan, Hua Feng
Angiographic vasospasm, especially in the early phases (<72h) of subarachnoid hemorrhage (SAH), is one of the major complications after an aneurysm rupture and is often the cause of delayed neurological deterioration. Scutellarin (SCU), a flavonoid extracted from the traditional Chinese herb Erigeron breviscapus, has been widely accepted as an antioxidant, but the effect of SCU on vasospasm after SAH remains elusive. Endovascular perforation was conducted to induce SAH in Sprague-Dawley rats. Then, the underlying mechanism of the anti-vasospasm effect of SCU was investigated using a modified Garcia scale, India ink angiography, cross-sectional area analysis, immunohistochemistry staining and western blot...
October 11, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Cong Qian, Xiaobo Yu, Jingyin Chen, Chi Gu, Lin Wang, Gao Chen, Yuying Dai
BACKGROUND AND OBJECTIVES: Vasospasm-related injury such as delayed ischemic neurological defect (DIND) or cerebral infarction is an important prognostic factor for aneurismal subarachnoid hemorrhage (SAH). Whether cerebrospinal fluid (CSF) drainage can achieve a better outcome in aneurismal SAH patients after coiling or clipping remains the subject of debate. Here, we report a meta-analysis of the related available literature to assess the effect of continuous CSF drainage on clinical outcomes in patients with aneurismal SAH...
October 2016: Medicine (Baltimore)
Georgios Tsivgoulis, Andrei V Alexandrov
PURPOSE OF REVIEW: Low cost, avoidance of irradiation, and high temporal resolution are inherent advantages of ultrasound imaging that translate into multiple clinical uses in many domains of neurology. This article presents clinical uses of ultrasound examination in cerebrovascular, neurodegenerative, and peripheral nervous system diseases. RECENT FINDINGS: Modern treatment and prevention of ischemic stroke rely on prompt diagnosis. Ultrasonography has found a place as a noninvasive screening test and bedside technique that provides estimates of the degree of stenosis as well as hemodynamic and structural information about intracranial and extracranial vessels in real time...
October 2016: Continuum: Lifelong Learning in Neurology
Makarand Kulkarni, Vinay Chauhan, Sudheer Shetty
Reversible cerebral vasoconstriction syndrome (RCVS) is a disease characterized by thunderclap headache with severe vasospasm of middle sized vessels of circle of Willis or the extracranial circulation which spontaneously revert back. We report a middle aged female with severe headache and vasospasm of the vertebral arteries and vessels of circle of Willis causing multiple cerebral infarcts. The vasospasm resolved within 3 months.
June 2016: Journal of the Association of Physicians of India
Fumihiro Kawakita, Masashi Fujimoto, Lei Liu, Fumi Nakano, Yoshinari Nakatsuka, Hidenori Suzuki
Toll-like receptor 4 (TLR4) signaling may play a crucial role in the occurrence of cerebral vasospasm after subarachnoid hemorrhage (SAH). The main purpose of this study was to assess if selective blockage of TLR4 on cerebral arteries prevents cerebral vasospasm development and neurological impairments after SAH in mice. One hundred fourteen mice underwent endovascular perforation SAH or sham operation and were randomly divided into the following 6 groups: sham+vehicle, sham+LPS-RS ultrapure 8 μg, sham+LPS-RS ultrapure 40 μg, SAH+vehicle, SAH+LPS-RS ultrapure 8 μg, and SAH+LPS-RS ultrapure 40 μg...
October 13, 2016: Molecular Neurobiology
Charles L Francoeur, Stephan A Mayer
For patients who survive the initial bleeding event of a ruptured brain aneurysm, delayed cerebral ischemia (DCI) is one of the most important causes of mortality and poor neurological outcome. New insights in the last decade have led to an important paradigm shift in the understanding of DCI pathogenesis. Large-vessel cerebral vasospasm has been challenged as the sole causal mechanism; new hypotheses now focus on the early brain injury, microcirculatory dysfunction, impaired autoregulation, and spreading depolarization...
October 14, 2016: Critical Care: the Official Journal of the Critical Care Forum
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