• World Neurosurg · Jul 2017

    Case Reports

    Quantitative susceptibility mapping as a possible tool to radiographically diagnose sentinel headache associated with intracranial aneurysm: Case report.

    • Daichi Nakagawa, Cameron Cushing, Yasunori Nagahama, Lauren Allan, and David Hasan.
    • Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Department of Biomedical Engineering, Seamans Center for the Engineering Arts and Sciences, University of Iowa, Iowa City, Iowa, USA.
    • World Neurosurg. 2017 Jul 1; 103: 954.e1-954.e4.

    BackgroundSentinel headache (SH) occurs before aneurysm rupture in an estimated 15%-60% of cases of aneurysmal subarachnoid hemorrhage (aSAH). By definition, noncontrast computed tomography (CT) scan of the brain and lumbar puncture are both negative in patients presenting with SH. One of the theories explaining this phenomenon is that microhemorrhage (MH) from the aneurysm wall contribute to iron deposition in the interface between the aneurysm wall and brain parenchyma. Quantitative susceptibility mapping (QSM) is a recently introduced magnetic resonance imaging (MRI) technique that has proven capable of localizing the deposition of paramagnetic metals, particularly ferric iron. Thus, the QSM sequence may be able to detect iron deposition secondary to MH.Case DescriptionA 76-year-old male presented with the "worst headache of my life." Noncontrast head CT scan and lumbar puncture were negative. Magnetic resonance angiography (MRA) of the brain revealed an anterior communicating artery (A-com) aneurysm measuring 7 mm with a large bleb. T1-weighted imaging (WI), T2-WI, MRA, T2 star-weighted angiography (SWAN), and QSM sequences were obtained. T2-WI, SWAN, and QSM revealed isointense, hypointense, and hyperintense signals, respectively, at the interface of the aneurysm wall and brain tissue. These findings were consistent with deposition of ferric iron at this interface. The A-com aneurysm was treated with coil embolization, and the patient exhibited no postoperative deficits.ConclusionsThe MRI QSM sequence can localize iron deposition resulting from MH within an aneurysmal wall. This sequence may be a promising imaging tool for screening patients presenting with SH.Copyright © 2017 Elsevier Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…