No shinkei geka. Neurological surgery
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Review Case Reports
[A case of de novo aneurysm of the distal posterior inferior cerebellar artery with intraventricular hemorrhage].
A case is presented of a de novo aneurysm of the distal posterior inferior cerebellar artery with intraventricular hemorrhage. A 67-year-old woman was admitted to our hospital with sudden onset of severe headache and loss of consciousness. Computed tomography (CT) scans showed subarachnoid hemorrhage. ⋯ In this case, the right posterior inferior cerebellar artery disappeared when the de novo aneurysm was found. So it is supposed that hemodynamic changes caused by the clipping of the right vertebral-posterior inferior cerebellar aneurysm and the left middle cerebral aneurysm had contributed to the formation of the de novo aneurysm of the left distal posterior inferior cerebellar artery. In the present study, we review the literature on the aneurysm at the distal posterior inferior cerebellar artery and on the de novo aneurysm of the vertebrobasilar artery, and discuss the radiological findings and features.
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Review Case Reports
[Simultaneous rupture of multiple intracranial aneurysms: a case report].
A rare case of simultaneous rupture of multiple aneurysms is reported. A 68-year-old man presented severe headache and vomiting and was transferred to our hospital. CT scan showed subarachnoid hemorrhage (SAH) in the interhemispheric fissure, the right basal cistern, the right sylvian fissure and intracerebral hemorrhage (ICH) in the paraventricle area. ⋯ These findings suggested that SAH was due to a ruptured aneurysm of A-com, and ICH was due to a ruptured aneurysm of the distal portion of MCA. Simultaneous rupture of multiple aneurysms was confirmed by surgical findings. This case indicates that the usual assumption of a single aneurysm rupture in a patient with multiple aneurysms may be erroneous.
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Thirty-five cases of unilateral acoustic neurinomas were analyzed with special reference to the postoperative eighth cranial nerve function. An additional three cases of bilateral acoustic neurinomas associated with neurofibromatosis were also analyzed. Out of a total of 40 neurinomas in all, 38 cases were retrospectively reviewed. ⋯ In conclusion, hearing preservation can be expected after removal of the acoustic neurinomas under the following situations; hearing acuity of less than 50-60dB in preoperative pure tone audiogram, tumor size of less than 20 mm in maximum diameter, cases with preservation of cochlear nerve and of the internal auditory artery during the operation, and no injury to the labyrinth during the operation. In some cases, tinnitus becomes aggravated in the case with cochlear nerve preservation associated with unserviceable hearing. Furthermore, the degree of tinnitus shows a decrease as postoperative hearing improves in some cases.
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We reported a case of juvenile cerebral infarction following minor head injury. The patient, a 12-year-old girl, developed right hemiparesis and aphasia almost immediately after having fallen from about 1 meter height during the exercise class at school. CT and MRI study showed lacunar lesions bilaterally and almost symmetrically in the paraventricular deep white matter on both sides. ⋯ She made a rapid recovery during her hospital stay and showed no more than a slight motor weakness in her right upper extremity on discharge. The literature was reviewed on the embryology of the aortic arch and brachiocephalic arteries. We speculate that the lacunar lesions found bilaterally are dilated large normal Virchow-Robin space, and the pathogenesis of the stroke in this patient was discussed.
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The patient was a 71-year-old female. On December 20, 1995, she suddenly developed a severe headache with vomiting and was transferred to our hospital. On admission, her conciousness level was 1-2 on the Japan Coma Scale, but there was no neurological deficit except for right oculomotor palsy. ⋯ Oculomotor palsy may have delayed the detection of the recurrence of the aneurysm. When residual neck is presented on follow-up angiography, the next angiography should be carried out within at least three years. In this case, antiplatelet therapy was effective to prevent thromboembolism from the aneurysm.