Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsDelayed post-traumatic pseudoaneurysmal formation of the intracranial ophthalmic artery after closed head injury. Case report.
A 42-year-old male presented with a rare case of delayed aneurysmal formation of the intracranial ophthalmic artery after closed head injury manifesting as subarachnoid hemorrhage. Initial magnetic resonance angiography revealed no aneurysmal formation, but angiography 7 days after the injury demonstrated an intracranial ophthalmic artery aneurysm. Follow-up computed tomography angiography demonstrated enlargement of the aneurysm. ⋯ Traumatic intracranial aneurysm (TICA) is rare and usually occurs in the peripheral arteries of the cerebral circulation or the basal portion of the internal carotid artery. The present case shows that failure to demonstrate an aneurysm on the initial angiography in the acute stage does not exclude the presence of traumatic aneurysm. This case clearly shows the time course of development of a TICA of the ophthalmic artery after closed head injury.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsTailored flow alteration treatment for intracranial internal carotid artery aneurysms: strategy beyond parent artery occlusion with bypass. Case report.
A 58-year-old woman with multiple right internal carotid artery (ICA) aneurysms detected incidentally was referred to us. Three-dimensional computed tomography (CT) angiography revealed a broad-necked paraclinoid aneurysm and an aneurysm on the C(1) segment. Aneurysm clipping with preservation of the anterior choroidal artery and posterior communicating artery was not possible because these vessels could not be adequately identified. ⋯ Reversal of the blood flow in the ICA via the EC-IC bypass primarily into the ophthalmic artery as the flow outlet by obliterating the cervical portion of the ICA was successful. To prevent ischemia in the territory fed by the perforating arteries of the ICA, tailored flow alteration treatment may be superior to simple parent artery occlusion of the ICA with/without bypass. The pattern of flow alteration should be deliberately based on individual anatomic variations, especially the preservation of flow outlets.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Subarachnoid hemorrhage complicated with neurogenic pulmonary edema and takotsubo-like cardiomyopathy.
Patients with poor-grade subarachnoid hemorrhage (SAH) are often complicated with acute cardiopulmonary dysfunctions, particularly neurogenic pulmonary edema (NPE) and takotsubo-like cardiomyopathy (TCM). This study retrospectively investigated the incidence, demographics, clinical characteristics, and outcomes of patients with SAH complicated with both NPE and TCM (NPE-TCM). The effects of aneurysm location and other clinical variables on the incidence of NPE-TCM were also investigated. ⋯ Patients with ruptured posterior circulation aneurysm may have elevated risk of developing NPE-TCM. Endovascular obliteration of the aneurysm may be preferable to open surgery, but the optimal treatment modality needs to be evaluated further. Considering the limited number of SAH patients complicated with NPE-TCM, a multi-center cooperative study may be required.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Lessons learned from moyamoya disease: outcome of direct/indirect revascularization surgery for 150 affected hemispheres.
Moyamoya disease is a chronic, occlusive cerebrovascular disease with unknown etiology characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Recent advances in molecular biology and genetic research have provided better understanding of the pathophysiology of moyamoya disease, but surgical revascularization still remains the preferred treatment for this entity. The present study investigated the clinical course of 106 consecutive patients with moyamoya disease who underwent superficial temporal artery-middle cerebral artery anastomosis with indirect pial synangiosis in 150 hemispheres. ⋯ Despite the favorable long-term outcome, the incidence of temporary neurological deterioration due to cerebral hyperperfusion was 18.0% (27/150), but no patients suffered permanent neurological deterioration directly caused by hyperperfusion. In conclusion, direct/indirect revascularization surgery is a safe and effective treatment for moyamoya disease, although the issue of bleeding/re-bleeding remains to be solved. Postoperative cerebral hyperperfusion and peri-operative infarction are potential complications of this procedure, so we recommend intensive postoperative care and cerebral blood flow measurement in the acute stage, because the management of hyperperfusion is contradictory to that of ischemia.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Surgical treatment of Spetzler-Martin grade III to V cerebral arteriovenous malformations: 10 years experience in Kyoto University.
Cerebral arteriovenous malformations (AVMs) are abnormal connections between arteries and veins leading to arteriovenous shunting with nidus formation. This study reviewed the clinical outcomes of surgical treatment for AVMs of Spetzler-Martin grades III to V in our institute. ⋯ Excellent outcomes were obtained, but about 40% of all patients with AVMs could not receive surgical treatment. Multimodality approach including Onyx embolization may extend the surgical indications.