An eighty-four-year-old man was admitted to the hospital because of pain at rest in the lower extremities. On physical examination, trophic changes of the skin and petechiae in the limbs were observed. Computed tomographic scan of the abdomen showed focal renal infarctions and calcification of the descending aorta. Moreover, radionuclide ...

Aneurysmal subarachnoid hemorrhage (SAH) affects approximately 30,000 people each year in North America. At least 30% of these patients will develop vasospasm as a result of the initial hemorrhage, and two thirds of these develop permanent disabilities or die. Blood deposited into the basal cisterns from the ruptured aneurysm can ...

Reports of intraarterial papaverine infusion as treatment for cerebral vasospasm are few and documented complications are uncommon. The authors report the case of a patient with paradoxical aggravation of cerebral arterial narrowing during selective intraarterial papaverine infusion intended to treat vasospasm following aneurysmal subarachnoid hemorrhage (SAH). A 48-year-old man presented ...

Little information exists on the utility of transcranial Doppler sonography (TCD) in detecting anterior (ACA) and posterior cerebral artery (PCA) vasospasm following subarachnoid hemorrhage. During the period at risk for vasospasm, 53 patients with subarachnoid hemorrhage who had technically adequate TCD performed within 24 hours of cerebral angiography, allowing evaluation ...

This is a prospective study reporting the impact of angiographic vasospasm on the outcome following aneurysmal subarachnoid haemorrhage utilising a common regimen that includes nimodipine and angioplasty. The first 100 patients suffering an aneurysmal subarachnoid haemorrhage treated by surgery and this angioplasty driven protocol are reviewed. Angiography was performed if ...

Autosomal dominant polycystic kidney disease (ADPKD) is associated with increased prevalence of cerebral aneurysms and increased risk of subarachnoid hemorrhage. A decision analysis by Levey et al. in 1983 demonstrated that patients with ADPKD would not significantly benefit from routine arteriographic screening for cerebral aneurysms. We reexamined this conclusion in ...

Intracavernous carotid artery aneurysms usually cause symptoms because of gradual expansion without rupture. Most such aneurysms that do rupture lead to a carotid-cavernous fistula. Very few cases of rupture leading to subarachnoid hemorrhage have been reported. We report a case in which rupture of an entirely intracavernous carotid artery aneurysm ...

The case is presented of a 37-year-old man with spontaneous thrombosis of a 10-mm left posterior communicating artery aneurysm, following presumed subarachnoid hemorrhage with negative angiography. Sequential magnetic resonance angiography and magnetic resonance source imaging (at 2 weeks, 3 months, 2 years, and 2 years, 5 months) showed progressive shrinkage ...

BACKGROUND: Acute hydrocephalus is a potentially treatable cause of early neurological deterioration after aneurysmal subarachnoid hemorrhage (SAH). METHODS: A retrospective study of 105 consecutive cases of aneurysmal SAH was undertaken to determine those factors significantly related to the development of acute hydrocephalus. Acute hydrocephalus was diagnosed when the bicaudate index ...

Before nimodipine was introduced as a standard treatment in patients with aneurysmal subarachnoid haemorrhage (SAH) females had a significantly poorer outcome which might be due to a higher frequency of delayed cerebral ischaemia (DCI). We evaluated the overall outcome with regard to gender in 188 consecutive patients with a verified ...

We report a case of a 32-year-old man who presented with subarachnoid hemorrhage. As revealed by lumbar puncture, the cerebrospinal fluid had low glucose, high protein levels, and pleocytosis with 5% of eosinophils. Cultures were negative. Enzyme-linked immunosorbent assay and complement fixation reactions for cysticercosis in cerebrospinal fluid were positive. ...

Cerebral ischemia associated with subarachnoid hemorrhage may have severe consequences for neuronal functioning. The excitatory amino acid neurotransmitters glutamate and aspartate have been shown to be of particular importance for ischemia and ischemic neuronal damage. For seven patients who underwent early surgery for ruptured intracranial aneurysms, intracerebral microdialysis of glutamate ...

INTRODUCTION: Transcranial color-coded sonography (TCCS) allows imaging of basal cerebral arteries as well as brain parenchyma. It may therefore serve to monitor thrombolysis in acute stroke. CASE DESCRIPTION: rt-PA thrombolysis was performed in a patient, suffering from paradoxical embolism causing MCA occlusion. Hemorrhage immediately after completion of rt-PA infusion as ...

A woman with a refractory locally advanced recurrent cervical cancer was brought to the emergency room because of a life-threatening vaginal hemorrhage from the tumor. She presented with a compromised hemodynamic status that necessitated multiple blood transfusions and large volume of fluid resuscitation. An arteriogram revealed the site of bleeding ...

Little is known about the accuracy of transcranial Doppler (TCD) sonography in detecting intracranial internal carotid artery (IICA) and middle cerebral artery (MCA) vasospasm. TCD was performed in 49 patients with subarachnoid hemorrhage to evaluate 90 IICAs and 87 MCAs during the vasospasm period. When a mean velocity of at ...

A 71-year-old female presented with posttraumatic occlusion of the anterior cerebral artery (ACA) after a road accident in which she was hit in the mid-frontal region. Initial computed tomography (CT) demonstrated frontal skull fractures and pneumocephalus. High density areas were also identified in the right basal cisterns, suggesting traumatic subarachnoid ...

To delineate the distinctive features of familial subarachnoid hemorrhage, we compared gender and age at the time of subarachnoid hemorrhage, as well as site and number of aneurysms, in patients with familial subarachnoid hemorrhage (at least 1 first-degree relative with subarachnoid hemorrhage) and patients with sporadic subarachnoid hemorrhage (no subarachnoid ...

The case of a 24-year-old patient with severe post-partum hemorrhage resistant to medical therapy is reported. Active bleeding was documented on CT and confirmed by angiography. Selective embolization of the cervico-uterine artery promptly stopped the bleeding. Selective embolization is recommended as the treatment of choice for intractable post-partum hemorrhage.

This study examined the relationship between papaverine-sensitive and -insensitive components of vasospasm, arterial contractility and compliance, and time after subarachnoid hemorrhage (SAH) in dogs. Eighteen dogs underwent angiography and then two intracisternal injections of blood. Angiography was repeated 4 (n = 5), 7 (n = 4), 10 (n = 4), ...

A rare case of blunt chest trauma resulting in internal mammary artery hemorrhage and cardiac tamponade is presented. Thoracotomy revealed anterior mediastinal hemorrhage but no pericardial hematoma. The significance of chest wall vessel hemorrhage as a cause of widened mediastinum is reiterated. The importance of accurate angiographic assessment and vigilant ...

BACKGROUND: A new technique using intravascular ultrasound has been used for diagnosis of coronary artery in order to obtain intravascular echo images. In this study, an intracisternally positioned ultrasound catheter was introduced obtaining serial echo images of the first segment (MI) of the middle cerebral artery in order to detect ...

BACKGROUND: The purpose of this study is to investigate whether rapid spontaneous diminution of cisternal subarachnoid hemorrhage (SAH) alleviates vasospasm in the corresponding arterial territory. METHODS: The subjects were 103 patients in whom initial computed tomography scans were performed within 24 hours after SAH and repeated within 72 hours. We ...

Posttraumatic cerebral arterial spasm (vasospasm) has been demonstrated in the past by angiography, and recently by transcranial Doppler ultrasonography. Posttraumatic vasospasm is a delayed complication that involves the large basal intracranial arteries (e.g., internal carotid, middle cerebral, basilar) and occurs in 25-40% of head trauma patient. The time course of ...

Selective intraarterial infusion of papaverine is used in the treatment of symptomatic cerebral vasospasm. The authors report two episodes of severe thrombocytopenia in a patient that were related to intraarterial administration of papaverine. A 70-year-old man with a right internal carotid artery aneurysm underwent craniotomy and aneurysm clipping. He became ...

Hemorrhage is one of the most frequent complications after dilation and evacuation. A small fraction of patients with hemorrhage will not respond to standard therapies. We discuss a case where both reaspiration and standard pharmacologic therapy failed to control hemorrhage and where hemorrhage was ultimately controlled by tamponade with two ...

Thirty-one monkeys were randomly divided into three groups to undergo baseline cerebral angiography followed by induction of subarachnoid hemorrhage by placement of autologous blood clot along the right-sided arteries of the anterior circle of Willis (Day 0). The monkeys were then given drug vehicle or one of two endothelin (ET) ...

BACKGROUND: Late neurologic deterioration following subarachnoid hemorrhage is often due to vasospasm and rebleeding. Although the sudden onset of a focal neurologic deficit can actually be the result of thromboembolism, anticoagulation has rarely been used in such cases. METHODS: We report a case of a 55-year-old woman who developed recurrent ...

We present a case of subarachnoid and intraventricular hemorrhage due to an infratentorial metastasis of a renal cell carcinoma. The lesion was not apparent on initial magnetic resonance imaging (MRI) or in a follow-up examination (MRI and angiography) 6 weeks after the bleeding. The innocent bilateral posterior communicating artery aneurysms ...

A 77-year-old female presented with a rare aneurysmal subarachnoid hemorrhage accompanied by a remote hypertensive intracerebral hemorrhage. With a past history of hypertension, she suddenly developed right hemiparesis followed by delayed loss of consciousness. Left carotid angiography demonstrated a left internal carotid-posterior communicating artery aneurysm. The intracerebral hematoma was located ...

BACKGROUND: Cerebral vasospasm following subarachnoid hemorrhage (SAH) is one of the leading factors that deteriorate the clinical outcome after aneurysmal surgery. Percutaneous transluminal angioplasty (PTA) is a method to directly dilate the constricted vessel using the intravascular neurosurgical technique. METHODS: Angiographic, histologic, and pharmacologic evaluations related to PTA are presented, ...

Twelve patients with Hunt and Hess neurological Grades III to V underwent thrombosis of aneurysms using cellulose acetate polymer within 23 hours of aneurysm rupture. On computerized tomography (CT), nine of these patients had difuse or localized thick subarachnoid blood clots, two had diffuse thin clots and one had intraventricular ...

The source of bleeding remains obscure in most cases of subarachnoid hemorrhage (SAH) with a negative angiogram. From January 1, 1989, to July 1, 1993, 40 patients were admitted to the Massachusetts General Hospital with angiogram-negative SAH; 9 of these patients underwent surgical exploration. In seven of these explorations, an ...

A 58-year-old female, who had suffered from Weber-Christian disease for 26 years, presented with subarachnoid hemorrhage. Cerebral angiography showed dilatation of the basilar tip. An operation was performed in the chronic stage. The wall of dilated basilar artery was tough, but that of the right superior cerebellar artery was very ...

Endothelin (ET) may play a role in vasospasm after subarachnoid hemorrhage (SAH). The aim of our study was to test whether the systemic administration of bosentan, a nonpeptidic ET(A) and ETB receptor antagonist, could reverse vasospasm without inducing hypotension. In rabbits (single-hemorrhage model) and in dogs (double-hemorrhage model), SAH was ...

Following the Exxon Valdez oil spill, 347 oiled sea otters (Enhydra lutris) were treated in rehabilitation centers. Of these, 116 died, 94 within 10 days of presentation. Clinical records of 21 otters dying during the first 10 days of rehabilitation were reviewed to define the laboratory abnormalities and clinical syndromes ...

We analyzed 26 autopsy cases of cocaine induced intracerebral hemorrhage and compared those findings with those of 26 autopsy cases of cocaine induced cerebral aneurysm rupture. The incidence of hypertensive cardiovascular disease (HCVD) was significantly higher in persons with intracerebral hemorrhage than in those with aneurysm rupture. Our findings suggest ...

The phosphorylation of an M(r) 20,000 myosin light chain (MLC20) promotes the generation of contractile force through actin-myosin adenosine triphosphatase in most agonist-mediated vascular smooth muscle cell contraction. However, the role of calcium-mediated contractile processes in sustained arterial narrowing after subarachnoid hemorrhage remains unknown. In a femoral artery model of ...

A rare case of Aspergillus aneurysm of the central nervous system (CNS) leading to subarachnoid hemorrhage (SAH) is reported. An 83-year-old woman developed visual disturbance and headache. Computed tomographic scans showed no evidence of aneurysm or tumor in the intracranium. She suddenly died from SAH. Autopsy revealed massive SAH due ...

BACKGROUND AND PURPOSE: Although there is much speculation regarding the source of bleeding in patients with subarachnoid hemorrhage when no angiographic abnormality is found, little direct evidence has been obtained to document a cause. We report two cases of stroke in the distribution of a perforating or lenticulostriate artery occurring ...

Cerebral arterial vasospasm continues to be a major secondary medical complication of aneurysmal subarachnoid hemorrhage. Despite hypervolemic hemodilution, arterial hypertension, and pharmacological therapy, morbidity and mortality due to vasospasm remain high. The authors discuss a patient with vasospasm who did not respond to traditional medical therapy and who underwent intra-arterial ...

BACKGROUND: It is well-known that arachnoid cysts of the middle fossa are associated often with chronic subdural hematomas and/or intracystic hemorrhages. However, reports of an arachnoid cyst associated with an aneurysm are rare. CASE DESCRIPTION: A 45-year-old man was admitted with headache due to intracystic hemorrhage in the sylvian fissure, ...

We present the MR findings in three neurologically symptomatic newborns after vacuum extraction delivery. The lesions included subdural hematomas, one tentorial hematoma, and one intracerebellar hemorrhage. One patient had hydrocephalus that required shunting. We propose that the visualized abnormalities are probably the result of vertical stress leading to laceration of ...

This article describes a woman with hemorrhagic telangiectasia, or Osler-Weber-Rendu disease, with recurrent nosebleeds despite prior septal dermoplasty and laser treatments. Telangiectasias were clearly shown at the time of angiography. Embolization of abnormal vessels on both sides resulted in cessation of epistaxis for many months. Bilateral studies are important, even ...

Neurofibromatosis can involve the mediastinum. A 44-year-old woman with a dumbbell-shaped mediastinal mass developed a large pleural effusion, respiratory failure and fatal hemoptysis. Autopsy revealed systemic neurofibromatosis involving the mediastinum and pleura. Mediastinal and pleural hemorrhage probably occurred as a result of an eroded thoracic artery. Massive hemorrhage in mediastinal ...

In 40 patients middle cerebral artery trunk (M1) flow velocity was recorded just before 54 carotid angiography in 54 cases exhibiting vasospasm after aneurysm rupture. Angiographic vasospasm distribution was studied; cases of symptomatic vasospasm were noted and were compared with transcranial Doppler data. Angiographic vasospasm was present in M1 in ...

A possible mechanism for the induction of protein kinase C (PKC)-dependent vascular contraction independent to the increase of intracellular Ca++ was investigated in the pathogenesis of cerebral vasospasm in the double subarachnoid haemorrhage (SAH) model. The level of 1,2-diacylglycerol (DAG), which is an intrinsic PKC activator, significantly increased from days ...

OBJECTIVE: Clinicopathologic evaluation of patients with lower extremity paraparesis/-plegia following rupture and repair of anterior communicating artery (ACoA) aneurysms. DESIGN: Institution-based retrospective review. SETTING: A tertiary neurologic referral center. PATIENTS, PARTICIPANTS: Seven of 101 patients with subarachnoid hemorrhage from ruptured ACoA aneurysms treated between January 1987 and December 1992. MAIN ...

A case of a ruptured dissecting aneurysm of the vertebral artery, which was detected by repeated angiography (third time), is reported. A 59-year-old woman, whose preoperative angiogram showed no abnormality, underwent a bifrontal craniotomy and the total removal of the right frontal glioma. However, a subarachnoid hemorrhage was detected by ...

A review of the literature on cerebral vasospasm after aneurysmal subarachnoid haemorrhage (SAH) has shown that angiographic vasospasm occurs in 67.3% of cases when angiography is timed for the highest likelihood, and delayed ischaemic deficit or symptomatic vasospasm in 32.6%. The presence of vasospasm has a marked effect on overall ...

PURPOSE: To evaluate the techniques and efficacy of intracranial intraarterial papaverine infusion for symptomatic vasospasm after subarachnoid hemorrhage caused by aneurysm rupture. METHODS: Papaverine was infused on 19 occasions in 14 patients, 6 hours to 2 days after spasm became apparent clinically. Sixty vascular territories were treated. Infusion was made ...