Presence Of Intracranial Aneurysms Research Articles

ECT in the Presence of Intracranial Aneurysm

Two patients with known intracranial aneurysms (ICA) received electroconvulsive therapy (ECT). The first patient received ECT 4 years after the clipping of a right middle cerebral artery aneurysm. Treatment with esmolol failed to completely prevent an increase in blood pressure, but she did well nonetheless. The second patient underwent clipping of a basilar artery aneurysm 11 years before ECT. At the time of ECT, angiography showed a right paraophthalmic artery aneurysm. He received esmolol before each ECT, and, like the first patient, still had significant peri-ictal increases in his blood pressure, but otherwise tolerated the procedure well. Our experience and previously published literature indicate that even with pretreatment, patients often sustain significant increases in their blood pressure. However, this has not been accompanied by any morbidity. Possible guidelines for the management of ICA in association with ECT are discussed.

O-23-333 - Diagnosis and treatment of nontraumatic intracranial dissecting aneurysm presenting with subarachnoid hemorrhage

O-23-333 - Diagnosis and treatment of nontraumatic intracranial dissecting aneurysm presenting with subarachnoid hemorrhage

Subarachnoid hemorrhage and aneurysms

Ruptured intracranial aneurysms are the usual cause of acute subarachnoid hemorrhage (SAH). Noncontrast CT is the primary imaging procedure of choice for establishing the diagnosis of SAH. Conventional contrast angiography is the gold standard for establishing the presence of intracranial aneurysms, but CT and MRI have supplementary roles. The pathogenesis, presentation, and imaging of SAH and intracranial aneurysms are discussed.

Value of magnetic resonance angiography for the detection of intracranial aneurysms in autosomal dominant polycystic kidney disease.

The association of intracranial aneurysms with autosomal dominant polycystic kidney disease (ADPKD), the 30-day mortality rate exceeding 50% for aneurysmal rupture, the effectiveness of surgical repair of unruptured aneurysms with a low surgical risk, and the development of noninvasive imaging techniques for their detection have led physicians to consider the value of screening patients with ADPKD for unruptured intracranial aneurysms. The sensitivity and specificity of high-resolution computed tomography and magnetic resonance imaging for the diagnosis of small intracranial aneurysms have been disappointing. To determine the value of magnetic resonance angiography (MRA), 85 patients with ADPKD without symptoms related to an intracranial aneurysm and 2 patients with ADPKD presenting with a subarachnoid hemorrhage or a suspected aneurysmal leak were studied. MRA was performed with the Multisequence Vascular Package (GE Medical Systems) with use of three-dimensional time-of-flight and three-dimensional phase-contrast techniques, and postprocessing maximum intensity projection images were generated to eliminate the problem of overlapping vessels. Asymptomatic intracranial aneurysms were detected in 6 (22%) of 27 patients with and 3 (5%) of 56 patients without a family history of intracranial aneurysm or subarachnoid hemorrhage (P = 0.02, information missing in 2 patients) and in the 2 patients who presented with a symptomatic aneurysm. A stepwise logistic regression analysis indicated that a family history of intracranial aneurysm or subarachnoid hemorrhage was independently associated with the presence of intracranial aneurysms. All of the aneurysms were < or = 6.5 mm in diameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical experiences with giant intracranial aneurysms.

The common method of presentation of intracranial aneurysms is at the time of their rupture (with subarachnoid haemorrhage) or on the occasion of their compression of neighbouring structures. While giant aneurysms may occasionally present with subarachnoid haemorrhage, their more common methods of presentation are due to their space occupying and neighbourhood effects. Giant aneurysms are commonly defined as those with a diameter larger than 2.5 cm. Previously this diameter was assessed either by arteriography, so that size meant internal diameter, or by the displacement of surrounding structures, as for example, small perforating vessels, which could be attributed positively to the presence of a larger mass. Before CT scanning however, the factor of a very considerable larger aneurysm, partly occluded by clot could occasionally cause unexpected operative difficulty. The advent of CT scan and now especially MR imaging has made the prediction of the size of the aneurysm much easier and the extent of the intra-aneurysmal clot also clearly definable. This paper describes one surgeon's experience with 64 giant cerebral aneurysms operated on in the last 10 years (Table 1). It has emerged from this experience that the most satisfactory method of handling the lesion is to remove the intra-aneurysmal clot and clip the neck of the aneurysm, and the steps necessary to secure this laudable design from the burden of the paper.

Ruptured Intracranial Aneurysm Presenting as Cerebral Infarction in a Young Child

We describe a 15-month-old girl who presented with an acute hemiplegia. The sequence of events appears to have been clinically silent subarachnoid hemorrhage, vasospasm, infarction and a second lethal hemorrhage 3 months later. The old infarction was seen on computed tomography during her second illness. Autopsy confirmed the presence of a recent rupture of an intracranial aneurysm and old hemorrhage. In addition there was an unusual fibroblastic proliferation in the aneurysm wall. This case demonstrates that clinically silent subarachnoid hemorrhage, vasospasm and infarction can occur as complications of aneurysms, even in very young children.

Focal seizures: An unusual presentation of giant intracranial aneurysms. A report of four cases with comments on the natural history and treatment

Four patients with partial epileptic seizures for several years, but without permanent neurological deficits, were found to have giant aneurysms of the middle cerebral artery. None had a history of subarachnoid hemorrhage. Operative findings included compression of the medial temporal and subfrontal cortex, infarction of the superior temporal gyrus, and evidence of previous hemorrhage from the aneurysms. In two patients, clipping of the aneurysm with decompression of the adjacent temporal lobe cured the seizure disorder. In the other two patients, the aneurysms could only be wrapped, and the seizures continued. It is postulated that focal compression of temporal lobe structures and local hemodynamic phenomena caused by the giant aneurysm predispose to epilepsy in these patients.

Giant intracranial aneurysm presenting as a posterior fossa mass

A patient with signs of brainstem compression and hydrocephalus is reported. The clinical picture suggested a posterior fossa neoplasm. Computed tomography, however, proved highly accurate in making the diagnosis of a giant, partially thrombosed vertebrobasilar aneurysm. The radiographic appearance of this entity is summarized and pathologic correlation is offered.

Fibromuscular dysplasia of the posterior cerebral artery: report of a case and review of the literature.

A case of fibromuscular dysplasia (FMD) of the posterior cerebral artery with classic presumptive angiographical findings is presented, and the literature pertaining to FMD of the cervical arteries is reviewed. The focal neurological findings and characteristic changing pattern seen on sequential brain scans clearly associate the presence of this lesion to cerebral infarction. Various proposed etiologies and the characteristic pathological and radiological appearance of FMD are discussed. Emphasis is placed on the potential for this lesion to produce significant clinical sequelae, and on the relationship between FMD and the presence of intracranial aneurysms. The natural history and proper treatment remain uncertain; however, the general impression is for slow progression of existing lesions associated with development of new lesions in other locations.

The extra-renal ocular complications of diabetes mellitus. Current concepts of pathogenesis and management

Diabetes mellitus may affect any part of the visual system. Common ocular complications of diabetes include blepharoptosis which may resolve spontaneously, respond to topical phenylephrine or eventually require surgical correction. Increased glucose content of the tears occurs in diabetes without any apparent structural abnormality. Fusiform and saccular aneurysms are a common finding in the bulbar conjunctiva of diabetics, in individuals suffering from other diseases and in persons who are apparently healthy. Decreased corneal sensitivity often with small epithelial pits and folds in Descemet's membrane are also common findings in diabetics. Open angle glaucoma appears to have only a chance association with diabetes while diabetic iridopathy, changes in refractive power and cataract are more closely allied with abnormalities in carbohydrate metabolism.Rubeosis iridis with secondary organization and occlusion of the aqueous humor outflow channels is one of the disastrous complications of diabetes mellitus. Diabetic ophthalmoplegia, another poorly understood phenomenon, may falsely suggest the presence of intracranial aneurysm, tumor or other space occupying mass resulting in needless diagnostic tests. The physician who manages diabetic patients should recognize these abnormalities, the fact that many are harmless and require no treatment, that some are easily treated by simple medical or surgical measures and that others are catastrophies for which no satisfactory therapy is at hand.