Artery Aneurysm Rupture Research Articles

Embolization of Ruptured Distal Lenticulostriate Artery Aneurysms

To describe the critical role of endovascular treatment and safety for the patients who presented with intraventricular hemorrhage owing to rupture of the distal lenticulostriate artery aneurysms. Three patients who underwent endovascular treatment for distal lenticulostriate artery aneurysms related to intraventricular hemorrhage were selected and retrospectively reviewed. Patients were treated successfully using endovascular embolization without any complications. Endovascular therapy is available and safe as a treatment option for distal lateral lenticulostriate artery aneurysms.

Spontaneous omental bleeding: a case report and literature review

BackgroundSpontaneous rupture of omental vessels is an infrequent medical condition possibly causing severe intra-abdominal hemorrhage. Omental bleeding results from trauma associated injury and irritation, neoplasia, arterial aneurysm rupture, and anticoagulant treatment. Idiopathic omental bleeding rarely causes acute abdominal bleeding which has been reported to occur in previous studies. Here we reported a case with idiopathic omental hemorrhage due to vascular malformation. A systematic review of literature is provided.Case presentationA 58-year-old Han Chinese man arrived at the emergency department with left upper quadrant abdominal pain for 1 day. He had no significant previous medical history. There was no history of fever, vomiting, nausea, or anorexia. He was a non-smoker and did not consume alcohol. On physical examination, blood pressure was 118/72 mmHg, for a temperature of 37.7 °C; heart and respiratory rates of 130 per/min and 20 per/min were obtained, respectively. Abdomen assessment showed only mild tenderness in the left upper quadrant. Complete blood count (CBC) showed white cell and platelet counts of 16.69 × 103/L and 196 × 103/L, respectively. The haemoglobin value was 13.5 g/L at admission. Abdominal Computer Tomography (CT) was performed that showed peritoneal fluid appeared around the liver. Fresh blood was confirmed in the abdominocentesis. A hemoperitoneum was confirmed by abdominal enhanced CT, which presented a structural disorder in the left upper abdomen. The subject immediately underwent exploratory laparotomy. A massive hemoperitoneum originating from omental vessels was observed. The omental were partially removed. There was no evidence of malignancy or aneurysm upon palpation. Pathological assessment of the extracted tissue pointed to vascular malformation. The patient subsequently had an uneventful recovery; hospital discharge occurred at 7 days post-operation.Previous reports assessing idiopathic omental bleeding were systematically reviewed, summarizing published cases. A total of 12 hits were found in PubMed for idiopathic omental bleeding.ConclusionIdiopathic omental bleeding is a rare condition that requires emergency treatment. Treatment strategies include surgical intervention and transcatheter arterial embolization (TAE). The surgical option is suitable in subjects with persistent hypotension and those with unconfirmed diagnosis.

Вплив інтраопераційного розриву аневризм головного мозку на результати хірургічного лікування в ранній післяопераційний період

Objective – to study features of clinical neurological manifestations of intraoperative rupture of arterial aneurysms (AA) in the early postoperative period. Materials and methods. A retrospective study of the results of surgical treatment of 69 patients (31 (44.9 %) men and 38 (55.1 %) women) with acute cerebrovascular disorder in the hemorrhagic type was performed, due to the breakdown of brain aneurysm, in which there was an intraoperative rupture of arterial aneurysm. Age of patients from 21 to 65 years, the average age is (42.2 ± 14.2) year. In all cases the disease manifested itself as a clinic of non-traumatic intracranial hemorrhage as a result of the rupture of AA. The primary gap was observed in 57 (82.6 %) patients, repeated – in 12 (17.4 %) patients. The formation of intrahepatic hematoma was observed in 36 (52.2 %) patients. During hospitalization all patients underwent computer tomography of the brain to verify hemorrhage, cerebral edema, ischemic lesions and hydrocephalus expansion of the ventricular system. Diagnosis and determination of the degree of angiospasm were performed using transcranial dopplerography. The diagnosis of cerebral aneurysms was established using cerebral angiography and multispiral computer angiography. Intraoperative doppler screening was used to assess the radicalization of the aneurysm exclusion from the bloodstream. The Hunt-Hess scale, the World Federation of Neurological Surgeon Grading System for Subarachnoid Hemorrhage (WFNS SAH grading scales), Glasgow scale, was used to assess the clinical state of patients. Results. In the acute period 47 (68.12 %) patients were operated, in the subacute and cold period – 22 (31.9 %). In 63 patients, the intraoperative aneurysm rupture occurred during the allocation of aneurysms from arachnoidal adhesions, 2 at the time of aspiration of the intracerebral hematoma, 3 in the approach to aneurysm during to retraction of spatulas, 1 – noncontact aneurysm rupture during the trepanation stage. Temporary occlusion with a clip of an arterial carrier aneurysms as a measure of prevention of intraoperative rupture of brain aneurysms was aplicated in 66 (95.65 %) cases. Persistent neurological disorders arose in 15 (21.74 %) patients. 48 patients were discharge from the hospital in satisfactory condition. Six (8.7 %) patients (3 women and 3 men from 22 to 53 years old) died: 3 – due to the rupture of the aneurysm of anterior cerebral artery-anterior communicating artery on the left, 2 – aneurysms of anterior cerebral artery-anterior communicating artery on the right, 1 – the aneurysms of anterior inferior cerebellar artery on the right. In acute period operated 4 patients, in the distant period – 2. Conclusions. Intraoperative rupture of cerebral aneurysm – the most often intraoperative complications of clipping brain aneurysms, the appearance of which worsens the general condition of the patient, leads to the formation of persistent focal deficiency and increases the likelihood of postoperative lethality. The application of adequate surgical access to the optimal position of the patient on the operating table, induced arterial hypotension, temporary occlusion of the artery carrier aneurysms are reliable methods of preventing the onset of intraoperative ruptures of arterial aneurysms. Surgical tactics with an intraoperative rupture of aneurysm depends on the stage at which the bleeding from aneurysm occurred, its intensity and on anatomic-topographic features of aneurysms and arterial links of blood supply to the brain.

Клінічні особливості гострого періоду поодинокого аневризмального крововиливу внаслідок розриву артеріальних аневризм заднього півкільця артеріального кола мозку

Клінічні особливості гострого періоду поодинокого аневризмального крововиливу внаслідок розриву артеріальних аневризм заднього півкільця артеріального кола мозку

Extracranial Vertebral Artery Aneurysm Rupture Complicated by Extrapleural Haematoma.

IntroductionExtracranial vertebral artery aneurysm (EVAA) and extrapleural haematoma (EH) are rare clinical findings most often associated with blunt or penetrating trauma. However, EVAA rupture can be complicated by development of a large EH.ReportA 50 year old man underwent an emergency thrombectomy followed by graft reconstruction of an aorto-bi-femoral bypass. The post-operative course was complicated by respiratory failure and severe anaemia. Computed tomography revealed EVAA rupture and EH, so ligation of EVAA was performed with thoracotomy.DiscussionIn a patient with extensive peripheral vascular disease and rapid development of EH, the rupture of a supra-aortic vessel aneurysm might be considered.

Successful Treatment of Right Internal Iliac Artery Aneurysm Rupture with Arterio-rectal Fistula

Successful Treatment of Right Internal Iliac Artery Aneurysm Rupture with Arterio-rectal Fistula

24. Continuous EEG-SEP monitoring in acute brain injury: Unstable SEP trend preceding neurological deterioration

We describe two patients with acute brain injury who underwent continuous EEG-SEP monitoring: an unusual phase of SEPs amplitude instability preluded to cerebral perfusion alterations in one case and to neurological deterioration up to brain death in the other. Raw and quantitative EEG were continuously recorded. Cortical SEPs after stimulation of median nerves were recorded every hour, with amplitude and latency automatically trended. Patient 1 had a subarachnoid hemorrhage due to a left Middle Cerebral Artery (MCA) aneurysm rupture. Increase of intracranial pressure required left decompressive craniectomy. EEG-SEP monitoring was started on day 7, showing a prolonged instability of left SEP: left MCA vasospasm with temporo-parieto-occipital hypoperfusion was demonstrated. After treatment, hypoperfusion and SEP improved. Patient 2 suffered from a right MCA ischemic stroke, treated with systemic thrombolysis. After four days GCS dropped to 5–6, CT showed a severe hemispheric edema requiring a right decompressive craniectomy. Right SEP was absent but left SEP was normal. On day 6 EEG-SEP monitoring was started, showing left SEP instability and gradual deterioration until day 9, when SEP suddenly and permanently disappeared. On day 10 the brain dead of the patient was declared. In acute brain injury, SEP instability during continuous monitoring is an infrequent pattern, with a high risk of neurological deterioration.

Serial Follow-Up Evaluation With Computed Tomography After Conservative Medical Treatment in Patients With Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection.

There is no detailed information available about trend in the morphological change after conservative medical treatment in patients with symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD). We enrolled 27 consecutive patients with symptomatic SISMAD who underwent conservative medical treatment between 2006 and 2015. The long-term prognosis, natural history, and serial follow-up computed tomography (CT) findings of risk factors of rupture such as arterial diameter and false lumen enhancement were retrospectively assessed. Spontaneous isolated superior mesenteric artery dissection usually developed in middle-aged men around 50 years old who had a history of smoking. Follow-up CT was performed at 1 to 6 months, 7 to 12 months, and after 12 months. Superior mesenteric artery (SMA) maximum diameter was 10.3 mm (quartile 9.5-11.3) on initial CT and expanded in 47.1% patients during 1- to 6-month follow-up, which decreased over time ( P < .001 at 7- to 12-month follow-up, P = .001 after 12-month follow-up). On the other hand, false lumen enhancements were revealed in 9 (33.3%) patients on initial CT. The size of false lumen enhancement was expanded in the longest diameter in 35.3% patients and in shortest diameter in 29.4% during 1- to 6-month follow-up. However, the size of false lumen decreased in all patients after 12-month follow-up. All patients were alive without arterial aneurysm rupture and hospital readmission during the median of 523 days (170-799) study period. We demonstrated that both SMA maximum diameter and false lumen enhancement were transiently expanded in some patients during 6-month follow-up, but no longer expanded after 12-month follow-up. Patients with symptomatic SISMAD could be treated medically with scheduled careful follow-up CT evaluations.

Patient Outcomes and Cerebral Infarction after Ruptured Anterior Communicating Artery Aneurysm Treatment.

Anterior communicating artery aneurysm rupture and treatment is associated with high rates of dependency, which are more severe after clipping compared with coiling. To determine whether ischemic injury might account for these differences, we characterized cerebral infarction burden, infarction patterns, and patient outcomes after surgical or endovascular treatment of ruptured anterior communicating artery aneurysms. We performed a retrospective cohort study of consecutive patients with ruptured anterior communicating artery aneurysms. Patient data and neuroimaging studies were reviewed. A propensity score for outcome measures was calculated to account for the nonrandom assignment to treatment. Primary outcome was the frequency of frontal lobe and striatum ischemic injury. Secondary outcomes were patient mortality and clinical outcome at discharge and at 3 months. Coiled patients were older (median, 55 versus 50 years; P = .03), presented with a worse clinical status (60% with Hunt and Hess Score >2 versus 34% in clipped patients; P = .02), had a higher modified Fisher grade (P = .01), and were more likely to present with intraventricular hemorrhage (78% versus 56%; P = .03). Ischemic frontal lobe infarction (OR, 2.9; 95% CI, 1.1-8.4; P = .03) and recurrent artery of Heubner infarction (OR, 20.9; 95% CI, 3.5-403.7; P < .001) were more common in clipped patients. Clipped patients were more likely to be functionally dependent at discharge (OR, 3.2; P = .05) compared with coiled patients. Mortality and clinical outcome at 3 months were similar between coiled and clipped patients. Frontal lobe and recurrent artery of Heubner infarctions are more common after surgical clipping of ruptured anterior communicating artery aneurysms, and are associated with poorer clinical outcomes at discharge.

Angioarchitectures and Hemodynamic Characteristics of Posterior Communicating Artery Aneurysms and Their Association with Rupture Status.

Intracranial aneurysms originating at the posterior communicating artery are known to have high rupture risk compared with other locations. We tested the hypothesis that different angioarchitectures (ie, branch point configuration) of posterior communicating artery aneurysms are associated with aneurysm hemodynamics, which in turn predisposes aneurysms to rupture. A total of 313 posterior communicating artery aneurysms (145 ruptured, 168 unruptured) were studied with image-based computational fluid dynamics. Aneurysms were classified into different angioarchitecture types depending on the location of the aneurysm with respect to parent artery bifurcation. Hemodynamic characteristics were compared between ruptured and unruptured aneurysms, as well as among aneurysms with different angioarchitectures. Angioarchitecture was associated with rupture (P = .003). Ruptured aneurysms had higher, more concentrated, and more oscillatory wall shear stress distributions (maximum wall shear stress, P < .001; shear concentration index, P < .001; mean oscillatory shear index, P < .001), stronger and more concentrated inflow jets (represented as Q, P = .01; inflow concentration index, P < .001), and more complex and unstable flow patterns (vortex core length, P < .001; proper orthogonal decomposition entropy, P < .001) compared with unruptured aneurysms. These adverse conditions were more common in aneurysms with bifurcation-type angioarchitectures compared with those with lateral or sidewall angioarchitectures. Interestingly, ruptured aneurysms also had lower normalized mean wall shear stress (P = .02) and minimum wall shear stress (P = .002) than unruptured aneurysms. High-flow intrasaccular hemodynamic characteristics, commonly found in bifurcation-type angioarchitectures, are associated with the posterior communicating artery aneurysm rupture status. These characteristics include strong and concentrated inflow jets, concentrated regions of elevated wall shear stress, oscillatory wall shear stress, lower normalized wall shear stress, and complex and unstable flow patterns.

Issue Information

The current issue of PsyCh brings our fourth and final installment to an ongoing special collection on the theme of Single Case Studies. An opening Editorial comments on how the collection as a whole has illustrated the potential of single cases for exploratory research which can disclose previously unrecognized phenomena and thus enrichen research as a whole. Two case studies follow, the first a consideration of the appeal of Chinese abstract artist Lao Zhu's pictures, incorporating neurocognitive analysis in attempting to illuminate the nature of information processing during aesthetic appreciation. The second reports on split‐brain phenomena in an anterior communicating artery aneurysm rupture patient who was first evaluated by A. R. Luria in 1976. Two Short Communications follow, the first on motor imagery in two single cases of catatonic schizophrenia, and the second examining the influence of tactile exploration on neural activation patterns for visual imagery in a case of acquired blindness.As regular contributions, the issue then features an original article on an experimental investigation of flexible integration of retinal and extra‐retinal clues during self‐motion perception. Two Special Reports follow, the first considering the utility of investing in the cognitive capital of young children as a framework for policy decisions about the effective use of resources in China's next phase of development towards a more prosperous society. The second is a proposal from Mario Bunge, a highly innovative interdisciplinary thinker, for the reconceptualization of mental pathologies based on recognition of their grounding in brain processes, thereby overcoming the philosophical flaw of psychoneural dualism, in which mental diseases have long been regarded as disorders not of the brain but of an immaterial mind. Two Short Communications then complete the issue, the first being an attempted confirmatory factor analysis of the structure of the Swedish version of the Dark Triad Dirty Dozen, and the second a consideration of models for mechanisms, such as temporal windows, by which neural oscillations are utilized for time perception during information processing in the brain. image

Management of splenic artery aneurysm rupture following central pancreatectomy and ROUX-EN-Y pancreaticojejunostomy reconstruction

Objective: Hemorrhage from pseudoaneurysms following pancreatic surgery is a rare life-threatening and challenging complication. We present our experience management for this rare condition. Methods: 62 years old female found to have 2.7 cm pancreatic neck mass on imaging for vague abdominal pain associated with unintentional weight loss. EUS and FNA revealed non-functional low grade neuroendocrine tumor. Patient opted for central pancreatectomy with roux-en-y pancreaticojejunostomy. Procedure was uneventful. Drain fluids were negative for pancreatic fistula, and patient discharged on POD#10. The patient returned to the emergency department on POD#24 with diffuse abdominal pain, Nausea, vomiting, and hematochezia. CT imaging was read as negative, as well as colonoscopy. EGD noted duodenal ulcer with clean base. The Roux limb was not assessed. Patient discharged on HD#3. Patient returned to the ED on POD#33, with complaints of hematochezia and hematemesis, and syncopized during blood draw. NGT lavage removed 2 liters of blood from stomach, and patient diagnosed with hemorrhagic shock. Patient intubated for airway protection, and EGD performed failed to elicitate source. Patient underwent CTA, noting active extravasation from splenic artery pseudoaneurysm, and the splenic artery was coiled by interventional radiology. Results: Following massive transfusion protocol patient recovered, and discharged on HD#9. Conclusion: Delayed bleeding after pancreatic surgery is suspicious for a pseudoaneurysm. Contrast-enhanced CT followed by early angiography provides accurate diagnosis and treatment. Interventional radiological treatment should be preferred over primary surgery because it is currently the most life-saving approach.

Ruptured berry aneurysm with minimal subarachnoid hemorrhage

Cerebral artery aneurysm rupture is usually associated with significant subarachnoid hemorrhage; however, there are rare cases where there is a lack of hemorrhage into the subarachnoid space. While subdural hemorrhage can occur with ruptured aneurysms, isolated subdural hemorrhage is more often associated with trauma. In this case, a 51-year-old obese woman, who recently visited an Urgent Care Center for elevated blood pressure, was found dead roughly a month later. She had been complaining of headaches, and received medication for her blood pressure at the visit. A medicolegal autopsy revealed that the cause of death was determined to be a ruptured cerebral artery berry aneurysm of the right anterior cerebral artery, with a contributing underlying cause of hypertensive and atherosclerotic cardiovascular disease. There was significant subdural hemorrhage overlying the right cerebrum. Subarachnoid hemorrhage was present only minimally and in a patchy distribution, with virtual absence of basilar hemorrhage. An additional unruptured aneurysm was found in the left common carotid artery before the bifurcation. There was cardiomegaly (510 gm), and mild to moderate atherosclerosis in multiple vessels. The classic clinical presentation of a ruptured cerebral artery berry aneurysm involves the sudden onset of an excruciating headache.1 While angiography provides the most conclusive image-based antemortem evidence of an aneurysm, CT scans are used frequently in an emergency setting to identify basilar subarachnoid hemorrhage, a very common associated finding, thus allowing for a diagnosis of probable ruptured aneurysm.1 Depending on the circumstances of a given case, the presence of subdural hemorrhage with absence of subarachnoid hemorrhage on CT scan may suggest a different underlying process, such as trauma. The presented case serves to remind clinicians that ruptured berry aneurysms do not always produce significant subarachnoid hemorrhage.

Case Report on Ruptured Renal Artery Aneurysm

Renal aneurysms are a rare entity with an incidence of 0.09% of the population. They are often asymptomatic and frequently discovered incidentally during abdominal imaging for unrelated causes. Rupture of renal artery aneurysms is a surgical emergency, very often lethal. Swift diagnosis is crucial and is made by ultrasound and abdominal MDCT. We report the case of a renal artery rupture in a 58 year-old man who arrived in the emergency department with left flank pain of sudden onset followed by a hypovolemic shock. MDCT scan showed the rupture of an aneurysm of the left renal artery associated with a retroperitoneal hematoma. It is a life-threatening situation in case of delayed diagnosis. In our case, prompt imaging and diagnosis led to conservative treatment and nephrectomy was avoided.

Spontaneous splenic artery aneurysm rupture in a 38-year old female: a case report

Splenic artery aneurysm (SAA) is a rare and extremely difficult diagnosis. A rare case of a ruptured SAA in a 38-year old female, firstly treated with endovascular embolization and then with splenectomy, is presented. A 38-year old female presented to the emergency department with epigastric pain and fainting episodes. Direct catheter angiography revealed a ruptured SAA and distal, as well as proximal coil embolization was performed. Due to abdominal compartment syndrome the patient underwent open surgery with splenic artery ligation and splenectomy. Postoperative she showed signs of sepsis and was treated with i.v. fluids, steroids, packed red blood cells, platelets, fresh frozen plasma and antimicrobial treatment. Additionally, a multidrug resistant Acinetobacter baumanni was yielded from the urine culture. She had a satisfactory recovery. She is followed up a total of 5 years with no signs of overwhelming post-splenectomy infection syndrome. Direct catheter angiography is a very helpful option in diagnosis, as well as treatment, but a close monitoring after embolization is essential. Furthermore, post-splenectomy sepsis is a severe disease with high mortality rates that requires immediate appropriate treatment.

Risk Factors for the Rupture of Middle Cerebral Artery Bifurcation Aneurysms Using CT Angiography.

Background and PurposeTo investigate the clinical and morphological characteristics associated with risk factors for the rupture of bifurcation-type middle cerebral artery aneurysms (MCAAs).MethodsA total of 169 consecutive patients with 177 bifurcation-type MCAAs were reviewed from August 2011 to January 2016. Based on the clinical and morphologic characteristics findings, the risk factors of aneurysm rupture were assessed using statistical methods.ResultsAge, cerebral atherosclerosis, no hypertension, hypertension grade 2 and coronary artery disease (CAD) were negatively correlated with aneurysm rupture. The mean diameter (MD) of the parent and two daughter arteries was negatively correlated with rupture. Aneurysms with irregularity, depth, width, maximum size, aspect ratio, depth-to-width ratio, bottleneck factor, and size ratio were positively correlated with rupture. The multivariate logistic regression model revealed that irregular shape (odds ratio (OR) 2.697) and aspect ratio (OR 3.723) were significantly and positively correlated with rupture, while cerebral atherosclerosis (OR 0.033), CAD (OR 0.080), and MD (OR 0.201) were negatively correlated with rupture. Receiver operating characteristic analysis revealed that the threshold value of the aspect ratio and MD were 0.96 and 2.43 mm, respectively.ConclusionsCerebral atherosclerosis and CAD are protective factors against rupture. Morphological characteristics such as an aneurysm with an irregular shape, a high aspect ratio (>0.96) and a small MD (<2.43 mm) are likely better predictors of rupture.

Posttraumatic Cavernous Segment Internal Carotid Artery Aneurysmal Rupture Presenting as Tentorial Subdural Hematoma

Traumatic aneurysm rupture following a closed head injury is rare. The rupture of a cavernous internal carotid artery (ICA) aneurysm following a head injury presenting as a tentorial subdural hematoma has not been reported in the literature. We discuss a 50-year-old woman with a closed head injury with her initial computed tomography scan showing a tentorial subdural hematoma. Further investigations revealed the presence of a ruptured cavernous ICA aneurysm. We also conducted a literature review of posttraumatic ICA aneurysmal rupture.

Revisiting Fibromuscular Dysplasia: Rationale of the European Fibromuscular Dysplasia Initiative.

Fibromuscular dysplasia (FMD) has been defined as an idiopathic, segmental, nonatherosclerotic, and noninflammatory disease of the musculature of arterial walls, leading to stenosis of small- and medium-sized arteries.1,2 Furthermore, to confirm the diagnosis of FMD, arterial diseases of monogenic origin, inflammatory arterial diseases, and the use of arterial vasoconstrictors have to be excluded. Renal FMD may lead to renovascular hypertension, less frequently renal artery dissection, renal infarction, and aneurysm rupture.1 Cervico-cephalic FMD can result in ischemic or hemorrhagic stroke, cervical artery dissection, and may be also associated with intracerebral aneurysms and risk of subarachnoid hemorrhage.3 In some patients, the diagnosis of FMD can lead to invasive procedures, such as percutaneous angioplasty, reconstructive surgery, or intracranial aneurysm clipping. Thus, both the disease and its treatment can lead to significant morbidity and mortality.1 The French4–6 and the US7–10 registries have led to a reappraisal of the frequency, demographic characteristics, classification, pathophysiology, and management of FMD. The face of the disease is evolving from a rare disease of renal arteries accounting for a minority of cases of secondary hypertension in young women to a systemic vascular disease affecting renal and also cervico-cephalic, coronary, and iliac arteries1,11 (Table 1). In various cohorts, despite incomplete exploration, mostly driven by symptoms and clinical complaints, FMD of ≥2 vascular beds was consistently found in >30% of cases.1,7,12,13 The French ARCADIA (Assessment of Renal and Cervical Artery Dysplasia) registry, which required a standardized vascular work-up in all patients, will soon provide a more precise estimate of the frequency of diffuse FMD. Besides female sex and repeated mechanical trauma because of increased kidney mobility,14 recent works suggest a contribution of smoking6 in progression of the …

Anterior cerebral artery aneurysm rupture presenting as hemorrhage in the splenium of the corpus callosum.

Anterior cerebral artery aneurysm rupture presenting as hemorrhage in the splenium of the corpus callosum.

A new non-craniotomy model of subarachnoid hemorrhage in the pig: a pilot study.

Subarachnoid hemorrhage (SAH) from rupture of an intracranial arterial aneurysm is a devastating disease affecting young people, with serious lifelong disability or death as a frequent outcome. Large animal models that exhibit all the cardinal clinical features of human SAH are highly warranted. In this pilot study we aimed to develop a non-craniotomy model of SAH in pigs suitable for acute intervention studies. Six Norwegian Landrace pigs received advanced invasive hemodynamic and intracranial pressure (ICP) monitoring. The subarachnoid space, confirmed by a clear cerebrospinal fluid (CSF) tap, was reached by advancing a needle below the ocular bulb through the superior orbital fissure and into the interpeduncular cistern. SAH was induced by injecting 15 mL of autologous arterial blood into the subarachnoid space. Macro- and microanatomical investigations of the pig brain showed a typical blood distribution consistent with human aneurysmal SAH (aSAH) autopsy data. Immediately after SAH induction ICP sharply increased with a concomitant reduction in cerebral perfusion pressure (CPP). ICP returned to near normal values after 30 min, but increased subsequently during the experimental period. Signs of brain edema were confirmed by light microscopy post-mortem. None of the animals died during the experimental period. This new transorbital injection model of SAH in the pig mimics human aSAH and may be suitable for acute intervention studies. However, the model is technically challenging and needs further validation.