Source Of Subarachnoid Hemorrhage Research Articles

Superior Cerebellar Artery Aneurysm in a Case of Moyamoya Disease: A Rare Entity

AbstractMoyamoya disease is a rare condition characterized by progressive narrowing and occlusion of internal carotid artery and other major arteries of the brain with formation of multiple collaterals. The incidence of aneurysm in moyamoya disease is higher than normal population. Treating the simultaneous pathology of aneurysm and moyamoya disease in an individual is a rare entity. A 35-year-old male presented with headache, loss of consciousness, and generalized tonic-clonic seizure with subarachnoid hemorrhage. Digital Subtraction angiography showed moyamoya disease with left superior cerebellar artery aneurysm. Rupture of aneurysm was suspected to be the source of subarachnoid hemorrhage. Patient underwent clipping of the left superior cerebellar artery aneurysm with encephalo-duro-arterio-myo-synangiosis. Patient survived the procedures. All patients with subarachnoid hemorrhage in moyamoya disease should undergo angiogram and aneurysm should be looked for carefully. The site of aneurysm and the risk for damaging the collaterals should be kept in mind while planning the surgery in such cases.

Superficial siderosis of the central nervous system associated with ventral dural defects: bleeding from the epidural venous plexus.

Superficial siderosis of the central nervous system is a rare intractable disease induced by chronic subarachnoid hemorrhage. Neurological deficits, such as cerebellar ataxia and hearing difficulties, gradually progress if left undiagnosed. Hemosiderin deposition is irreversible because standard medical treatment has not yet been established. Interventions at the source of bleeding may be the key to a preferable outcome of treatment for chronic subarachnoid hemorrhage; however, the source is not clear in many cases. Among the consecutive cases diagnosed with a spontaneous cerebrospinal fluid (CSF) leak, cases of superficial siderosis associated with a CSF leak due to a ventral dural defect were retrospectively analyzed. Among 77 cases of a CSF leak, 7 cases (9%) of superficial siderosis were identified (median age of 59years, male, 4 cases). Defects were diagnosed on 1-mm sliced fast imaging employing steady-state acquisition MRI (n = 5), conventional myelographic CT (n = 1), or dynamic myelographic CT (n = 1) at high thoracic levels (T1-T4). All defects were repaired by direct neurosurgery. During surgery, continuous bleeding from the epidural veins of the internal vertebral venous plexus was identified as the source of subarachnoid hemorrhage. Epidural CSF pulsations through the defect prevented clot formation by the epidural veins. Dural repair stopped free communication between the subarachnoid and epidural spaces, leading to the disappearance of chronic subarachnoid hemorrhage. Bleeding from the epidural venous plexus may be the cause of superficial siderosis associated with ventral dural defects. Neurosurgical repair may stop the progression of this condition.

Yield of Catheter Angiography After Computed Tomography Negative, Lumbar Puncture Positive Subarachnoid Hemorrhage

Patients suspected of having aneurysmal subarachnoid hemorrhage (SAH) are initially evaluated with noncontrast head computed tomography. If the computed tomography is negative, but clinical concern for SAH is high, a lumbar puncture with cerebrospinal fluid analysis is typically performed. The purpose of this study was to evaluate the accuracy of cerebrospinal fluid xanthochromia and erythrocytosis for aneurysmal SAH. Medical records of all patients who underwent catheter angiography at Barnes Jewish Hospital between July 2002 and April 2012 for clinical suspicion of a ruptured brain aneurysm after a negative computed tomography scan and a lumbar puncture suspicious for SAH were reviewed. The cerebrospinal fluid analysis results, angiographic findings, and outcomes of each case were recorded. Fifty-seven patients were identified. Two angiographic lesions were identified in patients with xanthochromia (2/24 patients, ie, 8.3%), both of which were confirmed to have ruptured. The diagnostic yield in patients with nonclearing erythrocytosis and no xanthochromia was 6.3% (1/16 patients), although this lesion was not considered the source of SAH. Catheter angiography should be performed in patients with computed tomography negative but suspicious lumbar puncture, particularly in the presence of xanthochromia. The benefit of angiography in patients with erythrocytosis only is unclear and deserves future study.

Styloidogenic Jugular Venous Compression Syndrome: Diagnosis and Treatment (P05.261)

Objective: To present a case of Superficial Siderosis of the CNS in a patient with bilateral internal jugular vein narrowing from an external compression of elongated styloid processes. Background Superficial Siderosis of CNS is an uncommon disorder that results from hemosiderin deposition in leptomeninges, subpial layers of brain, and spinal cord from chronic subarachnoid hemorrhage (SAH). The source of SAH is not identified in half of the cases. We present a case of superficial siderosis in a patient with bilateral jugular vein narrowing causing venous congestion from an external compression of styloid processes. Design/Methods: Case report from a tertiary medical center. Results: A 59 year old female presented with slowly progressive gait ataxia, sensorineural hearing loss, and episodic headaches for 6 months. MRI of brain and spinal cord revealed a pituitary adenoma and T2 hypointensity involving the cerebellum, brainstem, and spinal cord consistent with superficial siderosis. CSF studies demonstrated elevated protein without xanthochromia. A dynamic cerebral venogram with extension and flexion views revealed severe bilateral internal jugular vein narrowing at the level of C1-C2, more severe with neck flexion, with considerable congestion of the paravertebral veins and spinal epidural venous plexus. Manometry study revealed an increased pressure gradient across the narrowing between the sigmoid sinuses and internal jugular veins, which was worse with neck flexion compared to neutral position. Computerized tomography angiography of the neck demonstrated elongated styloid processes with external compression of the internal jugular veins at the level of the narrowing. The patient was referred to surgery for styloidectomy. Conclusions: We present a case of superficial siderosis with possible etiology related to bilateral internal jugular vein narrowing leading to significant venous congestion from an external compression of elongated syloid processes. Disclosure: Dr. Gupta has nothing to disclose. Dr. Pandya has nothing to disclose. Dr. Lazzaro has nothing to disclose. Dr. Fitzsimmons has nothing to disclose.

Dimpled Appearance of a Posterior Communicating Artery Saccule: An Angiographic Indicator of Arterial Infundibula

Dimpled Appearance of a Posterior Communicating Artery Saccule: An Angiographic Indicator of Arterial InfundibulaTimothy J. Kaufmann1, Nasser Razack2, Harry J. Cloft1 and David F. Kallmes1Audio Available | Share

Rare cause of subarachnoid hemorrhage: spinal meningeal carcinomatosis

Subarachnoid hemorrhage (SAH) of spinal origin is a rare entity accounting for approximately 1% of all cases of SAH. Its most frequent causes are trauma and vascular malformations. Although primary spinal tumors, especially ependymomas, are also relatively common causes, SAH secondary to a metastatic spinal tumor arising from outside the central nervous system is an extremely rare condition; only one case has been reported in the literature. The authors present a case of spinal meningeal carcinomatosis secondary to cutaneous malignant melanoma in which the patient presented with only symptoms of SAH. Although very rare, this case underscores several factors. 1) Spinal SAH due to spinal metastases should be considered in the differential diagnosis of patients with previously known malignancy. 2) Spinal SAH may manifest without paraparesis or sensory deficit. 3) Magnetic resonance imaging of the spinal cord may be important to determine the source of SAH in patients in whom four-vessel cerebral angiography demonstrates no abnormal findings.

内頸動脈前壁動脈瘤

We reviewed 12 cases of anterior wall aneurysms of internal carotid artery. We classified those aneurysms into two types as follows: 1) “chimame” (blister) type, which has a thin wall and fragile neck; and 2) “non-chimame” type, which has a usual wall and neck. Six cases had “chimame” type aneurysms. All 6 patients were women, ranging in age from 37 to 61 years (mean, 49 years). All aneurysms were the source of subarachnoid hemorrhage (SAH). The size of the aneurysms varied from 1 to 4mm with a mean of 2.8mm. There were also 6 cases with “non-chimame” type aneurysms. Three patients were men and 3 were women, ranging in age from 47 to 68 years (mean, 56 years). Two aneurysms were the source of SAH. The size of aneurysms varied from 5 to 18mm with a mean of 12mm. Intraoperative rupture occurred in 5 of the 6 “chimame” type aneurysms, and in only one of the 6 “non-chimame” type aneurysms. Neck clipping was done in one of the 6 “chimame” type aneurysms, but was done in all of the “non-chimame” type aneurysms. One patient of “chimame” type aneurysm treated by trapping died, but the others had good recovery.“Chimame” type anterior wall aneurysm is easy to rupture, difficult to clip, and so necessitates special surgical techniques such as wrapping or trapping with bypass. On the other hand, “non-chimame” type anterior wall aneurysm can be clipped relatively safely. However, it is important not to induce intraoperative rupture during dissection and clipping, because the aneurysm is severely adherent to the frontal lobe or temporal lobe.

Coarctation of the aorta as a cause of spinal subarachnoid hemorrhage. Case report.

✓ A 40-year-old man with coarctation of the aorta suffered a subarachnoid hemorrhage but bilateral carotid and vertebral angiography as well as air ventriculography failed to demonstrate the source of bleeding. Postmortem examination showed the hemorrhage was due to rupture of a large collateral vessel on the surface of the spinal cord. The high incidence of berry aneurysms in patients with aortic coarctation is well known but where no lesion is shown intracranially, attention should be drawn to the intraspinal collateral circulation as a second possible source of subarachnoid hemorrhage.

Periarteritis nodosa as a source of subarachnoid hemorrhage and spinal cord compression; report of a case and review of the literature.

Periarteritis nodosa as a source of subarachnoid hemorrhage and spinal cord compression; report of a case and review of the literature.