Thalamoperforating Arteries Research Articles

Thalamo-mesencephalic Branches of the Posterior Cerebral Artery: a 3D Rotational Angiography Study

PurposeThe thalamo-mesencephalic (TM) branches of the posterior cerebral artery (PCA) supply critical structures. Previous descriptions of these vessels are inconsistent and almost exclusively rely on cadaver studies. We aimed to provide a neuroradiological description of TM vessels in vivo based on routine 3D rotational angiographies (3D-RA).MethodsWe analyzed 3D-RAs of 58 patients with pathologies remote from the PCA. PCA-origins were considered. Delineation, origin and number of branches of the collicular artery (CA), the accessory CA (ACA), the posterior thalamoperforating artery (PTA), the thalamogeniculate artery (TGA), and the posterior medial (PMCA) and lateral (PCLA) choroid arteries were assessed. The PTAs were categorized based on Percheron’s suggested classification.ResultsA CA was identified in 84%, an ACA in 20%. The PTA was delineated in 100%. In 27%, PTA anatomy had features of several Percheron types (n = 7) or vessels emanating from a net like origin (n = 9). 26% had a type IIb PTA. A fetal type PCA origin with hypoplastic ipsilateral P1 was observed in 5 cases with type IIa (n = 2) or type IIb (n = 3) PTAs originating from contralateral P1. The TGA was identified in 85% of patients, with ≥ 2 branches in 67%. The PMCA was delineable in 41%, the PLCA in 100%.ConclusionThe prevalence of a proper “Artery of Percheron” type IIb PTA seems to be higher than previously reported. A fetal type P1-origin may be predictive of a type IIa/b PTA emanating from contralateral P1. 3D-RA may be useful for planning PCA interventions, as impairment of TM branches is a severe risk.

A Case of Posterior Communicating Artery Aneurysm Combined With an Atypical Origin of the Ipsilateral Ophthalmic Artery

Objective: Anatomy of the ophthalmic artery (OA) is of great practical importance in surgery for anterior circulation aneurysms. In most cases, the OA arises from the supraclinoid segment of the internal carotid artery (ICA) and enters the orbit through the optic canal inferolaterally to the optic nerve. The OA arising from the anterior cerebral artery (ACA) and entering the optic canal above the optic nerve is extremely rare.Clinical case: We report a case of a 29-year-old female patient admitted to Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) with a ruptured true aneurysm of the left posterior communicating artery (PCoA) and an abnormal origin of the OA from the ACA. The disease manifested itself as ischemic stroke in the basal ganglia on the left causing diagnostic difficulties during initial hospitalization. Cerebral angiography confirmed a PCoA aneurysm and origin of the OA from the ipsilateral ACA. During surgery the neck of the aneurysm was clipped, and the aneurysm dome was opened to control the extent of clipping and remove thrombotic masses. During their removal, hemorrhage appeared from the posterior pole of the aneurysm. During the exploration it was found that the aneurysm was a dilated PCoA connecting the right ICA with the right posterior cerebral artery (PCA). A thrombosed anterior thalamoperforating artery emerged from the superior surface of the dome, and its junction with the precommunicating segment of the right PCA was detected in the region of the posterior pole of the aneurysm. The second clip was placed at the communication site between the aneurysm and the right PCA. The patient was discharged in satisfactory condition with a stable neurological status.Conclusions: The combination of abnormal anatomy of arteries at the base of the brain and cerebral aneurysms increases the risk of tactical errors and perioperative complications. Each such case requires a careful comparison of the clinical, imaging, and intraoperative findings. In the presented case of the patient with the ruptured rare PCoA aneurysm, the disease manifested atypically due to the partial thrombosis of the aneurysm and hemorrhage into the aneurysmal wall. The imaging findings revealed lacunar stroke in the thalamoperforating artery basin and an ICA aneurysm with no signs of subarachnoid hemorrhage. During the surgery the aneurysm was initially regarded as typical saccular. The opening of the dome and removal of all thrombotic masses made it possible to determine the eccentric fusiform nature of the aneurysm, perform its radical exclusion, and prevent fatal hemorrhage in the postoperative period.

Ruptured brainstem arteriovenous malformation associated with a thalamoperforating artery aneurysm arising from the P1 segment of the right posterior cerebral artery: illustrative case.

Cerebral aneurysms of perforating arteries are rare and can be difficult to detect on computed tomography angiography (CTA) and digital subtraction angiography. Treatment is challenging and associated with a significant risk of morbidity. Endovascular treatment of a thalamoperforating artery (TPA) aneurysm within the midbrain has not previously been reported. A 13-year-old girl with no previous medical history presented with unconsciousness and anisocoria. Head computed tomography showed a right midbrain hemorrhage. CTA showed a midbrain arteriovenous malformation fed by a TPA aneurysm arising from the P1 segment of the right posterior cerebral artery. The feeder had a small distal aneurysm, which increased in size over time. Endovascular embolization was then performed. Cerebral aneurysms of perforating arteries are rare and can be difficult to treat. This is the first report of the endovascular treatment of a TPA aneurysm within the midbrain. Understanding the individual patient's brainstem perforator anatomy and the associated blood flow is essential before occluding a TPA aneurysm to avoid causing ischemia or infarction. Arteriovenous malformation embolization within the brainstem should be avoided because of interperforator anastomoses.

Bypass surgery for ruptured dissecting aneurysms of the proximal posterior cerebral artery: illustrative case.

BACKGROUNDPosterior cerebral artery (PCA) dissecting aneurysms commonly occur in the proximal PCA and are considered rare. The treatment of proximal PCA dissecting aneurysms is challenging because of the existence of perforators supplying the vital neural structures. Recently, endovascular intervention has been used; however, concerns for ischemic or hemorrhagic complications exist.OBSERVATIONSA 54-year-old woman presented with subarachnoid hemorrhage due to dissecting aneurysm rupture at the P1-P2 junction of the PCA. The thalamoperforating artery (TPA) and medial posterior choroidal artery (MPchA) originated from the proximal end and the distal end of the aneurysm, respectively. Additionally, the posterior communicating artery (PcomA) connected with the dissected segment. To preserve these perforators, we performed surgical trapping combined with superficial temporal artery (STA) PCA anastomosis. Clips were applied for trapping the proximal and distal end of the aneurysm, with preservation of the TPA and MPchA origin. PcomA was left open for blood flow preservation to the perforators directly arising from the aneurysm. The postoperative course was uneventful, and the patient was discharged.LESSONSSurgical trapping using STA-PCA bypass could be a treatment of choice for proximal PCA dissecting aneurysms, considering its potential for cure and prevention of ischemic complications.

Validation of choroidal anastomosis on high-resolution magnetic resonance imaging as an imaging biomarker in hemorrhagic moyamoya disease.

This study aimed to investigate the association between dilation and proliferation and anastomosis of perforating arteries, and intracranial hemorrhage in moyamoya disease (MMD) patients, using high-resolution magnetic resonance imaging (HRMRI). Adult patients with MMD at advanced stages were prospectively enrolled and underwent HRMRI exams. Dilation and proliferation of the lenticulostriate artery (LSA), medullary artery, and anterior or posterior choroidal arteries (AChA or PChA) were assessed. Abnormal anastomoses were identified between (1) the LSA and the medullary or insular arteries; (2) the thalamo-geniculate, thalamo-tuberal, or thalamo-perforating arteries and the medullary or insular arteries; and (3) the AChA or PChA and the medullary or insular arteries. The association between these variables and hemorrhagic events was calculated using univariate and multivariate analyses. Fifty patients (14 men; mean age, 35.4 ± 9.7 years) were finally analyzed, including 17 hemorrhagic patients and 33 non-hemorrhagic patients. The inter-rater agreement for the qualitative evaluation of perforating arteries was good. Dilation and proliferation of the AChA or PChA (88.2% versus 54.5%, p = 0.027), and choroidal anastomosis (64.7% versus 18.2%, p = 0.002) were more frequently observed in patients with hemorrhage. Multivariate logistic regression showed that choroidal anastomosis remained significantly associated with hemorrhage (odds ratio = 5.95, 95% confidence interval = 1.21-29.25, p = 0.028). Choroidal anastomosis is independently associated with hemorrhagic events in adult patients with MMD at advanced stages. HRMRI can provide detailed information on both the anatomies and abnormal collaterals in MMD, which facilitates risk estimates of bleeding in MMD. • High-resolution magnetic resonance imaging allows for the evaluation of perforating arteries in patients with moyamoya disease. • Choroidal anastomosis is associated with hemorrhagic events in patients with moyamoya disease. • High-resolution magnetic resonance imaging might facilitate further grading and classification of moyamoya vessels.

Improved Depictions of the Anterior Choroidal Artery and Thalamoperforating Arteries on 3D-CTA Images Using Model-based Iterative Reconstruction

To evaluate the depictability of intracranial small arteries using high-resolution CTA with model-based iterative reconstruction (MBIR). We retrospectively analyzed 21 patients who underwent brain 3D-CTA. Axial and volume-rendered (VR) images were reconstructed from the 3D-CTA raw data using adaptive statistical image reconstruction (ASIR) and MBIR. As a quantitative assessment, intra-arterial CT values of the ICA and contrast-to-noise ratio were measured to evaluate vessel enhancement. Additionally, CT values and standard deviations (SDs) of CT values and signal to noise ratio in white matter parenchyma were measured to evaluate background noise. As a qualitative assessment, the degree of vessel depictability in the anterior choroidal artery (AchoA) and the perforating branches of thalamoperforating arteries (TPA) on VR images using two different reconstruction algorithms was visually evaluated using a 3-point grading system. The CT value of the ICA [605.27± 89.76 Hounsfield units (HU)] was significantly increased and the SD value (i.e., image noise) of the white matter parenchyma [6.79 ± 0.81(HU)] was decreased on MBIR compared with ASIR [546.76 ± 85.27 (HU)] and [8.04 ± 1.08 HU)] (p <.05 for all). Contrast-to-noise ratio of ICA [84.48 ± 20.17] and signal to noise ratio of white matter [6.18 ± 0.75] with MBIR were significantly higher than ASIR [65.98 ± 13.08] and [5.28 ± 0.78] (p < 0.05 for all). In addition, depictions of the AchoA and TPA on VR images were significantly improved using MBIR compared with ASIR (p < 0.05). MBIR allows depiction of small intracranial arteries such as AchoA and TPA with better visibility than ASIR without increasing the dose of radiation and the amount of contrast agent.

Infarction of Percheron artery: A rare case report

The thalamus has strategic cores, which are divided into different functional classes and manage important cortical functions in harmony with each other. The mechanism proposed in the bilateral paramedian thalamic infarction is an occlusion of a single undifferentiated thalamo-perforating artery which is an anatomic variant. This artery, called the Percheron artery, appears from the first segment of the posterior cerebral artery and gives bilateral medial thalamic perforating branches. Bilateral paramedian thalamic infarction causes specific clinical signs and symptoms such as changes in consciousness ranging from letarj to coma, vertical gaze paralysis, ocular congestion loss and amnesia. In this case we aimed to present clinical and radiological features of a rare condition with infarction of percheron artery.

Initial clinical experience of a prototype ultra-high-resolution CT for assessment of small intracranial arteries.

Diagnostic and neurosurgical procedures require the precise localization of small intracranial arteries, but this may be difficult using conventional computed tomography angiography (CTA). This study was conducted to evaluate the quality of CTA images acquired using a prototype ultra-high-resolution computed tomography (U-HRCT) system compared with those acquired using a conventional computed tomography (C-CT) system. From July through September 2015, 10 adult patients (6 women and 4 men) previously scanned by C-CT were examined using U-HRCT to locate and assess cerebral aneurysms. The bilateral ophthalmic artery (Opth A), anterior choroidal artery (Acho A), and thalamoperforating arteries (TPAs) were visually evaluated in randomly presented CTA images. Images were graded on a 5-point scale, and differences in scores between U-HRCT and C-CT were evaluated by the Wilcoxon signed-rank test. A p value < 0.05 was considered statistically significant. Visual evaluation scores for images of the Opth A, Acho A, and TPAs were significantly higher for U-HRCT than for C-CT. U-HRCT images achieved good visualization (score > 3) for C-CT images with poor visualization (score < 3) in 66.7-100% of all the small arteries. U-HRCT is superior to C-CT for detecting and evaluating clinically significant small intracranial arteries.

Cerebral Perforating Artery Disease : Characteristics on High-Resolution Magnetic Resonance Imaging.

Our aims were to evaluate the feasibility of high-resolution magnetic resonance imaging (HR-MRI) for displaying the cerebral perforating arteries in normal subjects and to discuss the value of HR-MRI for detecting the causes of infarctions in the territory of the lenticulostriate artery (LSA). Included in this study were 31 healthy subjects and 28 patients who had infarctions in the territory supplied by the LSA. The T1-weighted imaging (T1WI), T2WI, diffusion-weighted imaging (DWI), and HR-MRI, including 3‑dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and 3D fast spin-echo T1WI (namely CUBET1 in GE Healthcare), were applied on a3-Tesla scanner. The numbers and route of the perforating arteries on both sides were independently confirmed on HR-MRI by two physicians. The Wilcoxon test was used to compare the differences. The numbers of perforating arteries in healthy subjects observed on 3D-TOF-MRA were as follows: numbers of the bilateral recurrent artery of Heubner (RAH) ranged from 0-3 (median 1), numbers of the left LSA ranged from 0-7 (median 3), numbers of the right LSA ranged from 0-5 (median 3), numbers of the bilateral anterior choroidal artery ranged from 1-2 (median 1) and the numbers of the bilateral thalamoperforating artery ranged from 1-2 (median 1). In the patients with lenticulostriate infarctions, the numbers of LSAs on the affected side were lower than on the opposite and ipsilateral sides in the healthy subjects. The results were statistically significant. An abnormality of the RAH may lead to acentrum semiovale infarct pattern, whereas an abnormality of the LSA is associated with acorona radiata infarct pattern. The use of HR 3D-TOF-MRA and CUBE T1 had unique advantages in displaying the tiny perforating arteries in vivo. Moreover, effective recognition of the associated cerebral perforating artery and infarct patterns may enhance our understanding of the mechanism of stroke in patients with lenticulostriate infarctions.

The posterior thalamoperforating artery (the main perforating trunk from P1) microsurgical study

Thirty fresh human brains were studied regarding to the anatomy of the posterior thalamoperforating arteries (PThPA): origin, number, diameter, traject, distance from the basilar artery bifurcation, type of distribution and correspondent area of vascularization. Most of the PThPAs originated proximally in the posterior cerebral artery (PCA), irrigating the cerebral, peduncles, mammilary bodies, ventral portion of midbrain and, through the posterior perforated substance, the medial portion of thalamus. The mean number of PThPAs per hemisphere was 1.51, mean proximal diameter 0.60 mm and mean distance from PCA origin 2.47 mm. A deep knowledge of the microsurgical anatomy of PThPAs is stressed, as devastating lesions can develop after arterial compromise during neurosurgical procedures.

Diversity among posterior thalamoperforating branches originated from P1 segment: systematic review.

The P1 segment of the posterior cerebral artery (PCA) begins at the termination of the basilar artery and ends at the origin of posterior commu-nicating artery, within the interpeduncular cistern. Perforating branches arising from this segment are called posterior thalamoperforating arteries (TPAs) and the main and biggest artery among those is called TPA. Perforating branches are a crucial component of cerebrovascular system supplying the posterior part of the thalamus, subthalamus, hypothalamus, substantia nigra, perforated substance, posterior part of internal capsule and the nucleus of III and IV cranial nerve. It is very important for neurosurgeon to know the anatomy of perforating branches because of their susceptibility to injury. The aim of this study is to determine the morphometry of posterior TPAs and allow a better understanding of their bran-ching patterns and relation to basilar artery. An extensive search was undertaken in order to identify published literature related to the posterior cerebral circulation system and the anatomy of posterior TPAs using key words. Medline, Embase, Ovid and Google Scholar databases were searched for publications dated from 1970 until July 2016. We collected and analysed all the data describing the mean number of branches per P1 segment, range of branches, number of analysed PCA, largest diameter of TPA, mean diameter of TPA and average distance from the basilar artery bifurcation. Thirteen cadaver studies were analysed and the data was extracted. We focused on the mean number of branches arising from P1 segment, perforators range, mean diameter of perforating branches, largest diameter of perforating branches. Mean number of branches per hemisphere was 2.91 (min. 1.51, max. 4.1). In more than half of analysed studies, authors did not find any pre-sence of posterior TPAs. Mean diameter of those perforators was 0.51 mm (min. 0.125 mm, max. 0.8 mm). Average distance from basilar artery bifurcation was 2.29 mm (min. 1.93 mm, max. 2.75 mm). There were many branching patterns presented by different authors.

De Novo Posterior Thalamoperforating Artery Aneurysm Presenting with Subarachnoid Hemorrhage 7 Years after Surgery of a Posterior Cerebral Artery Aneurysm

De Novo Posterior Thalamoperforating Artery Aneurysm Presenting with Subarachnoid Hemorrhage 7 Years after Surgery of a Posterior Cerebral Artery Aneurysm

Superficial temporal artery to proximal posterior cerebral artery bypass through the anterior temporal approach.

Background:The superficial temporal artery (STA) to proximal posterior cerebral artery (PCA) (P2 segment) bypass is one of the most difficult procedures to perform because the proximal PCA is located deep and high within the ambient cistern. STA to proximal PCA bypass is usually performed through a subtemporal approach or posterior transpetrosal approach, and rarely through a transsylvian approach. The aim of this study was to describe the operative technique of STA to proximal PCA bypass through a modified transsylvian approach (anterior temporal approach).Methods:STA to proximal PCA bypass was performed through an anterior temporal approach in three patients with intracranial aneurysm. We describe the details of the surgical technique.Results:The STA was successfully anastomosed to the proximal PCA in all cases. One patient suffered hemiparesis and aphasia due to infarction in the anterior thalamoperforating artery territory.Conclusions:STA to proximal PCA bypass can be performed through an anterior temporal approach in selected patients. We recommend that every precaution, including complete hemostasis, placement of cellulose sponges beneath the recipient artery to elevate the site of the anastomosis, and placement of a continuous drainage tube at the bottom of the operative field to avoid blood contamination during the anastomosis, should be taken to shorten the temporary occlusion time.

Morphometric Study of the Anterior Thalamoperforating Arteries.

ObjectiveTo evaluate the morphometry of the anterior thalamoperforating arteries (ATPA).MethodsA microanatomical study was performed in 79 specimens from 42 formalin-fixed adult cadaver brains. The origins of the ATPAs were divided into anterior, middle, and posterior segments according to the crowding pattern. The morphometry of the ATPAs, including the premammillary artery (PMA), were examined under a surgical microscope.ResultsThe anterior and middle segments of the ATPAs arose at mean intervals of 1.75±1.62 mm and 5.86±2.05 mm from the internal carotid artery (ICA), and the interval between these segments was a mean of 3.17±1.64 mm. The posterior segment arose at a mean interval of 2.43±1.46 mm from the posterior cerebral artery (PCA), and the interval between the middle and posterior segments was a mean of 3.45±1.39 mm. The mean numbers of perforators were 2.66±1.19, 3.03±1.84, and 1.67±0.98 in the anterior, middle, and posterior segments, respectively. The PMA originated from the middle segment in 66% of cases. A perforator-free zone was located >2 mm from the ICA in 30.4% and >2 mm from the PCA in 67.1% of cases.ConclusionMost perforators arose from the anterior and middle segments, within the anterior two-thirds of the posterior communicating artery (PCoA). The safest perforator-free zone was located closest to the PCA. These anatomical findings may be helpful to verify safety when treating lesions around the PCoA and in the interpeduncular fossa.

Contribution to the Morphological Study of the Cerebral Arterial Circle (Circle of Willis) of Rats

In this paper the Circle of Willis (CW) was morphologically studied in 87 Wistar rats in the RibeirA£o Preto Medical School. The vessels of the brain were contrasted with colored latex, just after the euthanasia of the animal. After removal of the brain from the skull, the CW and their main components were dissected under microsurgical vision, schematically reproduced and photographed for analysis. The CW presented patterns and variations, which were more or less constant. The constant patterns were: 1. its components have anastomosis among them, making the circle a closed structure; 2. the middle cerebral artery (MCA) and the nasal olfactory artery (NOA) are patent vessels; 3. the origin of the superior cerebellar arteries (SCbAs) ocurred as terminal branches of the basilar artery (BA); and 4. the A2 segment of the anterior cerebral artery (ACA) is an azygos vessel. Among the not constant but frequently observed patterns: 1. the variation in the origin of the posterior cerebral arteries (PCAs), and the presence of the thalamoperforating arteries (TPAs); 2. the presence of the anterior choroidal artery (AChA), and of the corticoamygdaloid artery (CoAmA); 3. the singleness in the origin of the MCAs and of the A1 segments of the ACA; 4. the presence of anastomosis between both A1 segments of the ACAs; 5. the origin of the ventral olfactory artery (VOA) from the A1 segment of the ACA inside the longitudinal cerebral fissure; and 6. the junction of the A1 segments to form an A2 azygos vessel, inside the longitudinal cerebral fissure, near the genu of the corpus callosum. The results of this paper were in accordance with the most part of the data found in the literature, outstanding the finding of well-defined patterns for the anterior and posterior regions of the CW of rats, as well as, the main variations of their components, demonstrated through schemata and photographies.

Bilateral thalamoperforating arteries arising from the unilateral posterior cerebral artery revealed on 3.0-tesla MR imaging

The thalamoperforating artery (TPA), also referred as the paraedian thalamic artery or thalamic-subthalamic artery, arises from he proximal P1 peduncular segment of the posterior cerebral rtery (PCA) and supplies the posteromedial thalami. The thalaoperforating arteries of both sides may often arise from the P1 on ne side, either as a single trunk or as two separate closely related essels, thus supplying the thalamus bilaterally [1]. Here, a patient s described in whom 3.0-tesla magnetic resonance imaging (MRI) learly showed bilateral TPA arising from the unilateral posterior erebral artery. In this patient, we could sensibly account for the ssociation between the neurological symptoms and the vascular natomy of the perforating arteries.

A child with mutism after bilateral thalamic infarction

The occurence of mutism after thalamic lesions has rarely been observed before adulthood. We report a 6.5-year-old girl who presented with sudden mutism with a decreased level of alertness. Her MRI revealed a T2-fluid attenuated inversion recovery hyperintensity in both thalami, which suggested bithalamic infarction in the territory of the thalamo-perforating arteries and, more specifically, the para-median territories. Mutism was followed by a deficit of speech initiation with slow and slurred speech. Her speech returned to normal at 3 months after the onset of symptoms. Thus mutism could be the equivalent of akinetic mutism limited to the speech sphere.

Glue Embolization of Ruptured Anterior Thalamoperforating Artery Aneurysm in Patient with Both Internal Carotid Arteries Occlusion

Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.

Vaskuläre Syndrome des Thalamus

The thalamus comprises numerous nuclei that can be grouped into five major functional domains: (1) the reticular and intralaminar nuclei influence arousal and nociception, (2) sensory nuclei handle afferent pathways, (3) the effector nuclei are involved in motor function and language, (4) associative nuclei participate in higher cognitive functions and (5) limbic nuclei influence mood and motivation. The thalamic nuclei are mainly supplied by the following four cerebral arteries: paramedian artery, anterior thalamoperforating artery, thalamogeniculate artery and posterior choroidal artery (lateral branches). Occlusions of these arteries affect the thalamic nuclei to varying degrees and produce partly characteristic and partly overlapping deficits. This article describes the clinical pictures.

Spontaneous Intracerebral and Intraventricular Hemorrhage

This communication concerns a case of severe intracerebral hematoma and intraventricular hemorrhage in a young man, with continuous hemorrhage shown on angiography that was controlled by transarterial occlusion of a bleeding tha-lamoperforating artery. The pathophysiology of continuous intracranial bleeding in this particular case is discussed.