A ruptured aneurysm associated with pituitary tumor (author's transl)

The aneurysm case associated with brain tumor is not so rare. Most of aneurysms are non-ruptured and found incidentally during the examination for brain tumor. We have experienced with 4 aneurysm cases associated with brain tumor among 1,280 aneurysm cases during these 17 years. One out of 4 cases was of ruptured aneurysm associated with pituitary tumor. This rare case and review of the literature were described.     

Bronchial artery aneurysm as a cause of atelectasis

A 54-year-old nonsmoker female developed atelectasis of the anterior basal segment of the right lower lobe. A non-pulsating endobronchial tumor was observed bronchoscopically obstructing the right basal bronchus. The tumor was confirmed on arteriography to be a saccular aneurysm of the right bronchial artery. The aneurysm was treated with bronchial artery embolization. Bronchial artery aneurysm, without a predisposing disease, is quite rare, but should be considered as an etiological factor of atelectasis.     

Traumatic intracranial aneurysms after removal of tuberculum sellae meningioma: case report]

Two cases of traumatic aneurysms (TA) of the internal carotid artery (IC) due to removal of tuberculum sellae meningioma (TSM) are presented, and ideal treatment of those aneurysms is discussed. The tumor, compressing the IC laterally, was removed out without arterial injury in case 1. Though the patient's postoperative course was uneventful, frontal and intraventricular hemorrhage developed 2 months after the operation, and an IC dorsal aneurysm was detected. Preoperative angiograms showed no aneurysm, so it was considered to be a traumatic aneurysm due to the surgical procedure. The aneurysm was clipped at once, but postoperative angiograms showed recurrence of the aneurysm. IC balloon occlusion was carried out as the Matas test was negative. In case 2, a small tear in the IC was inadvertently made during recurrent TSM removal, which was wrapped with muscle using fibrin glue. 2 weeks after the operation, frontal hemorrhage developed. Angiograms revealed a small aneurysm of the IC, which was considered to be a traumatic aneurysm. IC balloon occlusion was performed as the Matas test was negative. These 2 patients have had no episodes of rerupture after the IC balloon occlusion. Tumors and main arteries are frequently adhesive, so arteries are easily injured during removal of meningiomas. Muscle wrapping was not enough to prevent TA formation. Neck clipping was not appropriate for treatment of TA, but IC balloon occlusion was an effective and excellent therapy for TA of IC.     

Campylobacter fetus endocarditis manifested by a popliteal mycotic aneurysm

BACKGROUND: Campylobacter fetus endocarditis is uncommon and may be life-threatening. CASE REPORT: A 91-year-old patient with rectal villous adenocarcinoma was admitted with fever and recent complaints of popliteal pain. The definite diagnosis of endocarditis and mycotic aneurysm related to C. fetus infection were accepted on the basis of clinical, radiological and microbiological data. Cure was achieved with antibiotics and surgery of the aneurysm without valvular replacement. DISCUSSION: C. fetus endocarditis was probably secondary to the iterative laser treatment of the rectal tumor that had been performed during the past weeks without antibiotic prophylaxis.     

Infected atrial myxoma

A patient with an infected atrial myxoma presented with clinical findings simulating bacterial endocarditis. The diagnosis was made with echocardiography, thus demonstrating the value of this rapid, noninvasive screening test. A ruptured mycotic aneurysm in the brain precluded early surgical excision of the tumor. The rapid evolution of this case to a fatal outcome underscores the need for prompt diagnosis.     

Aneurysmal bulb dilation of the azygos vein: radiological and clinical significance

An aneurysm of the azygos vein is usually detected in the course of routine chest X-rays. It presents as a sharply circumscribed tumor shadow in the area of the right tracheobonchial angle or as an enlargement of the upper right mediastinum. A tentative diagnosis is supplemented both by further X-rays in a supine position in combination with the Valsalva and Müller tests and by tomography. The most frequent cause of an azygos aneurysm found in our material is aplasia of the inferior vena cava. Infrahepatic interruption of the inferior vena cava with azygos continuation can also be an associated malformation. Therefore, bilateral pelvic phlebography with visualization of the retroperitoneal venous and azygos systems is mandatory for establishing the correct, complete diagnosis. We have found no concomitant hemodynamic derangements. It is important to note that under these circumstances no therapy is indicated.     

Round shadows in the thoracic roentgen picture, nicotine abuse

A 69 year old male patient was seen at our outpatient clinic because of a paravertebral mass in the routine x-ray-film of the chest. The patient was in good health, showed no loss of weight and complained only of slight cough probably due to his smoking habits. In view of these findings a benign lung tumor was suspected. However, the computed tomography of the chest revealed an aneurysm of the descending aorta which was successfully operated.     

Fenestrated oculomotor nerve caused by internal carotid-posterior communicating artery aneurysm: case report

OBJECTIVE AND IMPORTANCE: The fenestrated oculomotor nerve associated with the internal carotid-posterior communicating artery aneurysm is very rare. CLINICAL PRESENTATION: A 48-year-old woman had a history of subarachnoid hemorrhage caused by a ruptured right middle cerebral artery aneurysm, which was wrapped with good postoperative course. Twenty years later, the patient suffered frontal headache with a mild oculomotor nerve paresis in the right side. Follow-up neuroimaging studies demonstrated a de novo right internal carotid-posterior communicating artery aneurysm. INTERVENTION: The aneurysm was exposed and clipped via a right pterional route. The fenestrated oculomotor nerve associated with the aneurysm was confirmed at surgery. CONCLUSION: We speculated that the fenestration was most likely caused, by the growth of the aneurysm.     

Cranial bone flap fixation clamps: compatibility at MR imaging

To evaluate the compatibility of a commercially pure titanium aneurysm clip associated with magnetic resonance (MR) imaging at 1.5 T. Artifacts of the Spetzler titanium aneurysm clip were compared with those produced by six different nonferromagnetic aneurysm clips. With the titanium clip, no magnetic attraction was present, heating was minor, and the artifacts involved a small signal void. With the six other aneurysm clips, artifacts were larger. The presence of Spetzler titanium aneurysm clips is safe at MR imaging at 1.5 T or less.     

Concurrent subarachnoid hemorrhage due to ruptured aneurysm and hypertensive intracerebral hemorrhage--case report

A 64-year-old female presented with hypertensive thalamic hemorrhage concurrent with subarachnoid hemorrhage (SAH) due to a ruptured aneurysm manifesting as sudden onset of right hemiparesis followed by severe headache. The aneurysm was located in the basilar artery at the origin of the superior cerebellar artery, remote from the thalamic hematoma. The aneurysm was clipped 3 weeks after SAH. She was discharged with slight right hemiparesis. The method and timing of surgery for such patients depend on hematoma size, location of the aneurysm and hematoma, and neurological status. The intracerebral hemorrhage remote from the ruptured aneurysm should be treated initially if necessary, and the aneurysm clipped after the brain swelling has reduced.     

Association between exposure to crystalline silica and risk of sarcoidosis

A 56-year-old male with two mycotic aneurysms associated with infective endocarditis was treated by endovascular surgery before mitral valve replacement. Angiography revealed a ruptured proximal aneurysm and an unruptured distal aneurysm on the right middle cerebral artery. The ruptured aneurysm was successfully treated with an interlocking detachable coil, and patency of the parent artery was preserved. The unruptured distal aneurysm disappeared as a result of antibiotic therapy. Endovascular surgery of the mycotic aneurysm is less invasive and more effective than craniotomy under general anesthesia for patients with infective endocarditis.     

Aneurysm of the major vessels in neurofibromatosis

The case of a patient who presented with a ruptured aneurysm of the brachial artery and type I neurofibromatosis is presented. Angiography revealed a ruptured aneurysm of the brachial artery in the middle of the upper arm. Repair of the artery with autogenous vein grafting was impossible due to the extremely brittle brachial artery and accompanying veins. The blood supply distal to the aneurysm was secured by collaterals, and the aneurysm, including a relatively long portion of the brachial artery and veins adjacent to the aneurysm, was resected. The patient died of massive hemorrhage from the subclavian artery of the involved side 9 days postoperatively. Histological and immunohistological examinations of the tissues involved in the ruptured aneurysm were conducted. The resected brachial artery and veins were surrounded by hypertrophied tissue which tested positive for S-100 protein and negative for desmin and action. These findings suggest that the origin of the proliferating tissue was not mesodermal dysplasia, but neurofibroma occurring near or in the vessels. A ruptured aneurysm in a patient with neurofibromatosis should not be treated with reconstruction of the vessels. The treatment of choice is surgical or endovascular occlusion of the vessels involved.     

Fibromuscular dysplasia associated with intracranial giant aneurysm: report of a case

Although the correlation between fibromuscular dysplasia (FMD) and intracranial aneurysm is well established, the combination of FMD with a giant aneurysm is rare. This paper reports a patient with extracranial FMD associated with a giant intracavernous aneurysm compromising the trigeminal and abducens nerve. A review of the literature uncovered only four documented cases of FMD with concurrent giant intracranial aneurysms. The present case adds further weight to the argument for including FMD in the differential diagnosis list when confronted with a patient with a giant intracranial aneurysm. Absence of adequate collaterals in this patient eliminated ligation as a treatment strategy for the aneurysm.     

A large vertebrobasilar junction aneurysm grown at the proximal end of basilar artery fenestration--usefulness of balloon occlusion test with 99mTc-HMPAO SPECT under induced hypotension and consideration in therapeutic strategies

A 48-year-old lady suffered a transient loss of consciousness. CT and MRI revealed a large vascular lesion compressing the left lower pons. Angiography revealed a large aneurysm at vertebro-basilar junction, dome of which projected anteriorly and left to midline. Her previous vertebral angiogram taken 10 years ago when she suffered a subarachnoid hemorrhage from the left MCA aneurysm, had showed a fenestration of lower basilar artery without apparent aneurysm. Bilateral super-selective vertebral angiograms revealed that the aneurysm arose at the proximal end of the fenestration, and vertebrobasilar junction was incorporated into the aneurysm indicating broad neck aneurysm. The left posterior communicating artery was well developed. Balloon test occlusion (BTO) of bilateral vertebral artery was performed under normotension and induced hypotension. 99mHM-PAO SPECT was used to examine cerebral blood flow (CBF) during hypotensive BTO. The patient tolerated the test and CBF imaging showed insignificant sight decrease in bilateral cerebellar hemispheres. Exploration of the aneurysm was carried out by the right far lateral suboccipital approach. Bilateral vertebral arteries and the right segment of the basilar artery fenestration were identified. Neck clipping of the aneurysm with reconstruction of the parent vessels were tried with fenestrate clip. However, narrow operative field and large dome of the aneurysm made it hard to identify the left segment of the fenestration. Neck clipping was given up and clipping of bilateral vertebral arteries were performed distal to posterior inferior cerebellar artery with three body clippings. The patient showed moderate postoperative left lower nerve palsy, which was gradually improved in several weeks. Follow-up angiography revealed no opacification of the aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)     

Tentorial edge traumatic aneurysm of the superior cerebellar artery. Case report

The authors report an unusual case of a traumatic aneurysm of the right superior cerebellar artery (SCA). A 22-year-old woman presented with continuous headaches that appeared 15 days after she experienced closed head trauma as a result of a cycling accident. Computerized tomography scanning performed 3 months later showed a nodular lesion on the free edge of the tentorium, which mimicked a meningioma. The aneurysm was identified on magnetic resonance angiography, which showed the SCA as the parent vessel. The parent vessel was trapped, and the aneurysm sac was excised via right temporal craniotomy. Pathological examination of the sac revealed a false aneurysm. The patient's outcome was excellent. The pathophysiology of traumatic aneurysm at such a location suggests that surgery may be the treatment of choice.     

Etiology of immune stromal (interstitial) keratitis

BACKGROUND: Subarachnoid hemorrhage (SAH) with a spinal origin is a rare clinical entity. The most common source of SAH is an arteriovenous malformation. Only six cases of spinal hemangioblastomas causing SAH have been reported. CASE DESCRIPTION: This 48-year-old man had experienced severe headache 12 years earlier, which was diagnosed as SAH by computed tomography (CT) scan and lumbar puncture. However, cerebral angiography could not detect either aneurysm or arteriovenous malformation. Thereafter, he spent an uneventful life until he was incidentally diagnosed with a cervical tumor on magnetic resonance imaging (MRI) study for Meniere's disease. The tumor was situated at the cervicomedullary junction, and fed by the left vertebral artery. Histologic findings of the tumor showed features typical of hemangioblastoma. CONCLUSIONS: We describe a case of cervical spinal extramedullary hemangioblastoma with a past history of SAH. In our case, the SAH of 12 years ago perhaps occurred from the cervicomedullary junction hemangioblastoma. Since the etiology of SAH could not be detected at the first angiography, not only follow-up reangiography, but also MRI of the spinal cord and spinal angiography could have played an important role.     

Disappearance of the co-existing aneurysm and arteriovenous malformation after wrapping of aneurysm (author's transl)

The authors reported a case of an arteriovenous malformation associated with an aneurysm on its feeding vessel that is the left anterior inferior cerebellar artery. A housewife, aged 56-years, was admitted to our hospital with severe headache, nausea and vomiting. On admission, lumbar puncture revealed grossly bloody CSF. Neurological examination revealed meningeal irritation sign, horizontal nystgmus and disturbance of left auditory acuity. Bilateral carotid and retrograde brachial arteryography revealed an AVM near the left cerebellopontine angle and a small aneurysm of the left anterior inferior cerebellar artery at the left internal auditory meatus. At operation, the aneurysm was wrapped with a muscle piece and no surgical intervention for AVM. Post-operative course was uneventful except for disterbance of the left auditory acuity. Follow-up angiographies revealed a change of size the aneurysm and AVM and finaly failed to demonstrate the aneurysm and AVM demonstrated preoperatively. The spontaneous regression of the AVM might be due to the post-operative brain swelling and adhesion. We also speculated that the spontaneous disappearance of the aneurysm might be due to the decreased blood flow of parent artery by the spontaneous regression of the AVM. It is very rare that an aneurysm of anterior inferior cerebellar artery co-existed with AVM, and resulted in thrombosis of the aneurysm and regression of the AVM after wrapping alone.     

Serial magnetic resonance imaging of acute spontaneous thrombosis of a giant intracranial aneurysm--case report

A 46-year-old female presented with decreased bilateral visual acuity due to an unruptured non-thrombosed giant aneurysm arising from the left internal carotid artery. After admission, acute thrombosis of the aneurysm occurred spontaneously. Her consciousness and visual acuity temporarily worsened. Serial T2-weighted magnetic resonance (MR) imaging showed the size of the low intensity area near the orifice increased, and the aneurysm ruptured thereafter. Trapping of the aneurysm with a high-flow bypass was performed. Serial MR imaging findings clearly demonstrated the intraluminal structure of the thrombosed giant aneurysm. The aneurysm grew in size after thrombosis. The enlarging signal-void area on T2-weighted MR images were indicative of aneurysmal rupture. MR imaging is quite helpful to evaluate the changes of intraluminal thrombosis and size in giant aneurysms.     

Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature

The authors demonstrate the technical feasibility of using intravascular stents in conjunction with electrolytically detachable coils (Guglielmi detachable coils [GDCs]) for treatment of fusiform, broad-based, acutely ruptured intracranial aneurysms and review the literature on endovascular approaches to ruptured aneurysms and cerebral stent placement. A 77-year-old man presented with an acute subarachnoid hemorrhage of the posterior fossa. A fusiform aneurysm with a broad-based neck measuring 12 mm and involving the distal vertebral artery (VA) and proximal third of the basilar artery (BA) was demonstrated on cerebral angiography. The aneurysm was judged to be inoperable. Six days later a repeated hemorrhage occurred. A 15-mm-long intravascular stent was placed across the base of the aneurysm in the BA and expanded to 4 mm to act as a bridging scaffold to create a neck. A microcatheter was then guided through the interstices of the stent into the body and dome of the aneurysm, and GDCs were deposited for occlusion. The arteriogram obtained after stent placement demonstrated occlusion of the main dome and body of the aneurysm. The coils were stably positioned and held in place by the stent across the distal VA and BA fusiform aneurysm. Excellent blood flow to the distal BA and posterior cerebral artery was maintained through the stent. There were no new brainstem ischemic events attributable to the procedure. No rebleeding from the aneurysm had occurred by the 10.5-month follow-up evaluation, and the patient has experienced significant neurological improvement. Certain types of intracranial fusiform aneurysms may now be treated by combining intravascular stent and GDC placement for aneurysm occlusion via an endovascular approach. This is the first known clinical application of this novel approach in a ruptured cerebral aneurysm.