Growth of small unruptured intracranial aneurysm: case report

Magnetic resonance angiography (MRA) revealed silent but rapid growth of a small unruptured intracranial aneurysm until it was surgically treated to prevent rupture. Modern neuroimaging methods such as MRA and 3-dimensional computed tomography have increased opportunity to detect small unruptured cerebral aneurysms. Strict follow up is an option for the incidentally discovered small intact aneurysms using these methods.     

Ruptured intracranial aneurysm associated with unruptured abdominal aortic aneurysm--case report

A 61-year-old male with hypertension presented with sudden onset of headache and nausea due to subarachnoid hemorrhage (SAH). He had two siblings with history of SAH due to ruptured intracranial aneurysms. Right carotid angiography on admission showed an anterior communicating artery aneurysm. At that time, the extracranial arteries were not examined. The aneurysm was clipped with no complications. A pulsating mass was palpable in the abdomen 37 days after the onset. Ultrasonography and computed tomography showed an abdominal aortic aneurysm with intraluminal thrombus, measuring 8 x 9 x 8 cm. Normal pressure hydrocephalus had already developed. The patient underwent elective abdominal aortic aneurysm resection before ventriculoperitoneal shunting. After shunting, he recovered fully. The present case indicates that unpredictable sudden enlargement of associated abdominal aortic aneurysm is possible in patients with ruptured intracranial aneurysms.     

Hyperperfusion syndrome after clipping of an unruptured aneurysm. Case report

A 41-year-old man developed hyperperfusion 24 hours after undergoing successful clipping surgery for an unruptured middle cerebral artery aneurysm with temporary occlusion for 7 minutes. The patient exhibited motor aphasia 24 hours after surgery. Single photon emission computed tomography revealed hyperperfusion. The patient was sedated for 72 hours using propofol, and his symptoms gradually resolved. He returned to his previous job 2 months after surgery. Hyperperfusion syndrome is possible following any aneurysm surgery, including surgery for unruptured aneurysms using the temporary occlusion technique.     

Treatment of unruptured duplicated middle cerebral artery aneurysm: case report

BACKGROUND: Duplication of the middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery (ICA). The origin of the DMCA lies between the anterior choroidal artery and the distal end of the ICA. The association of cerebral aneurysm and DMCA is rare. CASE DESCRIPTION: In this 63-year-old woman, preoperative angiography and 3-dimensional computed tomography angiography revealed an aneurysm at the origin of the DMCA. The aneurysm was clipped and superficial temporal artery-DMCA anastomosis was performed. She was discharged with no neurologic deficits. Duplication of the middle cerebral artery can be divided into 2 types based on whether the site of separation from the ICA is at the top of the ICA (type A) or between the ICA top and the anterior choroidal artery (type B). The diameter of type A DMCA is comparable with that of the main middle cerebral artery trunk; in type B, it is smaller. In all 18 previously reported cases, the aneurysm was associated with type B DMCA. CONCLUSION: For appropriate treatment planning, it is necessary to determine the DMCA type and the anatomic relationship between the aneurysm and the DMCA. In patients with type B DMCA, the possibility of aneurysm formation should be considered.     

Delayed cerebral vasospasm after uncomplicated operation on an unruptured aneurysm: case report

We present the case of a patient who developed significant vasospasm on the 9th postoperative day after the uneventful clipping of an unruptured asymptomatic berry aneurysm. We discuss the literature and potential mechanisms for vasospasm in the absence of subarachnoid hemorrhage.     

脾动脉瘤1例

患者　女,27岁。左上腹包块6年。无外伤、感染史,无疟疾、血吸虫病史。体查:轻度贫血貌,左侧肋缘下4ｃｍ可扪及脾脏,质地中等,无触痛,无震颤,无血管杂音。肝未扪及。血红蛋白117ｇＬ,白细胞26×109Ｌ,中性粒细胞051,淋巴细胞036,嗜酸性粒细胞013,网织红细胞:08%,血小板48×109Ｌ,ＨＢｓＡｇ( ),ＨＢｃＡｂ( ),ＨＢｅＡｂ( ),肝功能、肾功能正常。Ｂ超:脾厚89ｃｍ,脾尖变钝,脾静脉30ｃｍ。胃镜:食道静脉曲张;胃前壁近小弯处有一纵形突起,呈紫色。术前诊断:①肝硬化(代偿期);②脾机能亢进。予以手术治疗。术中发现肝脏形态质地正常。脾呈紫红…     

Spontaneous partial thrombosis of an unruptured peripheral, superior cerebellar artery aneurysm: a case report]

A 52-year-old female suddenly developed headache and dizziness. On admission she complained of gait disturbance with dizziness but cranial nerve palsy could not be detected. CT scan revealed a mild high density lesion in the right ambient cistern and the density of the lesion had become much higher 5 days after admission. MRI revealed a homogeneous iso-intense lesion on T1WI, T2WI 2 days after admission and the lesion had changed to homogeneous high. The lesion was suspected to be a fresh thrombus. Right vertebral angiography showed a part of aneurysm arising from the ambient segment of the right superior cerebellar artery and we diagnosed the lesion as a partially thrombosed superior cerebellar artery aneurysm. About forty cases of peripheral superior cerebellar artery aneurysm have been described in the literature, but cases of spontaneous thrombosis of the aneurysms have been very rare. Spontaneous thrombosis of aneurysms was usually thought to occur in large aneurysms, but the aneurysm in our case was not large. We suspected that in our case spontaneous thrombosis may have been caused by occlusion of the parent artery of the aneurysm.     

MRI demonstration of clot in a small unruptured aneurysm causing stroke. Case report

The case is reported of a 69-year-old woman with an 18-mm unruptured aneurysm of the right middle cerebral artery which caused a moderate stroke. Magnetic resonance imaging revealed a clot inside the aneurysm that was not visible on computerized tomography scans. The danger of embolism from the clot prompted clipping of the aneurysm.     

未破裂颅内动脉瘤直径与其血流动力学、形态学及瘤壁强化的关系

目的 观察未破裂颅内动脉瘤（UIA）直径与其血流动力学、形态学及瘤壁强化（AWE）的关系。方法 对前瞻性纳入的85例UIA患者行数字减影血管造影（DSA）、高分辨率MR管壁成像（HRMR-VWI）及四维血流MRI （4D flow MRI）,观察其100枚UIA的血流动力学、形态学及AWE,计算UIA纵横比（AR）、大小比（SR）、顶颈比（DNR）、高宽比（HWR）、强化率（ER）及壁面切应力（WSS）;比较直径<7 mm （n=78）及≥ 7 mm （n=22） UIA各参数的差异。结果 直径<7 mm与≥ 7 mm UIA患者既往蛛网膜下腔出血（SAH）史、动脉瘤相关症状、SR、DNR、形态、AWE、ER及WSS差异均有统计学意义（P均<0.05）。多因素logistic回归分析显示,既往SAH史、UIA的SR、形态及ER为其直径≥ 7 mm的独立危险因素。WSS与UIA直径、SR及ER均呈负相关（r=-0.70、-0.67、-0.63,P均<0.001）。观察者间判断AWE的一致性极高（Kappa=0.87）,测量ER及WSS的一致性均好（ICC=0.946、0.871,P均<0.001）。结论 既往SAH史,UIA的SR、形态及ER均为其直径≥ 7 mm的独立危险因素。     

Dejerine-Roussy syndrome following endovascular parent artery occlusion for an unruptured posterior cerebral artery aneurysm (P2 segment): case report

A right posterior cerebral artery (PCA) fusiform aneurysm was incidentally discovered in a 53-year-old man. Although the aneurysm was asymptomatic, treatment of the aneurysm was indicated to avoid possible hemorrhage and/or mass effect. Since the patient tolerated temporary balloon occlusion of the right PCA at P1-P2 segments and sufficient collateral flow to the right temporo-occipital region was observed during such occlusion, parent artery occlusion as well as intraluminal occlusion of the aneurysm was performed with Guglielmi detachable coils. The patient did not develop neurological deficit immediately after embolization. However, he subsequently developed Dejerine-Roussy syndrome due to an infarction in the territory of the thalamogeniculate artery. Parent artery occlusion together with intraluminal aneurysmal obliteration is an useful treatment for a fusiform aneurysm of the PCA. However, ischemic complication in the territory of the perforating artery can not be predicted.     

Delayed rupture of a previously coiled unruptured anterior communicating artery aneurysm: case report

OBJECTIVE AND IMPORTANCE: We describe a case of an unruptured anterior communicating aneurysm that was treated successfully with Guglielmi detachable coils, which subsequently ruptured 23 months after initial therapy. This report discusses only the second published case of an unruptured lesion that was well embolized (>95% occlusion) and stable at 6-month angiographic follow-up that ruptured in a delayed fashion almost 2 years after the primary procedure. CLINICAL PRESENTATION: An 80-year-old man presented in Hunt and Hess Grade IV as a result of a ruptured anterior communicating artery aneurysm. The patient had undergone endovascular therapy 23 months earlier with documented nearly complete (1-mm residual neck) occlusion at 0 and 6 months. INTERVENTION: The patient underwent diagnostic catheter angiography at the time of admission, which revealed a 10-mm aneurysm adjacent to the previously embolized lesion. No further therapy was administered, and the patient died within 24 hours as a result of ictus. The request for an autopsy was denied. CONCLUSION: Aneurysm rupture after Guglielmi detachable coil embolization is a rare event. Most cases involve previously ruptured lesions. To the best of our knowledge, only one previous case of delayed rupture of an unruptured aneurysm that was managed endovascularly has been published in the English-language literature. This second case points to the need for vigilance in the follow-up of patients with coiled lesions.     

Anterior (dorsal) paraclinoid aneurysm: case report

Saccular aneurysms arising at locations other than arterial divisions have been reported but are extremely rare. Such a case of a previously unclassified paraclinoid aneurysms that arose from the anterior (dorsal) wall of the proximal internal carotid artery is reported. The neck of this aneurysm was located distal to the junction of the ophthalmic artery, which originated in the cavernous sinus. I propose that this aneurysm be classified as an anterior (dorsal) paraclinoid aneurysm.     

Surgical repair of extracardiac unruptured aneurysm of the sinus of Valsalva; report of a case

A 65-year-old man presented with a 6 year history of dyspnea. An unruptured aneurysm of sinus of Valsalva and aortic regurgitation had been detected at another hospital a year previously, and he was referred to our hospital for surgery. At operation, an extracardiac saccular aneurysm was widely localized to the noncoronary sinus of Valsalva and protruded into the left atrium. The aneurysm of the sinus of Valsalva (ASV) was repaired with patch closure using a dacron sheet, and aortic valve replacement was performed with a 21 mm Carpentier-Edward valve. However, there was uncontrollable bleeding from the patch suture line, so ascending aorta replacement and repair of the Valsalva sinus were additionally needed. He was discharged without any postoperative complication 7 weeks after operation. Cases of an ASV protruding into the left atrium are very rare. We recommend remodeling of the aortic root with wide replacement of 1 sinus for extracardiac succular ASV, because the tissue around the ASV is so fragile.     

Surgical treatment for an asymptomatic and unruptured sinus of Valsalva aneurysm: report of a case

A 70-year-old male underwent a transthoracic echocardiography as a screening test for hypertension and an unruptured aneurysm was detected in the right sinus of Valsalva. The right sinus of Valsalva aneurysm obstructed the right ventricle outflow tract but he did not have any symptoms. The sinus of Valsalva aneurysm was treated successfully by a patch closure with a bovine pericardial patch.     

小肾癌误诊为肾动脉瘤1例

患者男,57岁。5年前无明显诱因出现双侧腰背部钝痛,伴尿频、尿急,无恶心、呕吐,无血尿,无发热。近半年体质量下降约15 kg。查体：右肾区压痛,双肾区叩击痛。1个月前肾脏CT检查见右肾肾窦内等密度结节灶,     

Complete penetration of the optic chiasm by an unruptured aneurysm of the ophthalmic segment: case report

BACKGROUND: It is well known that aneurysms of the ophthalmic segment sometimes elevate the optic nerve or chiasm, and in case of large or giant aneurysms, the optic apparatus can be dramatically thinned. Nonetheless, they rarely penetrate the optic pathway completely. To our knowledge, no previous reports have dealt with the complete penetration of the optic chiasm by unruptured aneurysms of the ophthalmic segment. CASE DESCRIPTION: A 70-year-old woman presented with visual dysfunction in her left eye that she had experienced for several months. Her left visual acuity had rapidly deteriorated to the level of finger counting and visual field testing demonstrated nasal hemianopsia in the left eye and upper temporal quadrant hemianopsia in the right eye. Left internal carotid angiograms and three-dimensional digital subtraction angiograms showed an aneurysm of the ophthalmic segment projecting superomedially. Intraoperative findings revealed complete penetration of the optic chiasm by the fundus of the aneurysm. The optic pathway adjacent to the dome had become remarkably thin and dark yellow. After clipping was completed, the fundus of the aneurysm was punctured to decompress the optic chiasm. Postoperatively, patient's visual acuity in the left eye gradually recovered, but the visual field deficit persisted after the operation. CONCLUSION: This rare case demonstrates the potentially aggressive behavior of unruptured aneurysms of the ophthalmic segment. Patients with unruptured aneurysms of the ophthalmic segment who present with visual symptoms should be treated with surgical clipping to decompress the optic pathway as soon as possible.