Two cases of azygos anterior cerebral artery aneurysm (author's transl)]

Two cases with azygos anterior cerebral artery were reported from an analysis of 37 cases of distal anterior cerebral artery aneurysm. Case 1 was a 57-year-old woman. She had an attack of subarachnoid hemorrhage two months before admission to our clinic. The anterior cerebral artery was not demonstrated on the right carotid angiogram, and an azygos anterior cerebral artery was visualized on the left carotid angiogram. The aneurysm was situated at the distal end of the azygos artery. Case 2 was a 71-year-old hypertensive woman. Subarachnoid hemorrhage occurred 6 days before admission to our clinic. The left carotid angiography with contraleteral compression revealed an azygos artery and an aneurysm in its middle part. The azygos arteries in both cases were confirmed at operation and aneurysmal necks were managed without any serious deficit. The distal anterior cerebral artery aneurysm is frequently accompanied by azygos artery. This vascular anomaly may cause a hemodynamic change and may be one of the factors of aneurysmal formation at this part.     

Rupture of intracranial aneurysm due to cerebral angiography (author's transl)]

The authors report a case of rupture of intracranial aneurysm by angiography which was done four hours after the subarachnoid hemorrhage. Case; A thirty-one year old male patient was brought to our outpatient's clinic by ambulance because of conscious loss and convulsive seizure on Feb. 5th, 1974. Lumbar puncture showed grossly hemorrhage in the CSF. Immediately he was hospitalized and administered anticonvulsants, hypotensive drugs, antibrinolytic agents and corticosteroid. His signs and symptoms on admission were mild headache, nausea, nuchal rigidity, anisocoria (right greater than left) and left hyper reflexia. This attach was his second. (He first noted the bleeding attack on January 30, 1974). Four hours after this attack cerebral angiography was done under local anesthesia with heavy premedication. Puncture of common carotid arteries were uneventful. Three injections of 60% Conray, at the dose of 8 ml each, were performed and three films were taken. Few minutes after injections, he suddenly became unconscious and ceased respiration for a few seconds. Blood pressure was 210 mmHg at systolic, although 120 mmHg two minutes before. Immediately resuscitation started. His respiration reappeared within 0.5 minute and his vital signs gradually improved. We stopped examination. When returned to his bed, right pupil dilated and optic fundi showed bleeding bilaterally. Arteriography showed a large dumbbell shaped aneurysm at the trification of the right middle cerebral artery but no finding of hematoma (Fig. 1). We decided emergency operation at once. When started the operation his both sides pupil dilated, B.P. was very low. OPERATION: Right side large frontolateral craniectomy was done. Large subdural hematoma (Fig. 2), severe diffuse subarachnoid hemorrhage (Fig. 3) and intracerebral hematoma were found. Aneurysmal neck clipping was successfully done. POSTOPERATIVE COURSE: His level of consciousness was semicomatous. But gradually his state deteriorated and died one week after the operation. AUTOPSY: There was severe edema in both sides cerebrum. The brain stem, especially interbrain, and pons, had fallen into softening, so called respirator brain. This complication of angiography is very rare. This case is the 24th reported case of the ruptured aneurysm by angiography.     

Acute communicating hydrocephalus due to rupture of cerebral aneurysm (author's transl)]

That direct intracranial operation in indicated in ruptured intracranial aneurysm which has passed the acute stage is an accepted procedure today. However, regarding the pros and cons of direct intracranial operation during the acute stage, settlement has yet to be made. This arises from the fact that various combined aggravated pathological states of cerebral vasospasm, brain edema, intracerebral hematoma, hydrocephalus etc. are present. The authors had attended to the acute hydrocephalus in the cases of ruptured aneurysm and conducted ventriculoatrial shunt for hydrocephalus actively. As a result, it was found that ventriculoatrial shunt brought about considable improvement of the patients condition to such an extent that an early operation became possible. The results are following: (1) The authors conducted cerebral angiography in the acute stage in 51 cases of ruptured intracranial aneurysm. Of this 51 cases as a result of angiographic findings, 12 cases, 23.5% showed ventricular dilation and accompanied lowering of consciousness level and increased intracranial pressure. (2) The largest number of acute hydrocephalus among our cases appeared in patients in the age level of 30-39, amounting to 44.4%. While this seemed to indicate the importance of the age factor, no correlation was seen with the localization of ruptured intracranial aneurysm or the number of experienced ruptures. (3) Of 12 cases of acute hydrocephalus 7 cases were subjected to ventriculoatrial shunt operations. Of 7 cases, after operation 6 cases showed an improvement in consciousness remarkably, thus making it possible to conduct an early intracranial operation of aneurysm. Ventricular drainage, V-A shunt for the following reasons: 1. Possibility of infection is very few. 2. The site of burr hole for V-A shunt located in parietal area. So craniotomy area, for example bifrontal craniotomy is apart from the site of V-A shunt. 3. The control of intracranial pressure is also easy after intracranial operation for aneurysm. 4. Normal pressure hydrocephalus can be prevented. 5. This method is useful for decreasing the brain bulk during the direct operation.     

RI-cisternography of traumatic pneumocephalus (author's transl)]

A radionuclide, when injected intrathecally, normally does not enter into the ventricle system. In our three cases of intra cerebral-ventricular pneumocephalus the radionuclide entered into the ventricle and concentrated in the cyst. Such an abnormal movement of the radionuclide was generally caused by the obstruction of subarachnoid space and the increased C.S.F. absorption in the enlarged ventricle. Under consideration of the pre-and post-operative cisternograms of our three cases we examined the principal factor which brought on the abnormal movement of a radionuclide. Each principal factor was the excessive C.S.F. rhinorrohea in the first case, the increased C.S.F. absorption in the enlarged ventricle and the cyst in the third case. An analysis of our three cases shows that the accumulation of radionuclide into the ventricle system is not necessarily due to the obstruction of subarachnoid space, but also due to more C.S.F. absorption in the ventricle system than that in the subarachnoid space.     

Chronic traumatic rupture of the diaphragm (author's transl)]

The rising number of traffic accidents increases the number of traumatic ruptures of the diaphragm. Often there are no characteristic symptoms or those of other injuries may dominate. Sometimes a long time elapses before signs of hernia appear. Therefore the mass X-ray screening of the population is very important to demonstrate such cases. Chest X-ray, barium meal and pneumoperitoneum are required to detect a late herniation. Prompt surgical repair will give patients the best chance of recovery, thus avoiding complications which greatly increase the mortality rate.     

Ulnar artery aneurysm on the hand (author's transl)]

A cured case of ulnar artery aneurysm on the hand is reported in the article, that is worth publishing because of its rarity.     

Giant anterior communicating artery aneurysm (author's transl)]

A case of giant aneurysm arising from the anterior communicating artery, 24 X 28 X 30 mm in diameter was found in a 30 year old man. About ten years ago he became blind and recently developed right anosmia and diencephalic seizures. No subarachnoid hemorrhage, however, was found. Radiograms and tomograms of the cranium showed a ring-like calcification, but by angiography it couldn't be recognized as a giant aneurysm. The right frontal craniotomy and partial resection, therefore, was performed. A histological study of the resected material revealed that it was a spontaneously thrombosed giant aneurysm. The inner layer of its wall had neither endothelium nor elastic lamina, but had deposits of calcium salt. The outer layer was composed of collagen fibers without cell infiltration. The aneurysm was thrombosed except for its neck but its organization occurred incompletely. We want to emphasize the importance of a correct preoperative diagnosis, as an erroneous operative procedure can result in disaster. Volume, viscosity and tension of flowing blood into the aneurysm as well as the size of its neck and dome regulate dynamic properties. These properties may determine the enlargement rate or growth of the aneurysm. The dynamic characteristics and features of the inner surface of the aneurysmal wall may regulate the formation of thrombosis in the aneurysm. The intraluminal thrombosis and strength of aneurysmal wall, for example, calcium deposits, may prohibit aneurysm from its rupture.     

Concerning the double-side traumatic hip dislocation (author's transl)]

The double-side posttraumatic dislocation of the hip of a 17 year old moped rider is in order to discuss our concept of treatment of hip-dislocation without fracture. The result of the 2-years check-up is reported.     

Co-existing aneurysm and arteriovenous malformation--case report (author's transl)]

A patient was presented with both an aneurysm of the frontobasal branch of the right anterior cerebral artery and an arterio-venous malformation fed by the same artery. A 36-year-old man with sudden headache, nausea and vomiting was admitted to the emergency clinic on July, 4, 1974. On admission, he was slightly lethargic and complained of severe headache. The blood pressure was 112 systolic and 64 diastolic. He showed no abnormal findings except for nuchal stiffness and bloody liquor (pressure 260 mmH2o). A right carotid angiogram revealed an aneurysm, 1.0 cm in diameter, on the frontabasal branch of the right anterior cerebral artery and distal to the aneurysm the artery continued to an arteriovenous malformation. No other vascular lesion was observed by other angiographies. On July, 24, 1974, the parent artery (frontobasal branch) of the aneurysm was clipped and the part of right frontal lobe containing the nidus excisted. The patient's post operative course was uneventful.     

Haemodilution and cerebral blood flow (author's transl)]

Cerebral blood flow has been estimated in 10 patients during acute haemodilution and during the consecutive operation. Cerebral blood flow showed a lasting increase during the time of haemodilution, but this increase did not parallel the decrease of haematocrit value. The increase of cerebral blood flow became pronounced only, when the haematocrit become lower than 30%. Assumably the elevation of cerebral flow is mainly due to autoregulative mechanisms of cerebral blood flow to sustain oxygenation. It is concluded, that haemodilution below values of 30% hc might be dangerous in patients suffering from cerebral sclerosis.