False aneurysm due to mycotic angitis-case report (author's transl)]

Cerebral mycotic angitis takes place as a secondary disease to inflammation which is precipitated on the arterial wall to the artery, most frequently the vasa vasorum, as a result of settlement of infectious embolus into there, and it is usually seen in the patient with cardiac disease. The middle cerebral artery is a major region where the lesion takes place in multitude, and it is only rarely seen in the patient having infection in the brain or dura mater. We have recently experienced a very rare case in which false aneurysm was induced in the internal carotid artery by angitis due to Aspergillus, and this report deals with case. A 26-year-old office-man: He was attacked by loss of consciousness, aphesia, right hemiparesis during work in his office. As left CAG demonstrated evidence of arteriovenous malformation, redical operation was performed. He took a favorable course postoperatively, but developed meningitis on 10th day, when massive antibiotic therapy was started. During treatment, however, his consciousness rapidly decreased, and it was found on left CAG that there was false aneurysm in the cisternal segment of the left internal carotid artery which has previously been completely healthy. Operation was practiced once again to reinforce the wall of the left internal carotid artery, but the patient died of aggravated meningitis. Autopsy demonstrated a very fragile left internal carotidartery associated with perporation which was surrounded byprominent coagula. Histological examinations indicated that the perforation of the vascular wall had been caused by angitis due to Aspergillus infection.     

Primary "mycotic" aneurysm of the common carotid artery. Report of one case (author's transl)

Primary mycotic aneurysm of the common carotid artery is exceptional. The clinical characteristics are dominated by the absence of a detectable infectious cause, by the macroscopic, nonsuppurative aspect and the sudden increase in volume requiring emergency operation. The treatment of these aneurysms is surgical, but little known owing to the rareness of these cases. Reconstructive surgery gives satisfactory results. Its details are discussed in relation to the operative appearance.     

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.     

Intracranial mycotic aneurysm--report of a case (author's transl)

A case of intracranial mycotic aneurysm has been reported. The case was a 26-year-old female and was admitted to our hospital on November 11, 1975. She was semicomatous and showed right hemiplegia. On auscultation systolic murmur radiating from the mitral area to the left axilla was found. Left carotid angiogram showed a saccular aneurysm 5 mm in diameter, arising from peripheral portion of the percentral cerebral artery and accompanied by intracerebral hematoma. Emergency craniotomy was performed. A thin subdural hematoma, coated with pus, was found and microabcesses were seen to be scattered in the nearby subarachnoid space. After aneurysmectomy and removal of intracranial hematoma, the patient improved without complications. On histological examination of the aneurysmal wall, moderate degree of neutrophilic infiltration was found. It was especially marked around the vasa vasorum. Heretofore only eight cases of intracranial mycotic aneurysm have been reported in the domestic literature.     

Vasoconstriction of external carotid arteries after the rupture of intracranial aneurysm (author's transl)]

A patient in whom vasospasm of not only intracranial but also extracranial arteries was demonstrated after the rupture of an intracranial aneurysm was reported. A 55-year-old male was admitted with a ruptured left IC-PC aneurysm. Intracranial direct operation and continuous ventricular drainage were performed 33 hours after the rupture. Six days after the surgery, right hemiparesis and consciousness disturbances developed. Angiography revealed severe vasospasm of intra-and extracranial arteries, especially branches of the external carotid artery. The symptoms improved markedly following the superior cervical ganglionectomy and perivascular sympathectomy of cervical internal carotid artery on the left side. Vasospasm of the external carotid system, which has not been reported, was further investigated angiographically in 23 patients who had vasospasm of the intracranial arteries after aneurysm rupture. In about 50% of these patients was found vasospasm of the external carotid system too. These changes were not found in control cases without vasospasm of the intracranial arteries. Pathogenesis of the vasospasm of the external carotid system was discussed with particular emphasis on the relationship with the sympathetic nerves.     

A case of the anterior choroidal artery aneurysm combined with the abnormal intracranial vascular network (author's transl)]

A case of the anterior choroidal artery aneurysm combined with the abnormal intracranial vascular net-work was reported. The patient was 43-year-old male who was attacked by subarachnoid hemorrhage in February 25th 1975. When he was admitted to our clinic 30 days after the ictus, his general status was good and the neurological examination showed no particular findings except only slightly accelerated deep tendon reflexes on the left side. Cerebrospinal fluid still remained xanthochromic although no nuchal rigidity was denoted. Based on the angiographic four vessel studies, the circulatory condition of the patient's brain was summarized as follows; the internal carotid arteries were stenosed or occluded between the C1 and C2 segment on both sides, and abundant collateral circulation was developed mainly around the circle of Willis making an angiographically peculiar vascular net-work in tha base of the brain. Another angiographic finding to be noticed was a berry aneurysm which originated from the distal part of the left anterior choirdal artery. No special treatment was performed on him. He was discharged without any neurological residuals. It would be difficult to find out any hemodynamic relationship between the occlusion of the internal carotid arteries and occurence of the aneurysm. But the abnormally dilated anterior choroidal artery might suggest that the vessel wall of this artery would be burdened in the abnormal distension stress due to the increased transaxial pressure in this artery. Unqder such a hemodynamically stressed state, it would be possible the aneurysm like outpouching of the vessel wall being developed in some fragile portion of the artery functioning as a prominent collateral circulation.     

A case of giant aneurysm associated with vertebral fenestration (author's transl)]

A case of giant aneurysm associated with vertebral fenestration was reported. A 18-year-old female had complained of visual disturbance of left eye for past 2 years without headache, nausea and vomiting. Neurological examinations revealed normal except for optic atrophy on the left side. Physiological examinations were normal. Skull plain films showed the small calcification at the left supraclinoid region. Left common carotid angiograms revealed a giant aneurysm at left internal carotid artery measuring 4 X 2 X 2 cm in size, and left middle cerebral artery was poorly visualized. Vertebral angiograms showed the fenestration at left craniospinal junction. Computerized tomograms showed a round, granular high density lesion, and this lesion was clearly homogenously enhanced by contrast medium. It was considered that the direct surgery to this aneurysm might be impossible, because the neck of the aneurysm was located at extradural portion. Ligation of her common carotid artery was performed with Selverstone clamp. Her postoperative course was uneventful, and the postoperative angiograms revealed the reduction of the size of aneurysm. The etiological hypotheses of these cerebral vascular anomalies were briefly discussed.     

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.