An anomalous hyperplastic anterior choroidal artery associated with an unruptured internal carotid–posterior communicating artery aneurysm

The anterior choroidal artery (AChA) injuries can result in severe neurologic deficits, so requiring careful observation to avoid inadvertent damage during neuroendovascular procedures. In this case report, we present the unusual case of an anomalous hyperplastic AChA associated with a fetal-type posterior communicating artery (PCoA), and an unruptured internal carotid artery (ICA) –PCoA aneurysm. A 54-year-old woman presented with persistent headache. Brain magnetic resonance imaging (MRI) showed an unruptured cerebral aneurysm in the right ICA, and cerebral angiography revealed a proximal fetal-type PComA and a distal anomalous hyperplastic AChA. Coil embolization was performed with no neurologic deficits and the target lesion was embolized with a total of 6 coils. An anomalous hyperplastic AchA has a lengthy course with numerous choroidal and perforating branches, and therefore, an abundant perfusion region. Thorough knowledge of the development and anatomy of anomalous arteries is important for safely performing endovascular procedures without causing any ischemic complications.     

A rare combination of complications of ruptured carotid artery aneurysm: A case report.

The giant aneurysm of the subclinoid portion of the internal carotid artery is a relatively rare disease that can present serious complications. We present the case of a 40-year-old guy who was suffering from a headache and had complete ophthalmoplegia in his right eye. A brain scan shows a right temporal subdural hematoma, associated with subarachnoid hemorrhage, and total Sylvian subacute ischemic stroke. CT angiography and MRI showed a ruptured and partially thrombosed aneurysm of the subclinoid portion of the right internal carotid artery complicated by subarachnoid hemorrhage, a right subdural temporal hematoma, and total Sylvian ischemic stroke. Our purpose is to recognize the possibility of an aneurysmal rupture when evaluating an acute subdural hematoma, alone or in combination with Ischemic stroke.     

Significant head motion can cause either hypermetabolic or hypometabolic cerebral activity on 18F-FDG PET/CT

We report 2 separate cases with significant head motion causing apparent hypometabolic and hypermetabolic cerebral activity on FDG PET/CT. Case 1 is a 57-year-old man with facial numbness status post chemotherapy for mantle cell lymphoma. Restaging attenuation-corrected PET showed increased left frontal region activity, whereas nonattenuation-corrected PET demonstrated evidence of patient motion with normal physiologic left frontal cortical activity. Case 2 is a 78-year-old man with history of malignant melanoma. Attenuation-corrected PET/CT demonstrated diffusely decreased activity in the left cerebral hemisphere, whereas nonattenuation-corrected PET showed significant head motion with intact cortical activity.     

Pregnancy-unrelated spontaneous rupture of a right ovarian artery aneurysm

Spontaneous rupture of an ovarian artery aneurysm is extremely rare. It can lead to retroperitoneal hemorrhage that is often life-threatening. We report a case of pregnancy-unrelated spontaneous rupture of a right ovarian artery aneurysm in a multiparous woman. A 29-year-old woman, gravida 3, para 3, whose latest pregnancy involved uneventful gestation and delivery 2 years previously, was admitted for right flank pain. The urine test result for pregnancy was negative. Computed tomography revealed a large retroperitoneal hematoma and right ovarian artery aneurysm with contrast extravasation. After selective angiography, embolization of the right ovarian artery was successfully achieved using microcoils. Diagnostic angiography with subsequent transcatheter arterial embolization is an effective and less invasive technique for the management of ovarian artery aneurysm.     

Fatal aortobronchial fistula

Aortobronchial fistula is a rare condition characterized by the development of a communication between the aorta and a branch of the bronchial tree that results from processes that arise within the aorta, in the tissues of the mediastinum, or in the adjacent thoracic organs. Three cases are reported to demonstrate characteristic features. Case 1: An 82-year-old woman was found collapsed with blood clot in her mouth. At autopsy an atherosclerotic thoracic aortic aneurysm was found which had eroded into the underlying left main bronchus with filling of the larynx, trachea and main bronchi with fluid blood. There was no evidence of dissection. Case 2: A 30-year-old woman collapsed and died. At autopsy, coarctation of the thoracic aorta was found with a saccular aneurysm distal to this which was joined to the left main bronchus by a mass of necrotic tissue. The bronchus contained a cast of blood; blood was also present within the trachea and within the distal airways of the left lung. Case 3: A six-year-old girl collapsed with massive airway haemorrhage following bronchoscopy. At autopsy coarctation of the thoracic aorta was identified with a saccular aneurysm distal to this. A transverse tear of the thinned aneurysm wall communicated with a mass of necrotic friable tissue that extended through the wall of the left main bronchus. Distal airways were filled with fluid blood. All three deaths were due to haemorrhage from aortobronchial fistulas. The pathogenesis of aortobronchial fistulas involves a variety of mechanical, infective and neoplastic processes. Many cases will not be diagnosed until autopsy examination is performed.     

Supplementary motor area activation in patients with frontal lobe tumors and arteriovenous malformations

BACKGROUND AND PURPOSE: Some patients who undergo surgical resection of portions of the supplementary motor area (SMA) have severe postoperative motor and language deficits, whereas others have no deficits. We tested the hypothesis that in some patients with lesions affecting the SMA, the contralateral SMA exhibits some of the activation normally associated with the ipsilateral SMA. METHODS: Functional MR imaging studies in seven healthy volunteers and 19 patients with frontal lobe tumors or arteriovenous malformations were reviewed retrospectively. The hemisphere in which the SMA activation predominated was tabulated for right and left motor tasks. The relative hemispheric dominance in the SMA for the right and left motor tasks was compared in the healthy and patient groups and with the location of the lesion in the patient group. RESULTS: None of the control subjects performing a right hand motor task activated predominantly the right SMA. Fifty percent of the patients with lesions overlapping the left SMA performing the right motor task activated predominantly the right SMA. Fifty-seven percent of control subjects performing the left hand motor task activated the left SMA predominantly. One hundred percent of patients with lesions overlapping the right frontal SMA performing the left motor task activated the left SMA predominantly. Differences between patients and controls were statistically significant. CONCLUSION: A lesion that contacts or overlaps the SMA is associated with an increased functional MR imaging response within the contralateral SMA.     

Cerebral atrophy and crossed cerebellar atrophy following acute subdural hematoma in infant

Crossed cerebellar atrophy (CCA) on imaging study reflects secondary degeneration of the cerebellar hemisphere caused by neuronal disconnection with the contralateral cerebral hemisphere. We report an 11-month-old child with traumatic left acute subdural hematoma, who showed crossed cerebellar atrophy on MR images. Eighteen months after the trauma, MR images showed brain atrophy not only in the left cerebral hemisphere but also in the right cerebellar hemisphere. The cerebellar atrophy was prominent in the lateral part. This finding is consistent with CCA and may support neuronal interactions between the cerebral hemisphere and the lateral part of the contralateral cerebellar hemisphere.     

儿童颅内外伤性动脉瘤的诊治

目的 评价儿童颅内外伤性动脉瘤的诊断、介入治疗疗效和安全性.方法 分析5例有明确头颅外伤史患儿颅内外伤性动脉瘤病例.经CT、MRI检查,2例为外伤性蛛网膜下腔出血,2例分别表现为右枕部颅内出血及左颞部颅内出血,另1例为后颅凹少量出血伴天幕缘少量硬膜下出血,右侧侧脑室三角区少量出血.5例患儿经DSA全脑血管造影分别诊断为左颈内动脉C1段外伤性动脉瘤,右侧裂动脉分支外伤性动脉瘤,左大脑中动脉分支外伤性动脉瘤,右大脑后动脉远端外伤性动脉瘤,右小脑后下动脉外伤性动脉瘤.其中左颈内动脉C.段外伤性动脉瘤和右侧裂动脉分支外伤性动脉瘤经GDC栓塞术治疗,左大脑中动脉分支外伤性动脉瘤及右小脑后下动脉外伤性动脉瘤于术夹闭.另1例严密随访观察.结果 2例外伤性颅内动脉瘤经GDC栓塞术及2例外伤性动脉瘤手术均获成功,末留任何后遗症;5例均能正常的学习和牛活.结论 儿童颅内外伤性动脉瘤虽属罕见,但GDC及手术治疗儿童颅内动脉瘤安全而有效,长期预后则有待于随访观察.     

Detection of unruptured familial intracranial aneurysms by intravenous digital subtraction angiography

Summary The authors discuss the detection of intracranial aneurysms (IA) by means of intravenous digital angiography (ivDSA) in (a)symptomatic first degree relatives of families in which two or more individuals have IA. ivDSA is an almost noninvasive and low-risk diagnostic procedure. Screening, by means of ivDSA, of two affected families is described. In family I which includes 7 members with proven IA, ivDSA has been carried out in 36 asymptomatic individuals: in one, a 6x15 mm aneurysm was found at the left posterior communicating artery (PCoA). In family II, including one member with a proven IA and another with a subarachnoid hemorrhage, ivDSA has been carried out in 4 members: one aneurysm with a diameter of 6 mm was found at the left PCoA. Conventional cerebral angiography (CCA) confirmed both IA's. Neurosurgical treatment followed. The advantages and disadvantages of ivDSA vs. CCA as elective screening procedure in such cases are discussed. Screening of asymptomatic first degree relatives of cases with familial IA by means of ivDSA is strongly advocated.     

Functioning heterotopic grey matter? Increased blood flow with voluntary movement and sensory stimulation

A 66-year-old woman with a right hemiplegia due to cerebral haemorrhage was found to have heterotopic grey matter in the left frontal and right frontal and parietal lobes. She had no neurological disturbance prior to the haemorrhage. Regional cerebral blood flow (rCBF) was measured by xenon-CT (Xe-CT) in the zones of heterotopic grey matter during voluntary movement and sensory stimulation of her left limbs. During voluntary movement, rCBF increased markedly in the heterotopic grey matter of the frontal lobes and the overlying cortex. During sensory stimulation, rCBF increased in the right parietal heterotopic grey matter and the overlying cortex. This strongly suggests that the heterotopic grey matter is functional.     

Endovascular Repair of a Ruptured Mycotic Aneurysm of the Common Iliac Artery

This report describes the case of a ruptured mycotic aneurysm of the left common iliac artery, successfully treated with endovascular stent-grafting. A 64-year-old woman underwent diagnostic coronary angiography complicated by an infected hematoma of the left groin. Seven days later, she developed methicillin-resistant Staphylococcus aureus septicemia and CT scan evidence of perivascular inflammation around the left common iliac artery. This was followed by rupture of a mycotic aneurysm of the left common iliac artery. The lesion was successfully treated with a stent-graft and prolonged antibiotic therapy, and the patient remains free of infection 10 months later. Accumulating evidence suggests that endovascular repair can be used safely for the repair of ruptured infected aneurysms.     

Distal-end aneurysm of the frontopolar artery with an atypical postoperative complication: case report

OBJECTIVE: We present a unique case of a saccular aneurysm originating from the distal end of the right frontopolar artery (FPA). METHODS: This previously healthy, 54-year-old man had sustained a mild head trauma. On admission, he was lethargic, but his neurological examination results were otherwise normal. Neuroradiological studies (including brain computed tomography, magnetic resonance imaging, and cerebral angiography) demonstrated a distal-end aneurysm of the right FPA. The aneurysm was clipped and resected via a right frontal craniotomy. RESULTS: The postoperative course was uneventful. Pathological examination of the resected specimen confirmed rupture of the wall of a true aneurysm. The patient's medical history was also negative for trauma in the past, previous neurological disease, and vascular collagen disorders. Routine angiography performed 30 days postoperatively demonstrated complete occlusion of the right FPA. The patient was free of focal neurological deficits. CONCLUSION: This case demonstrates that not all distally located aneurysms are necessarily mycotic or traumatic.     

Follow-up findings in regional cerebral blood flow (r-CBF)-SPECT in a case of idiopathic childhood hemidystonia. Functional neuroimaging and pathophysiological implications

A 9 1/2-year-old girl suffered from intermitting tremor and jitteriness of her left hand and oral muscles every 4 to 6 weeks with long lasting episodes. Clinically myoclonias and dystonic positioning of the left arm, hand and facial muscles were seen. No evidence of trauma, infection or inborn errors of metabolism was found. Successful therapy with carbamazepine was initiated while L-DOPA failed. An ictal 99m-Tc-HMPAO-SPECT showed severe asymmetry with focal hyperperfusion of the contralateral right thalamus and basal ganglia as well as of the bifrontal cortex, whereas no anatomical lesions were found by MRI. In contrast, an interictally performed 99m-Tc-HMPAO SPECT showed hypoperfusion of the right thalamus and normalisation of the frontal perfusion under medical treatment. These 99m-Tc-HMPAO-SPECT findings may provide new insights into the localisation and pathophysiological pathways of idiopathic childhood dystonia.     

Chronic contained rupture of abdominal aortic aneurysm (CCR-AAA) with massive vertebral bone erosion: computed tomography (CT), magnetic resonance imaging (MRI) and fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) findings

A 62-year-old male presented with sudden onset of low back and right leg pain. Contrast-enhanced computed tomography demonstrated an abdominal aortic aneurysm (AAA), along with a large mass lesion causing vertebral body erosion. Magnetic resonance imaging (MRI) suggested that the mass lesion consisted of a chronic hematoma. Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated increased uptake around the mass lesion, but not around the AAA. Surgical intervention was performed, and the subsequent histological diagnosis was chronic contained rupture of AAA. The mass lesion consisted of chronic hematoma and necrosis with inflammatory cell infiltration and hemosiderin deposition. This condition mimics some neoplastic diseases, but MRI and FDG-PET findings may help establish the correct diagnosis.     

The “Spot Sign” secondary to a ruptured lenticulostriate artery aneurysm

The “Spot Sign” is a well-recognized radiographic predictor for hematoma expansion in patients with intracerebral hemorrhages. Although the exact underlying pathophysiology is unknown, it is generally assumed to be the site of blood vessel rupture and contrast extravasation. We report a case of an 81-year-old man who presented with right basal ganglia hemorrhage and the “Spot Sign” on computed tomography angiography. Conventional angiography subsequently revealed a lenticulostriate artery aneurysm within the hematoma, which was treated with surgical clipping. This case demonstrates that rare entities such as lenticulostriate aneurysms must be kept in the differential diagnoses in order to optimize patient management and improve clinical outcome.     

Unilocular orbital,cerebral and intraventricular hydatid cysts: CT diagnosis

Summary A 10-year-old girl with surgically proven unilocular hydatid cysts within the frontal horn of the right lateral ventricle, in the right orbit and another the left frontal region is reported. The intraventricular cyst was diagnosed on CT examination with intrathecal contrast medium injected via lumbar puncture.     

Intracystic hemorrhage of the middle fossa arachnoid cyst and subdural hematoma caused by ruptured middle cerebral artery aneurysm.

We report a case of a cerebral aneurysm arising from the bifurcation of the left middle cerebral artery that ruptured into a left middle cranial fossa arachnoid cyst, associated with acute subdural hematoma. We discuss the relationships of aneurysm, arachnoid cyst, and subdural hematoma.     

Synchronous spontaneous arteriovenous fistula and aneurysm of the deep femoral artery incidentally found in a patient with aortic aneurysmal dissection

The patient was a 77-year-old man with sudden-onset chest and back pain. Computed tomography angiography (CTA) from the abdomen to the proximal thigh showed an aortic aneurysmal dissection (AAD) and a left deep femoral artery (DFA) aneurysm. The AAD was conservatively managed as there was no sign of increase. The left DFA aneurysm was surgically resected to avoid complications such as rupture, thromboembolism, and limb ischemia. On follow-up CTA obtained 3 weeks later, a spontaneous AVF in a varicose vein of the right DFA was noted. There were no symptoms associated with the AVF, and he was conservatively managed. However, the varicose vein gradually increased, and he underwent successful transarterial catheter embolization (TAE) with metal coils without any complications. After vascular repair of the aneurysm and the AVF of the right DFA, there was no sign of recurrence.     

Percutaneous treatment of aberrant right subclavian artery aneurysm with use of the Amplatzer septal occluder

Aberrant right subclavian artery (ARSA) aneurysms are rare but carry a high risk of rupture and require early elective treatment. The present report describes a 60-year-old man with an asymptomatic ARSA aneurysm for whom surgical treatment would have been associated with a high degree of risk. The ARSA aneurysm was occluded with use of Amplatzer septal occluders, which avoided high-risk surgery and preserved antegrade flow into the left common carotid, subclavian, and vertebral arteries and perfusion of the right upper extremity through an induced right subclavian steal. The eventual need for bypass surgery for perfusion of the right upper extremity was assessed after the procedure.     

Percutaneous puncture and pre-operative cyanoacrylate obliteration of a traumatic false aneurysm of an angular artery branch

We report a case of traumatic false aneurysm developed in the right glabella in a 5-year-old boy 3 weeks after an innocuous fall. Ultrasound, CT and facial arteriography did not reveal the feeding artery. After direct puncture of the glabellar bulge and rapid aspiration of blood, percutaneous contrast agent infusion revealed that the false aneurysm was supplied by the contralateral angular artery. Intralesional obliteration with cyanoacrylate was subsequently performed smoothly. Succeeding excision was easy and the cosmetic outcome was excellent.