Vertebral-basilar posterior cerebral territory stroke--delineation by proton nuclear magnetic resonance imaging

We used three-dimensional proton NMR images to study ischemic infarction in the territory of the vertebral-basilar posterior cerebral circulation. The study includes sixteen cases, eight of which are presented in detail. In seven cases, the infarctions were secondary to demonstrable large artery occlusive disease -- vertebral, basilar, or posterior cerebral. In nine cases, the infarctions were secondary to what was presumably small vessel disease. In fifteen of the sixteen cases, NMR imaging could locate the infarct, inversion recovery and spin-echo pulse sequences being more sensitive than the saturation recovery pulse sequence. This efficiency rests on the high sensitivity of ischemic infarction to changes in T1 and T2 relaxation time, highlighted in the inversion recovery and spin-echo images, respectively. The additional advantages of the three-dimensional approach, and the lack of bone artifact, make NMR imaging superior to CT scanning in identifying areas of infarction in the territory of posterior cerebral circulation.     

颅内椎-基底动脉夹层形态学与后循环缺血程度的相关性研究

目的 研究颅内椎-基底动脉夹层不同形态类型及不同狭窄程度对后循环缺血的影响.方法 回顾性分析解放军总医院第一医学中心2015年12月-2019年12月经DSA确诊的椎动脉颅内段及基底动脉夹层患者的多模式磁共振影像数据,利用MRA对后循环夹层的形态进行分组(瘤样扩张型、线珠型、狭窄-闭塞型),并根据MRA和高分辨率磁共振...     

Cerebral hemorrhage produced by ruptured dissecting aneurysm in miliary aneurysm

This report describes, for what may be only the second time, a ruptured miliary aneurysm within a cerebral hemorrhage. The report is unique in that the aneurysm has arisen at the site of a dissection within the wall of an arteriole at a site of fibrinoid necrosis. The case not only is a unique illustration of this pathogenetic pathway to miliary aneurysm formation, but also reemphasizes the relationship between fibrinoid and miliary aneurysm formation.     

Dissecting intracranial aneurysm

Summary A case of spontaneous dissecting aneurysm of the right internal carotid and middle cerebral arteries is presented in a 13-year-old boy. The pathogenetic factors incriminated in previously reported cases are reviewed and the pathological findings are discussed. The abnormalities of the internal elastic lamina as seen in this patient have been observed in numerous cases of intracranial dissecting aneurysms. It is concluded that these defects play an important role in the development of dissection.     

Giant intracranial aneurysm

The authors describe a case of a giant intracranial aneurysm of the left internal carotid artery in which signs of raised intracranial pressure predominated. In view of presence of internal hydrocephalus Holter's valve was implanted. The aneurysm was excluded from the circulation by trapping the afferent vessel. A good therapeutic result was achieved.     

Intracranial dissecting aneurysm

Summary The case of a 47-year-old man who died one month after a history of paroxysmal occipital headaches, vertigo, vomiting, weakness, and sweating is presented. The death was due to a pontine softening caused by a subintimal dissecting aneurysm of the two vertebral, the basilar and the right posterior inferior cerebellar arteries. No etiological factor of the illness could be found. The clinical signs resembled those of a flap-valve tumor of the IIIrd ventricle.     

Chronic fusiform aneurysm evolving into giant aneurysm in the basilar artery

Fusiform basilar aneurysm is a rare condition with elevated mortality within a few days if untreated. On the basis of clinical course, the fusiform aneurysm can be distinguished in an acute type, such as dissecting aneurysm, which usually causes subarachnoid hemorrhage or cerebral ischemia and in a chronic type with a relatively slow growth, which may evolve into a giant aneurysm leading to serious complications. We report a case of an 80-year-old man with a surgically untreated fusiform aneurysm that evolved into a giant aneurysm of the basilar artery within 4 years. The patient presented recurrent ischemic events involving the posterior circulation without aneurysmal rupture or bleeding.     

Iatrogenic false aneurysm caused by surgery of a traumatic intracranial false aneurysm

A superficial temporal artery (STA) false aneurysm caused by surgery of a traumatic intracranial false aneurysm is reported. A 28-year-old man underwent craniotomy for aneurysm clipping 20 days after traumatic head injury. At surgery the aneurysm was a false aneurysm due to its avulsion from the parent artery without a real neck. A "clip wrapping" technique was used to repair the deficit on the parent artery. On postoperative Day 25, repeat digital subtraction angiogram (DSA) revealed a new right STA aneurysm, which was not apparent in the preoperative DSA. We feel that this aneurysm might have probably resulted from the iatrogenic injury to the STA during the initial surgery as the location of aneurysm was at the initial craniotomy site. The pathophysiology, etiology, surgical treatment and preventive measures of false aneurysms have been discussed.     

Bypass induced cerebral aneurysm

The development of aneurysm after EC-IC bypass was studied in 6 cases by angiography. Increase in blood flow and alteration of slow pattern are contributing factors. It is suggested that the difference in structure between cortical arteries and scalp arteries enhances their sensitivity to transcranial pressure difference. High TCP gradients may induce post-operative aneurysm, and careful management of blood flow through the bypass is recommended.     

颅内动脉瘤夹闭术中动脉瘤破裂的危险因素分析

目的 探讨颅内动脉瘤病人夹闭术中动脉瘤破裂的危险因素。方法 回顾性分析2009年7月至2018年7月夹闭术治疗的296例颅内动脉瘤的临床资料。采用多因素logistic回归分析检验术中动脉瘤破裂的影响因素。结果 296例中,夹闭术中发生动脉瘤破裂59例,未破裂237例。多因素logistic 回归分析,年龄≥60岁、Hunt-Hess分级Ⅲ~Ⅴ级、发病至手术时间>3 d、手术器械不佳及手术操作不细致、动脉瘤瘤体血管弹性差及瘤体粘连是术中动脉瘤破裂的独立危险因素（P<0.05）。结论 高龄、Hunt-Hess分级高、发病至手术时间长、分离动脉瘤颈操作不细致、动脉瘤瘤体粘连为颅内动脉瘤病人夹闭术中动脉瘤破裂的主要危险因素     

Bypass induced cerebral aneurysm

The development of aneurysm after EC-IC bypass was studied in 6 cases by angiography. Increase in blood flow and alteration of slow pattern are contributing factors. It is suggested that the difference in structure between cortical arteries and scalp arteries enhances their sensitivity to transcranial pressure difference. High TCP gradients may induce post-operative aneurysm, and careful management of blood flow through the bypass is recommended.     

Timing of aneurysm surgery

Summary In a retrospective study covering a period of 8 years and 403 surgically treated patients the results of microsurgical aneurysm treatment were compared between two groups. One group received surgical treatment within 72 h and the second were treated surgically after this time interval. The data indicated that patients receiving delayed surgery had a better outcome at 6 months as compared to patients receiving immediate surgical intervention. The location of the aneurysm and the preoperative neurological status imparted the most significant impact on the subsequent outcome and on the incidence of rebleeding. High risk patients with poor neurological status on admission seemed to have a considerable chance of gaining satisfactory functional recovery, especially with a more delayed surgical approach. Despite its superior results delayed surgery was burdened with a rebleeding rate and an incidence of ischemic deficits due to cerebral vasospasm twice as high as in patients receiving early surgery. The implications of these results on surgical timing are discussed and it is concluded that despite the fact that late surgery yields better results than early surgery, the considerable reduction of recurrent hemorrhage and additional possibility of aggressive treatment of incipient vasospasm makes early surgery a promising alternative for the treatment of patients with aneurysmal subarachnoid hemorrhage.