Resolution of third nerve paresis after endovascular management of aneurysms of the posterior communicating artery.
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The effect of endovascular treatment on the recovery of neural function in patients with third nerve palsy caused by an aneurysm of the posterior communicating artery is poorly documented. We report three cases in which third nerve paresis resolved completely within 2 to 3 weeks of endovascular occlusion of a posterior communicating artery aneurysm. (+info)
BACKGROUND AND PURPOSE: The aim of our study was to compare outcome and its determinants in familial subarachnoid hemorrhage and in sporadic subarachnoid hemorrhage in a large and well-documented patient population. METHODS: Patients with aneurysmal subarachnoid hemorrhage (SAH) treated at the Department of Neurosurgery, Kuopio University Hospital, from 1977 to 1995 were included. Patients with polycystic kidney disease were excluded. The Glasgow Outcome Scale (GOS) score at 12 months was studied. RESULTS: There were 120 patients (97 first-, 15 second-, and 8 third-degree family connections) in 96 different families with familial SAH and 1237 patients with sporadic SAH. Age, gender, and admission grade on the Hunt and Hess scale did not differ between these 2 groups. In both groups >80% of patients were in relatively good condition at admission. The outcome was good (GOS score of 1 to 2) in 87 patients (73%) with familial SAH and in 874 patients (71%) with sporadic SAH. Analysis of 20 variables, including presence of coexisting diseases, aneurysm site and size, amount of blood shown on CT scan, intraventricular bleeding, preoperative intracerebral hematoma and hydrocephalus, as well as postoperative bleeding and vasospasm, revealed no significant differences between study groups. The degree of family connection (first-, second-, and third-degree) did not have any statistically important effect on outcome in the familial group in the Finnish study population. In multivariate analysis the knowledge of familial SAH was not an independent prognostic factor. CONCLUSIONS: Admission status, postoperative course, and outcome were similar in the familial and sporadic SAH groups in this Finnish population, in contrast to previous results. Familial SAH may not be a significant risk factor for poor outcome. (+info)
Aneurysm surgery in the acute stage: results of structured treatment.
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To evaluate the results of a structured treatment approach to aneurysm surgery in the acute stage, 150 consecutive patients with aneurysmal subarachnoid hemorrhage were studied, including 46 males and 104 females; World Federation of Neurological Surgeons grade I: 21 cases, II: 65, III: 41, IV: 23; day of operation < or = day 3: 103 cases, < or = day 7: 131. Patients underwent angiography on the day of admission or the next followed by surgery. The lamina terminalis and the membrane of Liliequest were routinely opened at surgery. The aneurysm neck was radically clipped after temporary clipping or trapping of the parent arteries. Intraoperative hemodynamic monitoring was used, and the craniotomies were closed without cisternal, epidural, or subgaleal drains. Nimodipine was given perioperatively (48 mg i.v./day for 10 to 14 days). Cases of symptomatic vasospasm were treated with selective intra-arterial administration of papaverine, sometimes combined with angioplasty. Outcome at discharge and 3 months later is good recovery in 61% and 75%, and death in 6% and 7%. The incidence of symptomatic vasospasm was 17%. Devastating vasospasms were observed in 5%. One-third of patients had mean flow velocities exceeding 120 cm/sec determined by transcranial Doppler sonography between days 4 and 14. Communicating hydrocephalus necessitating ventriculoperitoneal shunt occurred in 9%. Our results clearly show a favorable outcome compared with previous reports, especially with respect to the reduced occurrence of fatal vasospasm, hydrocephalus, and technical insufficiency. (+info)
Clinical characteristics of vertebrobasilar artery dissection.
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Sixteen patients with the diagnosis of vertebral or basilar artery dissection who were admitted at the Seoul National University Hospital from 1972 to 1996 are described. During the same period, we encountered 76 patients with posterior circulation aneurysms, so the vertebrobasilar artery dissection was 21% of posterior circulation aneurysms. The mean age was 44 years, and male predominated. Nine patients presented with subarachnoid hemorrhage (SAH) and seven with ischemic symptoms. The characteristic angiographic finding of patients with SAH was aneurysmal dilatation (pseudoaneurysm) in eight of nine cases. In cases of ischemic symptoms, only one case had aneurysmal dilatation. Some other angiographic findings were demonstrated such as string sign, tapered narrowing, complete occlusion, or double lumen. Clinical course of SAH group was much different from that of ischemic group. Rebleeding occurred in three patients of SAH group; immediately after the rebleeding all patients became comatose, but after extraventricular drainage, all patients with rebleeding recovered rapidly. In SAH group, four of nine cases died but there was no mortality in the ischemic group. These four patients showed signs of stem failure, when computed tomography (CT) demonstrated no evidence of additional bleeding and follow-up CT showed the infarction at a part of stem and/or cerebellum. Vasospasm or sudden extensive extension of dissection could be the cause of death. Surgical management was performed in three patients, endovascular intervention in four, and conservative management in two. The patients with incomplete embolization or conservative management had poor outcome. In ischemic group, all underwent conservative management including anticoagulation and/or antiplatelet therapy. On follow-up, most of the patients with ischemic symptoms made complete or very good recoveries. (+info)
Aneurysmal subarachnoid hemorrhage in Taiwan.
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In 1993, the annual report about prospective survey and registry of stroke revealed there were 439 cases of ruptured intracranial aneurysms in Taiwan area. Thirty-two of them had multiple aneurysms; therefore, totally 476 aneurysms occurred in these cases. The anatomic distribution of these aneurysms were as the following: internal carotid artery-posterior communicating artery 32%, anterior communicating artery 30%, middle cerebral artery 18%, carotid bifurcation 6%, anterior cerebral artery 4%, carotid-ophthalmic artery 2%, intracavernous carotid artery 2%, and vertebrobasilar system 6%. 364 cases received surgical or interventional treatment, which 88% was clipping procedure, 8% was interventional procedure with coil, and 4% was wrapping. The surgical mortality was 13%. (+info)
Management of non-traumatic subarachnoid hemorrhage in Filipinos.
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A retrospective study of a consecutive series of 110 Filipino patients with non-traumatic subarachnoid hemorrhage (SAH) treated by the author in an urban setting is presented as to etiology, sex and age, diagnostic procedures employed, and short- and long-term results of non-surgical and surgical management. Aneurysms were the source of hemorrhage in 48%, arteriovenous malformation in 9%, and "other SAH" (hypertension/undetermined causes) in 43%. Fifty-seven (52%) patients were initially seen by a general practitioner, 44 (40%) by a neurologist, and only nine (8%) were seen directly by the neurosurgeon. A male sex preponderance for aneurysm was seen below the age of 50 years and a female preponderance for other SAH and aneurysm above age 50 years. The great majority of patients were admitted on the same day they had SAH--usually within 8 hours of onset. Delay in hospitalization did not adversely affect the clinical grade. SAH was demonstrated by lumbar puncture (71%) and computed tomography (29%). Of 74 patients who underwent angiography, vasospasm was associated mainly with aneurysms and present in 50% of these cases. Medications most commonly utilized were for control of edema, sedation, and anti-vasospasm. Forty-three of 53 patients with aneurysms underwent surgical procedures of various types. In general, patients admitted with good clinical grade had good outcomes of treatment. For high grade patients the attitude was to wait for an improvement in clinical grade before performing surgery. (+info)
Incidence of subarachnoid hemorrhage from aneurysmal rupture in India.
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Incidence of subarachnoid hemorrhage from aneurysmal rupture is low in India when compared with that in Western world and Japan. A review of aneurysms seen in eight institutions of the country in 1985 and 1986 has shown a very small incidence of aneurysms. A study of circle of Willis in 1021 consecutive autopsies has also shown only two aneurysms on middle cerebral artery, the incidence being only 0.2%. For last 2-3 years, after an increasing awareness of its entity amongst the physicians and the population, only 300-350 aneurysms were seen in the cities of Bombay and Delhi with a population of 13 and 8 million, respectively. (+info)
Aneurysm surgery in Pakistan.
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The purpose of this study was to find out the incidence and outcome of aneurysms being operated in Pakistan. The data was collected from various neurosurgical centers in Pakistan where facilities for aneurysm surgery are available. The population of Pakistan is 130 million, with 28 neurosurgical centers in the country but only eight are equipped with facilities for performing aneurysm surgery. The period of study extended from January 1994 to December 1996. During this period 350 patients presented with subarachnoid hemorrhage (SAH). Diagnosis of SAH was confirmed by computed tomography (CT) brain scan, diagnostic lumbar puncture was performed in few patients only where CT scan was negative. After angiography, 240 patients had intracranial aneurysms, 79 had arteriovenous malformations, and three had bled in brain tumors. Of the 240 patients with proven intracranial aneurysms, 122 (51%) were male and 118 (49%) were female. The mean age at presentation was 40.5 years with a range from 7 to 68 and a peak incidence between 41 and 50 years. Subarachnoid bleeding was noticed in 179 (74.6%) patients, 52 (21.7%) had SAH associated with intracerebral hemorrhage, and nine (4%) patients presented with the third cranial nerve palsy. Anterior communicating artery was the commonest site for aneurysms (120, 50%), followed by posterior communicating artery (46, 19%) and middle cerebral artery (45, 19%). Aneurysm surgery was performed in 134 (56%) patients. Operative mortality was about 10%. At 3 months follow up 49% patients were in grade I Glasgow Outcome Scale. We conclude that intracranial aneurysms occur with equal frequency in both sexes with a peak incidence between 41-50 years and anterior communicating artery is the commonest site. SAH is the most common mode of presentation and is still a neglected from of stroke in Pakistan. Medical specialists and family physicians require education for early diagnosis and timely referral of patients with SAH to neurosurgical centers. (+info)