We report two cases in which volume subtraction three-dimensional CT angiography (VS-3DCTA) was used for cerebral aneurysm and vascular stenosis with intramural calcification. Case 1: VS-3DCTA with volume rendering clearly showed carotid cave aneurysm of the internal carotid artery. The location and size of the aneurysm was confirmed by digital subtraction angiography (DSA). In evaluation of the aneurysm, VS-3DCTA was equal to DSA and endovascular findings. Case 2: VS-3DCTA with volume rendering clearly showed stenosis of the middle cerebral artery, and intramural calcification with the cause of the stenosis was subtracted. On the other hand, it was difficult for DSA to reveal the stenosis because of the limitation of the imaging angle. In evaluation of the stenosis, VS-3DCTA was superior to DSA. VS-3DCTA was an important diagnostic tool that enabled visualization of the aneurysm in the area of the skull base and stenosis of the intracerebral artery.
Systemic lupus erythematosus (SLE) is a chronic disease with multiple pathologies that can affect every organ system of the body including central nervous system. Intracerebral aneurysms and subarachnoid hemorrhage (SAH) are one of comparatively rarer manifestations of central nervous system SLE. Here we present a case of known SLE complicated by the rupture of intra cerebral aneurysm at basilar artery tip which was successfully treated with endovascular coiling.
Keywords: cerebral aneurysm, endovascular surgery, SAH, SLE
Summary Background. Arterial bifurcations are sites of maximal hemodynamic stress, where cerebral aneurysms commonly develop. However, in our experience with endovascular treatment for aneurysms of the internal carotid artery (ICA) bifurcation, we often experienced that the aneurysmal neck did not necessarily exist only at the ICA bifurcation (ICBi). In this study, we have retrospectively evaluated characteristics of aneurysms at the ICBi. Methods. Ten ICBi aneurysms in 10 consecutive patients were studied retrospectively. The size of the aneurysms, the angles formed between the ICA and the anterior cerebral artery (ACA) and middle cerebral artery (MCA), and the diameter of the ICA, ACA and MCA were measured. Furthermore, to study the relationship between the location of the aneurysmal neck and the bifurcation of the ICA, the distance between the midline of the aneurysmal neck and of the ICA was measured. Results. The average aneurysm size was 6.3 3.2 mm and the average neck was 3.1 1.2 mm. The average ICA-ACA angle was 57.3 16.5 degrees, and the average ICA-MCA angle was 128.9 24.1 degrees. The average diameters of the ICA, ACA and MCA were 2.9 0.5 mm, 1.9 0.4 mm and 2.5 0.4 mm, respectively. The average distance between the midline of the aneurysmal neck and the ICA was 1.6 0.6 mm, and all aneurysmal necks of the ICBi arose from the side of the ACA. Conclusion. ICBi aneurysms were deviated to the side of the A1 segment of the ACA, where the artery might suffer higher hemodynamic stress.
An 18-year-old man presented with a rare case of a ruptured internal carotid artery (ICA)-persistent primitive anterior choroidal artery (PPAchA) manifesting as sudden onset of headache. Computed tomography (CT) showed subarachnoid hemorrhage. Three-dimensional CT angiography showed a saccular aneurysm at the right ICA-AchA region. Right internal carotid angiography showed a PPAchA and saccular aneurysm. Endovascular treatment of the aneurysm achieved complete aneurysm occlusion.
A case of cranial metastasis of hepatocellular carcinoma is reported. A 77-year-old woman with an elastic hard tumor in the right temporal region was referred to our department on April 30, 1992. On admission, the patient had slight weakness of the left upper limb. Plain skull X-ray and computed tomography (CT) showed bone destruction in the right temporal region. Magnetic resonance images (MRI) showed that the tumor was hypo-intense with T1-sequences and hyper-intense with T2-sequences, and included hyper-intense spots on both T1- and T2-images. Right carotid angiography showed that the tumor was fed by the middle meningeal and accessory meningeal arteries. The patient became disoriented, and the left hemiparesis worsened on May 4, 1992. CT scan revealed an irregular high-density area in the tumor because of intratumoral hemorrhage. After embolization of the arteries feeding the tumor, surgery was performed on May 8, 1992, and the tumor was totally removed. Histological examination of the tumor specimen revealed that it was a metastatic hepatocellular carcinoma. The patient died 8 months after initial diagnosis because of hepatocellular carcinoma.
