Intracranial Aneurysm with Systemic Lupus Erythematosus Treated by Endovascular Intervention
5
Citation
7
Reference
10
Related Paper
Citation Trend
Abstract:
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, SLEIntroduсtion: Acute symptomatic seizure (ASS) is a most frequently complication after a stroke. Seizures could be associated with the worse outcome. Nowadays the prophylactic antiepileptic treatment after the stroke is not advisable. However this question have to be discussed in a particular groups of patients. The aim: To study the prevalence of ASS in the particular groups of patients after intracerebral hemorrhage as well as to determine the predictors of the sizure occurrence in these groups of patients.Materials and methods: The retrospective analysis of the clinical features of intracerebral hemorrhage for 305 patients was performed. Among them there were 127 patients with aneurysmal subarachnoid hemorrhage as well as 178 patients were with nonaneurysmal intracerebral hemorrhage.Results: In 12 patients from 127 with subarachnoid hemorrhage were occurred onset seizures. 4 patients from 12 with subarachnoid hemorrhage died (28.5% of all deaths in the group of patients with subarachnoid hemorrhage (SAH)). In the group of patients with seizures 10 of them had aneurysm in anterior part of Willi's Circle. In 11 patients from 178 with nonaneurysmal intracerebral hemorrhage occurred onset seizures. Only one patient from 72 with medial localization of intracerebral hemorrhage had seizures.Conclusions: Prevalence of ASS after intracerebral hemorrhage reaches 7.5%, in the group of patients with SAH - 9.5%, in the group of patients with intracerebral nonaneurysmal hemorrhage - 6.25%. Initial seizures at the onset of subarachnoid hemorrhage is an unfavorable prognostic criteria and is associated with higher mortality. Localization of aneurysm in anterior part of Willi's Circle and lateral localisation of intracerebral hemorrhage are associated with a higher risk of the ASS development.
Stroke
Subdural hemorrhage
Cite
Citations (0)
Intracerebral Hemorrhage and Subarachnoid Hemorrhage as a Result of InfectiveEndocarditis : A Case Report
Infective Endocarditis
Cite
Citations (0)
Objective To investigate the expression of HIF-1αin intracerebral hemorrhage and find out its significance and its correlation with the time of intracerebral hemorrhage.Methods The expression of HIF-1α were assessed by Immunohistochemistry staining.Results In 65 cease of intracerebral hemorrhage positive expression rates of HIF-1α was 61.5%(40/65) and 0 in normal braintissues.The positive rate was significantly higher in intracerebral hemorrhage than in normal brain tissues(P0.05).HIF-1α positive expression rates were 20%(3/15) in 6h,62.5%(20/32) between 6h to 24h and 94.4%(17/18) after 24h of intracerebral hemorrhage.HIF-1α expression was closely related with time of operation after intracerebral hemorrhage(P0.05).Conclusion HIF-1α was over expressed in intracerebral hemorrhage,and there is a significant correlation with the time after intracerebral hemorrhage.It can help hypoxic neurons survive in the condition of hypoxia.
Positive correlation
Hypoxia
Negative correlation
Spontaneous intracerebral hemorrhage
Clinical Significance
Cite
Citations (0)
Objective To discuss the reasons of false judgments of localization of the rupture aneurysms and find the way to fix this problem in patients with multiple intracranial aneurysms. Methods The clinical data of 25 consecutive patients, who presented with their first spontaneous subarachnoid hemorrhage and had multiple intracranial aneurysms from 2003 to 2009 in our hospital, were analyzed retrospectively. The rupture aneurysms were determined according to Nehls' method that reported before, and the supposed responsible rupture aneurysms w0ere clipped within 48 hours after hemorrhage in all patients. More aneurysms that could not be accessed in the same surgical session were surgically terated later. Results The location of the rupture aneurysm was verified at the time of surgery in all 25 patients. The concordance rate of the prediction and the reality of the rupture aneurysm was 80% (20/25). Four patients ( 16% ) ,in whom the ruptured aneurysm was not correctly identified,rebled after surgery,and 2 patients died as a result of the rebleeding One patients had no clear diagnosis at the end. Conclusion In the reported cases, about 80% rupture aneurysms could be correctly diagnosed before treatment according to the CT and DSA examinations. If clear diagnosis couldn't be made,additional examinations should be considered, such as CTA or MRI. Rupture aneurysms must be confirmed during the operation and the other aneurysms should be checked to exclude additional responsible aneurysms in all cases.
Key words:
Spontaneous subarachnoid hemorrhage; Multiple cerebral aneurysms; Cerebral angiography
Concordance
Cite
Citations (0)
Clinical use of four-vessels angiography increased the frequency of detection of intracranial aneurysm in patients who had episode of subarachnoid hemorrhage. However, some cases of subarachnoid hemorrhage did not show intracranial and intraspinal source of bleeding angiographically. Bjökesten and Troupp pointed out that some cases who were negative in angiography may have a very small intracranial aneurysm. Hassler described the minute aneurysm sized less than 2 mm in diameter from finding autpsy of the cases of subarachnoid hemorrhage and he emphasized that source of subarachnoid hemorrhage in tow cases were ruptured minute aneurysm. From the authors' experiences of ten very small intracranial aneurysms, the authors' advocated a name of miliary intracranial aneurysm in clinical practice. The author's criteria of the miliary intracranial aneurysm are as follows: (1) the miliary aneurysm grew from the wall of main trunk of intracranial artery, (2) the maximum diameter and height of protrusion of the miliary intracranial aneurysm are less than the diameter of parent artery. Ten miliary intracranial aneurysms are divided into two groups, one is the miliary intracranial aneurysm which is source of subarachnoid hemorrhage and the other is an accessory aneurysm bedise the another ruptured main aneurysm. These two groups were 5 aneurysms respectively. The majority of the accessory miliary intracranial aneurysms were observed in middle cerebral artery but the ruptured miliary intracranial aneurysms were observed in internal carotid artery, anterior communicating artery and middle cerebral artery. When the clinical symptom occurred at the time of rupture of miliary intracranial aneurysm compare with the one by rupture of usual major intracranial aneurysm, clinical symptom due to meningeal irritation was not different with each other but disturbance of consciousness and other neurological symptom were slight in miliary intracranial aneurysm cases. Angiographic diagnosis of miliary intracranial aneurysm is difficult, because differentiation of the miliary intracranial aneurysm from the loop or angulation of small artery is difficult in routine angiogram. In the case who showed questionable shadow as miliary intracranial aneurysm, the repeated angiography under modified direction of X-ray and modified head position of patient is required. The magnification cerebral angiography of three fold is also useful in diagnosis of miliary intracranial aneurysm. The intracranial treatment of miliary intracranial aneurysms were done by coating except one case whose aneurysm was clipped.
Anterior communicating artery
Cite
Citations (0)
Our purpose was to describe and further understand the determinants of the time of onset of parenchymatous intracerebral hemorrhage and subarachnoid hemorrhage in patients enrolled in the Stroke Data Bank.We analyzed the observed times of onset of intracerebral hemorrhage (n = 237 patients) and subarachnoid hemorrhage (n = 243 patients) compared with expected times of onset if the probability of onset was constant across all time intervals. We also analyzed the role of clinical features (if any) in explaining the findings.For intracerebral hemorrhage, 52.5% of patients reported onset times between 0600 hours and 1400 hours, with peak onset between 1000 and 1200 hours (chi 2 = 62.94, df = 11, p less than 0.001). Patients with subarachnoid hemorrhage were more likely to lack a history of hypertension compared with patients who had intracerebral hemorrhage (chi 2 = 23.3, df = 1, p less than 0.001). Patients with subarachnoid hemorrhage were more likely to have more uniform onset time throughout the day (chi ...
Stroke
Spontaneous intracerebral hemorrhage
Cite
Citations (0)
Techniques for surgical treatment of subarachnoid hemorrhage in the acute stage have recently been developed. But problems still exist in the treatment of aneurysms in the posterior circulation. This paper identifies the cause of the inoperability in patients with basilar aneurysm and its outcome. We have treat 145 cases of basilar aneurysm and we studied 44 cases without direct operation among the 145 cases. The most common reason for not operating on the basilar aneurysm is the rerupture of the aneurysm. Thirty-seven cases (84%) showed subarachnoid hemorrhage from a basilar aneurysm. Rerupture of the basilar aneurysm was observed in seven patients (46%) and this caused the patient to deteriorate. Sixteen patients (96%) died following rerupture of a basilar aneurysm. Only one patient survived but in a vegetative state. Three cases with acute hydrocephalus showed rerupture of the aneurysm directly after ventricular drainage. The second common reason for not operating was severe primary damage due to the first subarachnoid hemorrhage. Nine cases (20%) were too damaged to be operated on, and their outcome was poor. Only one patient recovered almost completely, while others died due to primary subarachnoid hemorrhage. Six cases was not operated on because of the severe complication of age or position of aneurysm. All except one of these cases showed good outcome. Five cases (11%) was not operated on because of severe vasospasm. Problems such as rerupture of aneurysm, primary brain damage following subarachnoid hemorrhage, and vasospasm originate from the first attack of subarachnoid hemorrhage. Rerupture of the aneurysm might be decreased by direct operation in the acute stage. Vasospasm following the attack of subarachnoid hemorrhage might be prevented if the clot of the subarachnoid hemorrhage was removed in the acute stage. Volume expansion, induced hypertension, calcium antagonist or other treatment may decrease the ischemic deficit from vasospasm if direct operation for the aneurysm is performed in the acute stage. Though the high risk of aneurysmal surgery in the acute stage must be recognized, it is worth trying the operation in the acute stage for the treatment of acute hydrocephalus, rerupture, and vasospasm. Two to three percent of unruptured aneurysms per year showed subarachnoid hemorrhage and we heve showed the outcome of unruptured aneurysm surgery is good. It is difficult to decide to operate for an unruptured basilar aneurysm. But we must give more careful consideration to the operation of unruptured basilar aneurysms than to supratentorial unruptured aneurysm. Our results indicate that rerupture of ruptured basilar aneurysms was frequent and the outcome was poor. Direct operation for ruptured basilar aneurysms should be considered in selected patients to prevent rerupture of the aneurysm, vasospasm following an attack of subarachnoid hemorrhage or acute hydrocephalus.
Cite
Citations (0)
Background: Subarachnoid hemorrhage has a high mortality and morbidity rates, and the cerebral aneurysm is the most common cause. The location of the ruptured cerebral aneurysm is diagnosed by cerebral angiogram and by computed tomography (CT) pattern of the subarachnoid hemorrhage. Objective: To find the incidence of CT pattern of each cerebral aneurysm and the correlation between CT pattern of subarachnoid hemorrhage and each location of cerebral aneurysm. Materials and Methods: The 126 patients with ruptured cerebral aneurysm were included in the present study. The information of the patients and CT were recorded and analyzed. Results: There were 49 male and 77 female patients. The highest location of cerebral aneurysm is anterior communicating aneurysm (59 patients, 47.6%). There were correlations between A region and anterior cerebral and anterior communicating aneurysm, and left D legion and the other location aneurysm. There were correlations between intracerebral hemorrhage and anterior communication, posterior communication cerebral, and anterior cerebral and middle cerebral artery aneurysm. Conclusion: The common location of cerebral aneurysm is anterior communicating artery aneurysm. There are correlations between the most thickness region of A and D region with anterior communicating aneurysm and the posterior circulation aneurysm, and the correlation between intracerebral hemorrhage and anterior communicating aneurysm, posterior communicating aneurysm, and middle cerebral artery aneurysm. Keywords: Subarachnoid hemorrhage, Cerebral aneurysm, Intracerebral hemorrhage, Thickness
Anterior communicating artery
Anterior cerebral artery
Posterior communicating artery
Cite
Citations (0)