scholarly journals Bilateral Acute Subdural Hematomas With Intracerebral Hemorrhage Without Subarachnoid Hemorrhage, Caused by Rupture of an Internal Carotid Artery Dorsal Wall Aneurysm

2009 ◽  
Vol 49 (4) ◽  
pp. 152-154 ◽  
Author(s):  
Tomofumi NISHIKAWA ◽  
Tetsuya UEBA ◽  
Motohiro KAJIWARA ◽  
Kohsuke YAMASHITA
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intracerebral Hemorrhage ◽  
Internal Carotid ◽  
Dorsal Wall ◽  
Subdural Hematomas

Aneurysms at Nonbranching Sites in the Supraclinoid Portion of the Internal Carotid Artery: Internal Carotid Artery Trunk Aneurysms

Neurosurgery ◽  
2000 ◽  
Vol 47 (3) ◽  
pp. 578-586 ◽  
Author(s):  
Akira Ogawa ◽  
Michiyasu Suzuki ◽  
Kuniaki Ogasawara
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Clinicopathological Features ◽  
Clinical Entity ◽  
Dorsal Wall ◽  
Different Shapes ◽  
Aneurysmal Bleeding ◽  
Supraclinoid Internal Carotid Artery

ABSTRACT OBJECTIVE Aneurysms at nonbranching sites in the supraclinoid internal carotid artery (ICA), known as blood blister-like aneurysms or ICA anterior or dorsal wall aneurysms, are not well understood. To clarify this clinical entity, 7408 patients with subarachnoid hemorrhage who were treated during a 5-year period were analyzed. METHODS Forty-eight patients had aneurysms that were intraoperatively confirmed to be located at a nonbranching site in the supraclinoid portion of the ICA. Neuroradiological and clinicopathological features and outcomes were studied. RESULTS The aneurysms were divided into the “blister type,” with a blood blister-like configuration and fragile walls, and the “saccular type,” with a saccular configuration and a relatively firm neck, like ordinary berry aneurysms. The most frequent origin was the anteromedial wall for both types. ICA dissection was associated only with the blister type, and hypertension was more frequent with the blister type (P = 0.0978). The preoperative conditions of the patients were the same, but the outcomes for patients with blister-type aneurysms were worse, because of frequent intra- and postoperative aneurysmal bleeding. Saccular-type aneurysms were safely clipped. Treatment of blister-type aneurysms by clipping on wrapping material achieved good results, but ICA trapping (P = 0.0952), clipping (P = 0.0146), and wrapping (P = 0.0110) were associated with much worse results. CONCLUSION Blister-type and saccular-type aneurysms have different shapes and wall characteristics. The saccular type can be treated by clipping, whereas the blister type requires clipping on wrapping material. ICA trunk aneurysms may be a better designation to express the diversity of these aneurysms, rather than ICA blood blister-like or anterior or dorsal wall aneurysms.

Abstract 1122‐000187: Acute Stroke, Subarachnoid Hemorrhage, VZV vasculopathy, and Carotid Dissection: An Interesting Case

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Hashaam Arshad ◽  
Zhenhua Gui ◽  
Dakota Owens ◽  
Binod Wagle ◽  
Charles Donohoe
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Lumbar Puncture ◽  
Internal Carotid ◽  
Acute Encephalopathy ◽  
Igg Antibody ◽  
Cerebral Angiogram ◽  
Ct Angiogram ◽  
The Right

Introduction : A 51‐year‐old lady with a past medical history of Essential Hypertension, Hypothyroidism, prior Herpes Zoster infection 8 weeks ago was admitted with complaints of abdominal pain, bilateral flank pain, and restlessness. Her initial workup was significant for hyponatremia and hypokalemia. On the 3rd day of admission, she developed acute hypoxemic respiratory failure which led to intubation. At that time, CTA Chest was not done but CT Chest revealed prominent mucous plugging with left side glass ground opacities, Ultrasound of lower extremities revealed right common femoral vein DVT which led to concerns that she may have suffered from Pulmonary Embolism and led to starting Heparin drip. On the 6th day of admission, she developed Acute Encephalopathy, MRI Brain revealed acute infarcts in bilateral cerebral cortices and cerebella, CT Angiogram Head showed acute subarachnoid hemorrhage in the high posterior right parietal lobe, stenosis of the right high cervical internal carotid artery, and irregular, the appearance of the arterial vasculature throughout and CT Angiogram Neck abrupt change in caliber of the right ICA, 1.5 cm distal to the bifurcation with markedly severe narrowing of the majority of the extracranial right ICA throughout its course. A cerebral Angiogram was done which showed diffuse tandem segments of tandem cervical and intracranial portions of the right internal carotid artery and she was given nitroglycerin was administered as a therapeutic intervention. Lumbar Puncture showed WBC 2, RBC 7, Protein 162, Glucose 64, VZV PCR was negative, CSF VZV IgG Antibody positive at 303 IV (>165 IV indicative of current or past infection). Serum VZV IgG Antibody was positive at >4000 IV. Infectious Diseases were consulted after Lumbar Puncture, they initially started Acyclovir but once the Serum VZV IgG Antibody came back much higher than Serum VZV IgG Antibody levels, their assessment was that VZV vasculitis is unlikely and Acyclovir was discontinued. Eventually, the case was discussed at Neuroradiology which led to us getting a repeat MRA Neck without contrast which showed a concentric T1 and T2 hyperintensity along with a small and irregular caliber right cervical ICA consistent with dissection. She eventually completed a 21‐day course of Nimodipine due to underlying Subarachnoid Hemorrhage. Methods : NA Results : NA Conclusions : Our case demonstrates how it can become difficult to ascertain the etiology of stroke in certain patients. Our patient presented with multiple non‐specific symptoms initially and it was later on due to her Acute Encephalopathy that her Strokes and Subarachnoid Hemorrhage were discovered. It is still difficult to pinpoint whether the cause of strokes was dissection or VZV infection. Lumbar Puncture remains an essential tool to complete work up on uncommon etiologies of stroke.

Blister Aneurysm of the Internal Carotid Artery

2019 ◽  
pp. 5-13
Author(s):  
Peter Nakaji ◽  
Michael R. Levitt
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Surgical Management ◽  
Medical Management ◽  
Internal Carotid ◽  
Conventional Imaging ◽  
Catheter Angiography ◽  
Intraoperative Rupture ◽  
Open Management

Abstract: Blister aneurysms are a rare cause of subarachnoid hemorrhage. They are easily overlooked on conventional imaging and catheter angiography due to their small size and unusual anatomic location. Whereas the medical management of subarachnoid hemorrhage is similar to that of saccular aneurysms, the surgical management of blister aneurysms is more challenging due to their unique pathology and higher risk of intraoperative rupture. Special consideration should be made for open management such as preparation of the option of bypass or the emerging use of endovascular techniques such as flow diversion. This chapter reviews the diagnosis and medical and surgical management of blister aneurysms.

scholarly journals Surgical Treatment of Proximal Segmental Occlusion of the Internal Carotid Artery

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Srdjan Babić ◽  
Slobodan Tanasković ◽  
Mihailo Nešković ◽  
Predrag Gajin ◽  
Dragoslav Nenezić ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intracerebral Hemorrhage ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Long Term Results ◽  
Common Symptom ◽  
Coronary Syndrome

Purpose. To present the feasibility, safety, and efficacy of carotid endarterectomy in patients with type II internal carotid artery occlusions, including the long-term outcomes. Methods. From March 2008 to August 2015, 74 consecutive patients (48 men with a mean age of 65.1 ± 8.06 years) underwent carotid endarterectomy because of internal carotid artery (ICA) segmental occlusions. These were verified with preoperative carotid duplex scans (CDS) and CT angiography (CTA). Also, brain CT scanning was performed in all these patients. The indication for treatment was made jointly by a vascular surgeon, neurologist, and an interventional radiologist in a multidisciplinary team (MDT) context. After successful treatment, all the patients were followed-up at 1, 3, 6, and 12 months, then every 6 months thereafter. Results. The most common symptom at presentation was transient ischaemic attack (TIA) in 49 patients (66.2%), followed by stroke in the past six months in the 17 remaining patients (23%). Revascularisation of the ICA with endarterectomy techniques was performed successfully in all the patients with an average clamp time of 11.9 min. All the procedures were performed under general anaesthesia in combination with a superficial cervical block. The early complication rate was 8.1% and included two cardiac events (2.7%) (one rhythm disorder and one acute coronary syndrome), three TIAs (4.1%), and one intracerebral hemorrhage (1.3%). Only one patient with the intracerebral hemorrhage died 5 days after surgery giving a postoperative mortality of 1.3% for this series. During the follow-up period (mean 50.4 ± 31.3 months), the primary patency rates at 1, 3, 5, and 7 years were 98.4%, 94.9%, 92.9%, and 82.9%, respectively. Likewise, the survival rates were 98.7%, 96.8%, 89%, and 77.6%, respectively. Ultrasound Doppler controls during follow-up detected 8 ICA restenoses; however, only 3 of these patients required further endovascular treatment. Conclusions. Carotid endarterectomy of internal carotid artery (ICA) segmental occlusion is a safe and effective procedure associated with acceptable risk and good long-term results. Therefore, the current guidelines which do not recommend carotid endarterectomy in this patient group should be reassessed, with the requirement for ongoing large-scale randomized controlled trials to compare CEA with best medical therapy in this patient cohort.

Ischemic stroke and subarachnoid hemorrhage, two sides of a story: Congenital absence of the internal carotid artery

2008 ◽  
Vol 255 (12) ◽  
pp. 1985-1987 ◽  
Author(s):  
K. Hüttemann ◽  
T. Nowe ◽  
T. Engelhorn ◽  
A. Doerfler ◽  
P. D. Schellinger ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Congenital Absence ◽  
Two Sides
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