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Cureus 2022 May 24;14(5):e25283. Epub 2022 May 24.

Neuroradiology, Prisma Health Greenville Memorial Hospital, Greenville, USA.

Pseudo subarachnoid hemorrhage (SAH) is an entity defined when characteristic computed tomography (CT) findings of SAH are seen without evidence of hemorrhage on MRI, autopsy, or cerebrospinal fluid analysis. This imaging phenomenon has been reported in association with multiple clinical settings including diffuse cerebral edema, hypoxic-ischemic injury, post percutaneous coronary intervention, and the focus of our report, acute bacterial meningitis. The mechanisms leading to this finding are poorly understood. Read More

Neurol Res Pract 2022 Jun 27;4(1):25. Epub 2022 Jun 27.

Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, USA.

Purpose: External ventricular drains (EVD) are commonly used in aneurysmal subarachnoid hemorrhage (aSAH) patients and can be life-saving by diverting cerebrospinal fluid. However, the overall relationship between EVD use and outcome is poorly understood.

Methods: In an exploratory analysis of an aSAH patient cohort, we examined EVD use in relation to modified Rankin Scale (mRS) at hospital discharge and at 6 months (unfavorable outcome = mRS > 2) using univariable and multivariable analyses. Read More

Neurol Clin Pract 2022 Jun;12(3):e25-e27

Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.

Objective: COVID-19 infection is suggested as one of the causes for hydrocephalus (HCP) of unknown etiology. COVID-19 infection may present with a range of neurologic symptoms given viral neurotropic and neuroinvasive properties. Postinfectious HCP is a severe complication as a potential sequela of COVID-19 infection. Read More

J Med Case Rep 2022 Jun 23;16(1):265. Epub 2022 Jun 23.

Department of Rehabilitation, Nagoya City Midori Municipal Hospital, 1-77, Shiomigaoka, Midori-ku, Nagoya-shi, Aichi, 458-0037, Japan.

Background: Pulmonary complications can be caused by intraoperative mechanical ventilation. In particular, prolonged mechanical ventilation is associated with a high mortality rate, a risk of pulmonary complications, prolonged hospitalization, and an unfavorable discharge destination. Pre- and postoperative rehabilitation are important for the resolution of pulmonary complications in acute cases. Read More

World Neurosurg 2022 Jun 20. Epub 2022 Jun 20.

Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA. Electronic address:

Objective: Diagnosis and management of aneurysmal subarachnoid hemorrhage (aSAH) depends heavily on imaging modalities that repeatedly expose patients to ionizing radiation. There is limited literature on cumulative radiation exposure in this patient population, which is a problem compounded by wide variation between institutions. The present study quantifies the cumulative cranial exposure to ionizing radiation resulting from diagnostic medical imaging and medical procedures during initial hospitalization for ruptured aneurysmal subarachnoid hemorrhage at a single academic institution and estimates the risk of future adverse events related to radiation injury. Read More

Tomography 2022 May 25;8(3):1429-1436. Epub 2022 May 25.

Academic Neurology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Ospedale A. Fiorini, "Sapienza" University of Rome, 04019 Terracina, Italy.

The aim of this study was to identify early radiological signs of secondary hydrocephalus. We retrieved neuroradiological data from scans performed at various times in patients who underwent surgery for secondary hydrocephalus due to severe traumatic brain injury (TBI), subarachnoid haemorrhage (SAH), or brain tumour (BT). Baseline measurements, performed on the earliest images acquired after the neurological event (T0), included Evans' index, the distance between frontal horns, and the widths of both temporal horns. Read More

J Neurosurg Case Lessons 2022 May 30;3(22):CASE21690. Epub 2022 May 30.

Department of Neurosurgery, Gifu University Hospital, Gifu, Japan.

Background: Perianeurysmal cysts in the brainstem after endovascular coil embolization are rare, and their underlying mechanism remains unclear. The authors reported a case of a postcoiling perianeurysmal cyst that developed 6 years after endovascular coil embolization for a ruptured aneurysm and reviewed the related literature.

Observations: A 77-year-old woman had a history of subarachnoid hemorrhage 6 years earlier. Read More

J Neurol 2022 Jun 22. Epub 2022 Jun 22.

Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstrasse 22, 81675, Munich, Germany.

Background: Aneurysm treatment during cerebral vasospasm (CVS) phase is frequently considered as particularly dangerous, mainly because of the risk of cerebral infarct.

Objective: We aimed to evaluate the risk of aneurysmal subarachnoid haemorrhage (aSAH)-specific complications and functional outcome in patients treated during CVS phase.

Methods: We retrospectively analysed a large, retro- and prospectively collected database of aSAH patients admitted to our department between March 2006 and March 2020. Read More

J Neurosurg Case Lessons 2022 May 9;3(19). Epub 2022 May 9.

Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, Florida.

Background: Recognizing rare signs of delayed cerebral ischemia (DCI) is crucial to caring for patients with subarachnoid hemorrhage. The authors presented a case of central hearing loss that occurred during the clinical course of a patient treated for aneurysmal subarachnoid hemorrhage.

Observations: The patient had a ruptured right posterior communicating artery aneurysm successfully treated with coil embolization but later developed severe vasospasm and DCI. Read More

Am Fam Physician 2022 Jun;105(6):616-624

Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

Stroke accounts for significant morbidity and mortality and is the fifth leading cause of death in the United States, with direct and indirect costs of more than $100 billion annually. Expedient recognition of acute neurologic deficits with appropriate history, physical examination, and glucose testing will help diagnose stroke and rule out mimicking presentations. The National Institutes of Health Stroke Scale should be used to determine stroke severity and to monitor for evolving changes in clinical presentation. Read More

Neurointervention 2022 Jun 15. Epub 2022 Jun 15.

Department of Diagnostic and Interventional Radiology, Nicosia General Hospital, Nicosia, Cyprus.

The scope of this technical note is to report our experience with balloon remodeling for wideneck aneurysms and balloon angioplasty of post-subarachnoid hemorrhage vasospasm using the novel Scepter Mini balloon (SMB). Five cases were treated with balloon remodeling for aneurysmal subarachnoid hemorrhage, 2 of which were additionally treated with angioplasty due to post-bleeding vasospasm. All patients had their aneurysm located on parent vessels with a diameter smaller than 2 mm. Read More

J Neurointerv Surg 2022 Jun 14. Epub 2022 Jun 14.

Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

In vivo morphological change of flow diverter stents (FDS) is a known phenomenon and can be seen secondary to various device- and vasculature-related factors such as improper sizing of the device, twisting of the device in tortuous anatomy, insufficient proximal landing zone, and insufficient chronic resistive force of the stent, etc. However, we have encountered a case where severe vasospasm due to aneurysmal subarachnoid hemorrhage led to the collapse of the proximal end of the FDS. Development of vasospasm and consequent possible failure of the device should be taken into consideration when planning flow diversion in ruptured aneurysms. Read More

Am J Emerg Med 2022 May 28. Epub 2022 May 28.

Chesapeake Regional Medical Center, Chesapeake, VA, USA.

Acute headache is a common emergency department (ED) chief complaint that usually has a benign course. Rare etiologies such as subarachnoid hemorrhage (SAH) can lead to extensive disability or even death. If suspected, SAH requires an intricate and intensive diagnostic investigation. Read More

J Neurol Neurosurg Psychiatry 2022 Jun 10. Epub 2022 Jun 10.

Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.

Background: Management of incidental unruptured intracranial aneurysms (UIAs) remains challenging and depends on their risk of rupture, estimated from the assumed prevalence of aneurysms and the incidence of aneurysmal subarachnoid haemorrhage. Reported prevalence varies, and consistent criteria for definition of UIAs are lacking. We aimed to study the prevalence of UIAs in a general population according to different definitions of aneurysm. Read More

Phys Sportsmed 2022 Jun 13:1-8. Epub 2022 Jun 13.

Department of Sports Medicine, Orthopedic Specialists of North Carolina, Raleigh NC, USA.

Professional boxing, kickboxing, and mixed martial arts (MMA) are popular sports with substantial risk for both acute and chronic traumatic brain injury (TBI). Although rare, combat sports athletes have died in the ring or soon after the completion of a bout. Deaths in these instances are usually the result of an acute catastrophic neurological event such as an acute subdural hematoma (SDH). Read More

BMC Neurol 2022 Jun 6;22(1):208. Epub 2022 Jun 6.

Department of Neurosurgery, Japanese Red Cross Nagahama Hospital, Miyamae-cho 14-7, Nagahama, Shiga, Japan.

Background: Persistent primitive trigeminal artery (PPTA) is a remnant of the carotid-vertebrobasilar anastomoses in the embryo. Although PPTAs are discovered incidentally in most cases, altered hemodynamics may lead to increased risk of stroke. To the best of our knowledge, no reports of PPTA associated with superior cerebellar artery (SCA) dissecting aneurysms have been published in the English language. Read More

Stroke 2022 Jun 2:101161STROKEAHA121038035. Epub 2022 Jun 2.

Department of Neurosurgery (R.M., M.W.A., J.M.C.v.D.), University of Groningen, University Medical Center Groningen, the Netherlands.

Background: The risk of aneurysmal subarachnoid hemorrhage (aSAH) is increased in postmenopausal women compared with men of similar age, suggesting a role for sex hormones. We aimed to explore whether sex hormones, and age at menarche/menopause have a causal effect on aSAH risk by conducting a 2-sample MR study (Mendelian randomization).

Methods: We obtained sex-specific genetic instruments for serum estradiol, bioavailable testosterone (BioT), SHBG (sex hormone-binding globulin), and age at menarche/menopause from genome-wide association studies. Read More

BMC Neurol 2022 Jun 1;22(1):201. Epub 2022 Jun 1.

Department of Radiology, Banan People's Hospital, Chongqing Medical University, Chongqing, 400037, China.

Background: For patients with aneurysmal subarachnoid hemorrhages (SAHs) and multiple intracranial aneurysms (MIAs), a simple and fast imaging method that can identify ruptured intracranial aneurysms (RIAs) may have great clinical value. We sought to use the aneurysm-specific prediction score to identify RIAs in patients with MIAs and evaluate the aneurysm-specific prediction score.

Methods: Between May 2018 and May 2021, 134 patients with 290 MIAs were retrospectively analyzed. Read More

eNeurologicalSci 2022 Jun 21;27:100405. Epub 2022 May 21.

Department of Neurology, University of Toledo, Toledo, OH, USA.

Brain MRI in Status Epilepticus (SE) is often helpful in diagnosis, lateralization and localization of the seizure focus. MRI changes in SE include predominantly ipsilateral diffusion weighted imaging (DWI) changes in the hippocampus and pulvinar or similar changes involving basal ganglia, thalamus, cerebellum, brain stem and external capsule (Chatzikonstantinou et al., 2011 [1]). Read More

NMC Case Rep J 2022 28;9:95-100. Epub 2022 Apr 28.

Department of Neurosurgery, Iwate Medical University, Shiwa, Iwate, Japan.

The coronavirus disease 2019 (COVID-19) pandemic continues to spread around the world, and widespread vaccination is considered the most effective way to end it. Although the efficacy of COVID-19 vaccines has been confirmed, their safety remains a concern. In this paper, we report two cases of ruptured vertebral artery dissecting aneurysm (VADA) immediately after messenger RNA (mRNA) anti-COVID-19 vaccination. Read More

World Neurosurg 2022 May 25. Epub 2022 May 25.

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

Objective: To study the effect of preoperative digital subtractive angiography (DSA) for planning stereoelectroencephalography (sEEG) electrode trajectories on the rate of postoperative radiographic hemorrhage.

Methods: A retrospective, single-center observational study was conducted examining every sEEG implantation consisting of 72 implantations of 1028 total electrodes with each patient having received a preoperative planning DSA. Postimplant imaging was analyzed for the presence of hemorrhage. Read More

Comput Intell Neurosci 2022 19;2022:3279090. Epub 2022 May 19.

Guizhou Medical University, Guiyang 550000, China.

In this study, a case of bilateral common carotid artery occlusion and aneurysm in the V4 segment of the right vertebral artery with constriction of the left vertebral artery is presented. By improving digital subtraction angiography, an elderly female patient with subarachnoid haemorrhage (SAH) was diagnosed with a V4 segment of right vertebral artery aneurysm, a microaneurysm at the beginning of basilar aneurysms, bilateral common carotid artery occlusion, and narrowing vessel of left vertebral artery (DSA). Through the compensation of the basilar artery, the bilateral vertebral arteries provide intracranial and extracranial blood. Read More

Brain Sci 2022 May 5;12(5). Epub 2022 May 5.

Department of Neurosurgery, Radboud University Medical Center, 6525 XZ Nijmegen, The Netherlands.

Intracranial aneurysms are pouch-like extrusions from the vessels at the base of the brain which can rupture and cause a subarachnoid hemorrhage. The pathophysiological mechanism of aneurysm formation is thought to be a consequence of blood flow (hemodynamic) induced changes on the endothelium. In this study, the results of a personalized aneurysm-on-a-chip model using patient-specific flow parameters and patient-specific cells are presented. Read More

Front Aging Neurosci 2022 9;14:904085. Epub 2022 May 9.

Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.

We aimed to develop and validate an objective and easy-to-use model for identifying patients with spontaneous intracerebral hemorrhage (ICH) who have a poor 90-day prognosis. This three-center retrospective study included a large cohort of 1,122 patients with ICH who presented within 6 h of symptom onset [training cohort, = 835; internal validation cohort, = 201; external validation cohort (center 2 and 3), = 86]. We collected the patients' baseline clinical, radiological, and laboratory data as well as the 90-day functional outcomes. Read More

Radiol Case Rep 2022 Jul 13;17(7):2537-2541. Epub 2022 May 13.

Department of Neurosurgery, Jeonbuk National University Hospital and Medical School, Jeon-Ju, Korea.

We report a case of subarachnoid hemorrhage due to a dissecting middle cerebral artery that was misdiagnosed as saccular aneurysm. A 74-years old female patient presented with headache and neck pain for 4 days. Brain magnetic resonance imaging revealed subarachnoid hemorrhage in both Sylvian fissures. Read More

J Neurointerv Surg 2022 May 18. Epub 2022 May 18.

Department of Neuroradiology, APHM La Timone, Marseille, France.

Background: Balloon-assisted mechanical angioplasty for cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) has a number of limitations, including transient occlusion of the spastic blood vessel. Comaneci is an FDA-approved device for temporary coil embolization assistance which has recently also been approved for the treatment of distal symptomatic refractory vasospasm. We aimed to report the feasibility, efficacy and safety of our experience with Comaneci angioplasty for refractory distal vasospasm (up to the second segment of the cerebral arteries) following aSAH. Read More

J Belg Soc Radiol 2022 26;106(1):18. Epub 2022 Apr 26.

Sana Klinikum Duisburg, DE.

Purpose: To evaluate the detection rate of intracranial aneurysms on reconstructed thin slice non enhanced CT (NECT) scans.

Methods: NECT scans from 34 patients with 35 aneurysms and 35 individuals without aneurysms were collected. Thin slice maximum intensity projections of the NECT scans were reconstructed. Read More

Scanning 2022 26;2022:3397967. Epub 2022 Apr 26.

Department of Emergency, Beijing Tongren Hospital, Capital Medical University, 100176, China.

In order to explore the regression equation for the prediction model of subarachnoid hemorrhage and cerebral vasospasm, the nomogram prediction model of SCVS occurrence was established. This study is a retrospective analysis of 125 cases of aSAH admitted to a hospital; the patients were divided into SCVS group and non-SCVS group. Select SIRI as a simple and reliable marker of inflammation, analyze its correlation with SCVS and its predictive value, and analyze the predictive value of SIRI to SCVS through ROC curve. Read More

Cureus 2022 Apr 13;14(4):e24102. Epub 2022 Apr 13.

Neurology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND.

Intracranial aneurysms are typically asymptomatic. They are usually incidentally detected or detected only after rupture. Ischemic stroke or transient ischemic attack (TIA) due to unruptured intracranial aneurysms (UIAs) is rare. Read More

Korean J Neurotrauma 2022 Apr 12;18(1):98-102. Epub 2021 Nov 12.

Department of Neurosurgery, Inha University Hospital, Incheon, Korea.

We describe the case of a 57-year-old man who had traumatic subarachnoid hemorrhage (SAH) with a delayed growth of an ophthalmic artery aneurysm. Initially, computed tomography angiography did not show any evidence of aneurysmal dilatation, but digital subtraction angiography (DSA) after 3 days showed small aneurysmal dilatation or dissection of a presumed lesion. Early intervention or surgery was difficult because of the patient's unstable condition. Read More