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Neurosurgery 2021 Jun 10. Epub 2021 Jun 10.

Department of Neurosurgery, Guro Hospital, Korea University, College of Medicine, Seoul, Republic of Korea.

Background: Many physicians consider aneurysmal wall enhancement (AWE) on high resolution-vessel wall imaging (HR-VWI) as an imaging biomarker of unstable unruptured intracranial aneurysms (UIAs).

Objective: To evaluate the clinical value of different AWE signal intensities (SIs) by assessing the correlation between the AWE SIs and surgical findings and rupture risk assessment tools.

Methods: Twenty-six patients with 34 aneurysms who underwent surgical clipping were included. Read More

Front Surg 2021 25;8:669433. Epub 2021 May 25.

Department of Neurosurgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China.

Anterior inferior cerebellar artery (AICA) aneurysms are relatively rare in clinical practice, accounting for <1% of all intracranial arteries. After the diagnosis and location are confirmed by angiography, magnetic resonance, and other imaging examinations, interventional, or surgical treatment is often used, but some complex aneurysms require reconstructive surgery. An 8-year-old male child was admitted to the hospital due to sudden disturbance of consciousness for 2 weeks. Read More

Front Neurol 2021 25;12:663058. Epub 2021 May 25.

Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada.

The indications for mechanical thrombectomy in acute ischemic stroke continue to broaden, leading neurointerventionalists to treat vessel occlusions at increasingly distal locations farther in time from stroke onset. Accessing these smaller vessels raises the concern of iatrogenic subarachnoid hemorrhage (SAH) owing to increasing complexity in device navigation and retrieval. This study aims to determine the prevalence of SAH following mechanical thrombectomy, associated predictors, and resulting functional outcomes using a multicenter registry and compare this with a systematic review and meta-analysis of the literature. Read More

J Neurol Sci 2021 Jun 5;427:117533. Epub 2021 Jun 5.

Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany. Electronic address:

Objectives: Adrenomedullin (ADM) has been identified as a promising biomarker of mortality and outcome in sepsis, heart failure and after major surgery. A recently developed assay specific for bioactive adrenomedullin (bio-ADM) has not yet been assessed in aneurysmal subarachnoid hemorrhage (aSAH). The objective of this prospective trial was to assess the time course of bio-ADM after aSAH in relation to the development of delayed cerebral ischemia (DCI) and its association with clinical outcome. Read More

Rev Med Chil 2021 Jan;149(1):76-87

Departamento de Neurología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Amyloid angiopathy (AA) is a selective deposition of amyloid in the walls of the brain vessels. It is a form of sporadic and localized amyloidosis, constituted by the Aβ4 protein, the same of Alzheimer's disease senile plaques. The most consistent clinical effect of AA is spontaneous brain hemorrhage (BH). Read More

J Med Life 2021 Mar-Apr;14(2):216-224

Neurology Department, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania.

With the exponential growth of COVID-19 cases, the neurological complications reported during or after the infection became more common. There is limited knowledge regarding the pathophysiological mechanisms that are responsible for these complications. Recent data provides compelling evidence for the neurotropic nature of SARS-CoV-2, based on neurological manifestations reported during the current pandemic, as well as on previous experience with other coronaviruses. Read More

Curr Med Imaging 2021 Jun 8. Epub 2021 Jun 8.

Department of Neurology, China-Japan Union Hospital of Jilin University, China.

Introduction: At present, the mechanism of telangiectasia is unknown, but some evidence suggests that it may be related to genetic abnormalities. Telangiectasia may lead to bleeding of multiple sites. CT-negative subarachnoid hemorrhage is rare, which is mostly related to hemorrhage with a little amount of bleeding. Read More

Oper Neurosurg (Hagerstown) 2021 Jun 7. Epub 2021 Jun 7.

Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.

Dorsal internal carotid artery (ICA) blister aneurysms are an uncommon aneurysm variant constituting 0.3% to 1% of intracranial aneurysms and can be due to ulceration, atherosclerosis, or dissection.1-3 Despite its rarity, it carries a high risk of rupture with an estimation of 0. Read More

Surg Neurol Int 2021 3;12:204. Epub 2021 May 3.

Superior Medical Experts, Saint Paul, Minnesota, United States.

Background: We present a rare case of a ruptured neoplastic aneurysms (NCA) caused by metastatic spread of triple-negative breast cancer (TNBC) in a female patient in her 60s. The patient had a medical history of TNBC and presented to the emergency department after experiencing 3 days of persistent headache.

Case Description: Head computed tomography (CT) revealed a small volume subarachnoid hemorrhage and digital subtraction angiography revealed a 3. Read More

Transl Stroke Res 2021 Jun 2. Epub 2021 Jun 2.

Department of Neurosurgery, University of Michigan, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA.

Subarachnoid hemorrhage (SAH) is associated with a high incidence of morbidity and mortality, particularly within the first 72 h after aneurysm rupture. We recently found ultra-early cerebral thrombosis, detectable on T2* magnetic resonance imaging (MRI), in a mouse SAH model at 4 h after onset. The current study examined whether such changes also occur in rat at 24 h after SAH, the vessels involved, whether the degree of thrombosis varied with SAH severity and brain injury, and if it differed between male and female rats. Read More

World Neurosurg 2021 May 29. Epub 2021 May 29.

Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States.

Background: Digital subtraction angiography (DSA) and computed tomographic angiography (CTA) are used to identify the cause of non-traumatic subarachnoid hemorrhage (SAH). There is no consensus on which to choose as the first diagnostic tool. We aimed to compare cost-effectiveness of CTA versus DSA as a primary tool for the cause of non-traumatic SAH. Read More

Kyobu Geka 2021 Jun;74(6):477-480

Department of Thoracic Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan.

A 68-year-old man was referred to our hospital for further examination for chest abnormal shadow in the right lung field. He had a past history of subarachnoid hemorrhage. He was diagnosed with pulmonary arteriovenous malformation (PAVM) and recommended early treatment, but he didnot accept immediate surgical treatment. Read More

Front Neurol 2021 12;12:676749. Epub 2021 May 12.

Angiography and Interventional Radiology Unit, Department of Radiology, University Hospital of Udine, Udine, Italy.

Flow diverting stents are designed to divert blood flow from the aneurysm sac, allowing for eventual occlusion following endovascular therapy. This case series reports clinical experience using the Silk Vista Baby (SVB, Balt Extrusion, Montmorency, France), a flow diverter (FD) designed to treat intracranial aneurysms in small, distal vessels. All patients who underwent treatment with SVB at the University Hospital "Santa Maria della Misericordia" of Udine between July 2018 and September 2020 were retrospectively identified. Read More

Neuroradiology 2021 May 25. Epub 2021 May 25.

Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Neuroendovascular Program, 55 Fruit St, WAC 745, Boston, MA, USA.

Purpose: The Woven EndoBridge (WEB) can be used to treat wide-necked aneurysms without antiplatelet medications, suggesting it may have advantages in the setting of aneurysmal subarachnoid hemorrhage (aSAH). The goal was assessment of safety and efficacy of WEB in aSAH given the delayed nature of aneurysmal thrombosis.

Methods: An international retrospective analysis of patients with aSAH treated with WEB was conducted at 7 tertiary centers from 2016 to 2020. Read More

World Neurosurg 2021 May 18. Epub 2021 May 18.

Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.

Objective: To elucidate the incidence rate of enlargement of vertebral artery dissecting aneurysms (VADAs) during the acute phase and factors associated with enlargement.

Methods: Of 115 patients with unilateral intracranial vertebral artery dissection who did not experience subarachnoid hemorrhage, 64 with the pearl sign of vertebral artery dissection (VADA without stenosis) participated in the study. We performed initial magnetic resonance imaging to diagnose VADA and subsequent magnetic resonance imaging to evaluate VADA enlargement. Read More

BMJ Case Rep 2021 May 20;14(5). Epub 2021 May 20.

Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

We present two cases of 17-year-old man and 10-year-old boy presenting with subarachnoid haemorrhage and a history of road traffic accident. One patient had dissecting aneurysm of the posterior cerebral artery (PCA), and the other patient had partially thrombosed aneurysm on CT angiography. On digital subtraction angiography of the second patient, there was formation of PCA pontomesencephalic vein pial arteriovenous fistula (PAVF). Read More

Neurointervention 2021 May 21. Epub 2021 May 21.

Department of Neurosurgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.

A 44-year-old woman presented with acute confusion, apparently due to a clinically silent subarachnoid hemorrhage followed by vasospasm, which in turn led to an ischemic stroke. During the initial evaluation, an acute ischemic stroke in the left middle cerebral artery territory was observed. Magnetic resonance imaging revealed a late subacute hemorrhage in the left basal cistern. Read More

NMC Case Rep J 2021 Apr 2;8(1):85-88. Epub 2021 Apr 2.

Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan.

Ischemic stroke associated with intracranial aneurysm is rare but potentially happens because of emboli originating from aneurysm sac or aneurysmal thrombosis extension to the parent artery. We describe two patients who present subarachnoid hemorrhage (SAH) soon after ischemic stroke. Case 1. Read More

Eur Rev Med Pharmacol Sci 2021 May;25(9):3519-3529

Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, South Korea.

Objective: We aimed to analyze clinical characteristics, treatment patterns, and prognosis of patients with reversible cerebral vasoconstriction syndrome (RCVS).

Materials And Methods: Two investigators independently searched PubMed and EMBASE, and 191 cases were included in this study. Information regarding demographics, triggering factors, brain imaging findings, treatment modalities, recurrence, and clinical outcome was collected. Read More

World J Clin Cases 2021 May;9(14):3356-3364

Department of Neurosurgery, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China.

Background: Spontaneous subarachnoid hemorrhage (SAH) is primarily caused by a ruptured intracranial aneurysm. Perimesencephalic nonaneurysmal SAH (PNSAH) accounts for approximately 5% of all spontaneous SAH. PNSAH displays favorable prognosis. Read More

J Neuroophthalmol 2021 Apr 26. Epub 2021 Apr 26.

Faculty of Medicine (ASD), University of Toronto, Toronto, Canada; Department of Medical Imaging (WCG, AB), Division of Neuroradiology, St. Michael's Hospital, University of Toronto, Toronto, Canada; and Department of Ophthalmology and Vision Sciences (JAM), St. Michael's Hospital, University of Toronto, Toronto, Canada.

Abstract: It is recommended that every patient with a new third nerve palsy undergo urgent neuroimaging (computed tomography angiography or magnetic resonance angiography) to exclude a posterior communicating artery aneurysm. Because of the novel coronavirus (COVID-19) pandemic, our institution noted a significant decline in the number of patients with aneurysmal subarachnoid hemorrhage presenting to the hospital. We report one such example of a patient who developed new-onset severe headache and vomiting and did not seek medical attention because of COVID-19. Read More

Pediatr Radiol 2021 May 17;51(6):891-897. Epub 2021 May 17.

Division of Pediatric Neuroradiology, Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.

Enlarged subarachnoid spaces are a common finding in infants and young children imaged for macrocephaly or an enlarging head circumference, and benign enlargement of the subarachnoid spaces is often diagnosed. Infrequently, presumed "spontaneous" subdural hemorrhages or subdural collections might complicate these enlarged subarachnoid spaces. Children with large bilateral subdural collections might also present for imaging with macrocephaly. Read More

Front Neurol 2021 29;12:656112. Epub 2021 Apr 29.

Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States.

Recently developed machine-learning algorithms have demonstrated strong performance in the detection of intracranial hemorrhage (ICH) and large vessel occlusion (LVO). However, their generalizability is often limited by geographic bias of studies. The aim of this study was to validate a commercially available deep learning-based tool in the detection of both ICH and LVO across multiple hospital sites and vendors throughout the U. Read More

Sci Rep 2021 May 13;11(1):10297. Epub 2021 May 13.

Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA.

Existing paradigms for stroke diagnosis typically involve computed tomography (CT) imaging to classify ischemic versus hemorrhagic stroke variants, as treatment for these subtypes varies widely. Delays in diagnosis and transport of unstable patients may worsen neurological status. To address these issues, we describe the development of a rapid, portable, and accurate eddy current damping (ECD) stroke sensor. Read More

Am J Case Rep 2021 May 14;22:e931376. Epub 2021 May 14.

Department of Infectious Disease, Rockledge Regional Medical Center, Rockledge, FL, USA.

BACKGROUND Convexal subarachnoid hemorrhage (cSAH), a rare form of non-aneurysmal subarachnoid hemorrhage, is confined to cerebral convexities without extension into basal cisterns or ventricles. Typical presentation includes thunderclap/progressive headache or transient focal neurological symptoms; rare manifestations include seizures, intractable vomiting, or altered mental status. Here, we report the first case of convexal subarachnoid hemorrhage and multifocal ischemic lesions caused by infective endocarditis (IE) in a treatment-naïve advanced HIV patient. Read More

Case Rep Neurol 2021 Jan-Apr;13(1):218-224. Epub 2021 Apr 6.

Department of Neurosurgery, Na Homolce Hospital, Prague, Czechia.

The misdiagnosis of a ruptured aneurysm directly endangers patient's life and health due to the high risk of rebleeding and its sequelae. In this paper, we present two uncommon cases of anterior communicating artery aneurysm rupture with a relatively small intracerebral bleeding, seemingly without a diffuse subarachnoid hemorrhage (SAH), and a relatively mild clinical presentation. In these cases, the initial diagnosis failed, leading to missed aneurysmal ruptures. Read More

Gan To Kagaku Ryoho 2021 Apr;48(4):596-598

Dept. of Gastroenterological Surgery, Toho University Omori Medical Center.

The case is a 59‒year‒old woman. A detailed examination of fecal occult blood revealed a diagnosis of cStage Ⅳ sigmoid colon cancer cT3N1M1b(liver H2, hilar liver and celiac artery lymph nodes). After excision of the primary lesion, decided to give chemotherapy. Read More

Clin Neuroradiol 2021 May 11. Epub 2021 May 11.

Siemens Healthineers Ltd., Seoul, Korea (Republic of).

Purpose: In 15-20% of patients with nontraumatic diffuse subarachnoid hemorrhage (SAH), the initial conventional angiography does not reveal a causative vascular abnormality, such as intracranial aneurysm. In this study, we evaluated clinical utility of 3D high-resolution vessel wall magnetic resonance imaging (HR-VWI) in patients with diffuse nonaneurysmal SAH.

Methods: A total of 17 patients with diffuse nonaneurysmal SAH were included in this retrospective study. Read More

Cochrane Database Syst Rev 2021 May 10;5:CD013312. Epub 2021 May 10.

Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil.

Background: Unruptured intracranial aneurysms are relatively common lesions in the general population, with a prevalence of 3.2%, and are being diagnosed with greater frequency as non-invasive techniques for imaging of intracranial vessels have become increasingly available and used. If not treated, an intracranial aneurysm can be catastrophic. Read More

Front Neurol 2021 23;12:599197. Epub 2021 Apr 23.

Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.

Spontaneous vertebral artery dissecting aneurysm has been increasingly attributed as a major cause of focal neurological deficits due to vertebrobasilar artery ischemia or subarachnoid hemorrhage (SAH). Although the development of spontaneous vertebral artery dissecting aneurysm (VADA) is rare, VADA after treatment of contralateral vertebral artery (VA) is more less frequently observed. There are only a few reports related to VADA after treatment of the contralateral VA in the medical literature. Read More