Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0013362 (dysarthria)
 3,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case of a rapidly growing cerebral aneurysm in the basal abnormal vascular network associated with spontaneous middle cerebral artery (MCA) occlusion. The aneurysm disappeared spontaneously shortly after performing STA-MCA anastomosis. A 54-year-old female was admitted to our hospital because of repeated attacks of right hemisensory disturbance and dysarthria. CT scan and MRI images showed the infarcted focus in the left parieto-occipital lobe. Bilateral MCAs were undetectable on MRI images. Cerebral angiography revealed that the bilateral MCAs were occluded in their proximal origin with basal abnormal vascular networks. The distal MCA branches were perfused via the vascular networks. A small aneurysm was detected in the distal portion of the left Heubner's artery. There were no abnormalities in the bilateral internal carotid arteries, the anterior cerebral arteries, and the basilar artery. The follow-up angiography performed 29 days after admission revealed a growing aneurysm with a diameter of 3 mm in the distal enhanced lesion consistent with the aneurysm observed in the angiography. An STA-MCA anastomosis was performed for improvement of cerebral misery perfusion. Single photon emission tomography (SPECT) performed 9 days after the bypass operation revealed improvement of cerebral blood flow in the left parieto-occipital lobe, and her TIA attacks disappeared. The aneurysm was undetected in the cerebral angiography performed 24 days after the bypass operation. Spontaneous MCA occlusion is a rare condition of chronic cerebrovascular occlusive diseases. Diagnostic criteria of the disease includes the MCA occlusions or stenosis with basal abnormal vascular networks. Usually the phenomenon is seen unilaterally, which differs from moyamoya disease. Diagnosis must exclude diseases caused by the etiologies such as those of arteriosclerotic origin. There have been 24 reported cases of spontaneous MCA occlusion including our case. Among them, 9 cases presented cerebral aneurysm located in abnormal vascular networks, and all the reported cases presented cerebral hemorrhage at their onset. The abnormal basal vascular network may be developed as collateral vessels to supply blood to the ischemic regions in this disease. An increased hemodynamic stress in the abnormal basal vascular network may produce a true aneurysm in the distal portion of the perforating arteries. STA-MCA anastomosis reduced the TIA attacks, but also decreased the hemodynamic stress on the abnormal basal vascular network and resulted in reduction in size or thrombosis of the aneurysm. STA-MCA anastomosis can be considered effective to treat cerebral aneurysms located in vessels with increased hemodynamic stress.
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PMID:[A case of spontaneous middle cerebral artery occlusion associated with a cerebral aneurysm angiographically disappearing after STA-MCA anastomosis]. 926 66

Infectious intracranial aneurysm (IIA), a rare type of cerebral aneurysm, is often observed in patients with infective endocarditis. Hemorrhage or infarction often occurs; however, the presentation of both hemorrhagic and ischemic components is rare. A 41-year-old man with progressive motor weakness, dysarthria, and severe headache was admitted to our hospital. Brain computed tomography scan revealed a scanty subarachnoid hemorrhage (SAH), and diffusion magnetic resonance imaging confirmed acute cerebral infarction around the external capsule and insular lobe. A digital subtraction cerebral angiogram revealed an obstruction in the middle cerebral artery (MCA). The patient's neurological symptoms improved remarkably on the fifth day, and a follow-up angiogram revealed recanalized MCA with pseudoaneurysm, which was not observed on the previous angiogram. A blood culture result confirmed bacteremia, and the patient was then diagnosed with infective endocarditis. The pseudoaneurysm was treated with anastomosis of the superficial temporal artery and MCA with trapping of the parent artery. He was discharged with no neurological deficits. Herein, we present a patient with IIA, who sequentially developed SAH and cerebral infarction, and underwent extracranial-intracranial bypass with trapping of the parent artery. Although the treatment strategy for IIA is controversial, the treatment plan should be cautiously discussed with the patient. In addition, the assessment of an underlying infectious disease is required.
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PMID:Unusual presentation of infectious intracranial aneurysm with sequential hemorrhagic and ischemic components. 3266 16