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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors present a case of dissecting aneurysm of the right posterior inferior cerebellar artery (PICA) in a 47-year-old female, who suffered from mild subarachnoid hemorrhage. Right vertebral angiogram showed typical "pearl and string" sign of the PICA, but we could not fully understand the condition until a surgical exposure revealed a purple sausage-like dissecting aneurysm of the PICA. The aneurysm was wrapped with muscle pieces. Postoperatively she developed Wallenberg's syndrome, but it subsided gradually. No specific disorder concerning the mural dissection was found in this patient, except for a history of mild hypertension. This case is unusual because it affected not an arterial trunk but a small branch and we could find only one other case reported in the literature. Other formerly reported cases were of arterial trunks. The intracranial dissecting aneurysm has been known as a rare cause of cerebral infarct in children and adolescents. Infants are also affected and referred to as "infantile hemiplegia". It mainly affects one of the trunk arteries and cause a severe ischemic stroke, and surgically treatable case is rare. But as the typical angiographic findings are commonly known the number of the reported cases is increasing at an accelerating rate, and some of them are being noted to need surgical treatment because they cause subarachnoid hemorrhage. We here emphasize that not only trunk arteries but also small branch arteries can develop mural dissection, leading to subarachnoid hemorrhage. Dissecting aneurysm of a smaller artery would be milder in symptom, and would give more chance for surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Dissecting aneurysm of the posterior inferior cerebellar artery--a case report]. 343 31

During the last ten years, 29 aneurysms of the renal artery, observed in 20 patients were operated on. These cases represent 10% of the total number of renal vascularization procedures performed during the same period. Diagnosis was made most often during the workup for arterial hypertension (16 patients). There were 20 cases of sacciform aneurysms, eight cases of fusiform aneurysms, usually associated with stenotic lesions, and one case of dissecting aneurysm. Fibromuscular dysplasia was the principal etiological factor. A total of 22 kidneys were involved. Restoration was performed "in situ" in 15 cases (21 aneurysms), using aortorenal bypass in fusiform aneurysms and usually aneurysmorrhaphy for sacciform aneurysms. Six cases (seven aneurysms) were treated with "ex situ" surgery. Primary nephrectomy was performed in one patient. There was no operative mortality. Early occlusion occurred in two cases, resulting in secondary nephrectomy. During a mean follow-up period of 51 months, there were no secondary occlusions. Blood pressure control was obtained in 14 patients (87%). Surgical management is recommended for most renal artery aneurysms. Repair using "in situ" techniques is usually feasible and provides satisfactory long-lasting results in most cases.
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PMID:Aneurysms of the renal artery and its branches. 350 44

In an unselected series of 3,375 autopsies performed during five years there were 114 cases of aortic aneurysm (3.4%). Males were affected 9.4 times as often as females. Average age at death of those with aneurysm was 72.8 years, of those with rupture 69 years. Of the aneurysms 73.8% were located in the lumbar aorta, 22.8% in the thoracic aorta and 3.5% involved the entire aorta. Saccular or fusiform aneurysms accounted for 73.4%, dissecting ones for 18.4% and pseudoaneurysms for 1.8%. Arteriosclerosis was the underlying cause of the aneurysm in 95.6% of cases; in 41.2% rupture was the direct cause of death. Aneurysms of the thoracic aorta were ruptured in 65.4%, of the lumbar aorta in 32.1%. The incidence of rupture was highest for dissecting aneurysm of the thoracic aorta and the entire aorta--75% each. Hypertension was found to be a risk factor of rupture.
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PMID:[Incidence, etiology and risk of rupture of aortic aneurysm. An autopsy study]. 360 54

We studied 36 patients (21 women and 15 men) with spontaneous dissection of the internal carotid arteries. The ages of these patients ranged from 21 to 63 years. Focal unilateral headache was the most common symptom. Other common clinical manifestations (in decreasing order of frequency) included focal cerebral ischemic symptoms, oculosympathetic paresis, bruits, light-headedness, and neck pain. Less common symptoms were syncope, amaurosis fugax, scalp tenderness, swelling in the neck, and dysgeusia. Common angiographic manifestations (in decreasing order of frequency) were elongated, irregular, and frequently tapered narrowing of the lumen; abrupt luminal reconstitution (often at the carotid canal); aneurysms; intimal flaps; slow internal carotid artery--middle cerebral artery flow; tapered occlusion; and distal branch occlusions. The incidence of hypertension in these patients was considerably higher than that in the general population. Angiographic evidence of fibromuscular dysplasia was found in 14% of the patients, but atherosclerotic changes were uncommon. Follow-up ranged from 14 to 140 months (mean, 58.5 months). Twenty-three patients with 29 dissected internal carotid arteries were also restudied angiographically. The stenosis of the internal carotid artery either completely resolved or substantially improved in more than 85% of the dissected vessels. About two-thirds of the dissecting aneurysms either resolved or decreased in size. Clinically more than 85% of the patients had an excellent or complete recovery. Recurrence of the dissection or rupture of a dissecting aneurysm was not noted. Despite their disconcerting appearance on angiography, spontaneous dissections of the internal carotid arteries are often associated with a good prognosis.
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PMID:Spontaneous dissection of the cervical internal carotid artery. 396 55

Spontaneous dissecting aneurysm of the vertebral artery is an infrequent cause of vertebro basilar ischemic strokes. Previously reported cases concern essentially occlusion of the basilar artery. Only 14 cases of spontaneous dissecting aneurysm concern the extracranial vertebral artery among these eight were angiographically documented. In this study based upon 15 patients (20 dissecting aneurysms), the authors discuss etiological factors, such as hypertension or fibromuscular dysplasia: on clinical findings they insist upon the diagnostic value of preliminary symptoms, cervical pain or posterior headaches; the most frequent angiographic appearance was a long and irregular stenosis of one or two segments of the vertebral artery. The prognosis of these aneurysms most often appears favourable in this group.
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PMID:Spontaneous dissecting aneurysm of the extracranial vertebral artery (20 cases). 404 89

A spontaneous dissecting aneurysm of the intracranial portion of the dominant right vertebral artery presented as massive subarachnoid hemorrhage, excruciating headache, and respiratory arrest in a 57-year-old white man with a history of systemic hypertension. He died on the 3rd day. Postmortem examination revealed a dissecting hemorrhage extending for 2.1 cm along the artery; rupture of the intima, media, and adventitia could be demonstrated. The intramural accumulation of blood in the proximal segments appeared to be related to retrograde dissection within a media weakened by cystic degeneration. Accumulation of pools of mucoid ground substance was also demonstrated in other intracranial and extracranial arteries. Hemodynamic stresses due to arterial hypertension and physical exertion may have played a contributory role in the etiopathogenesis of this uncommon form of cerebrovascular accident. A comprehensive literature review permits a comparison of supratentorial and infratentorial dissecting aneurysms; vertebral and basilar artery dissections are presented in tabular form.
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PMID:Dissecting aneurysm of intracranial vertebral artery: case report and review of literature. 619 70

A review of the literature on Spontaneous Dissecting Aneurysms (DA's) of cerebral arteries is presented with 3 personal cases of DA's of the Internal Carotid Artery (ICA). Patients with spontaneous DA's of the extracranial ICA are of middle age (30 to 60 year old) and present with an ipsilateral pain in the neck or face and/or with TIAs (45 p. 100 and 50 p. 100 of the cases respectively). Claude Bernard-Horner's sign is frequent. The clinical, radiological and pathological data suggest that in most cases, if not all, neurological deficits are due to embolism and/or anterograde thrombus. This has led to recommend anticoagulant therapy. Nevertheless, surgery may be indicated is some situations such as in DA's on kinking arteries. The treatment of spontaneous DA's of extracranial vertebral arteries is still a detectable matter, though they have common features with DA's of the extracranial ICA. The DA's of the basilar and intracranial vertebral arteries are often associated with a subarachnoid haemorrhage and most of them have a severe outcome. Lesions of the arterial wall such as cystic medial necrosis and fibromuscular dysplasia play a role in the extent, and presumably in the initiation, of the so-called spontaneous DA's at least in some cases. Minor trauma, high blood pressure (20 p. 100 of the cases), oral contraceptives and coughing have been as well suspected.
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PMID:[Spontaneous dissecting aneurysms of the cerebral arteries]. 636 8

This is a case report of a 37-year-old Japanese woman with primary aldosteronism who was found to have high plasma renin activity during toxemia of pregnancy and who died of a dissecting aneurysm of the aorta about 2 years later. The autopsy findings showed cystic medial necrosis in the aorta and a right adrenocortical adenoma. The dissecting aneurysm in this case is probably related to hypertension and cystic medial necrosis. A definite diagnosis of primary aldosteronism cannot be made during toxemia of pregnancy, and it is necessary to do serial determinations of plasma renin activity and plasma aldosterone concentration after delivery to confirm the diagnosis.
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PMID:Elevation of plasma renin activity during pregnancy and rupture of a dissecting aortic aneurysm in a patient with primary aldosteronism. 636 96

A 43-year-old man suddenly experienced severe headaches and involuntary flexion-extension movements of four limbs, which were followed by hypertonic extension of the limbs lasting for a few hours. Two days later, he experienced generalized tonic seizure without loss of consciousness. After the seizures, he remained hemiparetic on the right side. His past medical history was non-remarkable, and the histories of hypertension, diabetes mellitus, head trauma and significant infectious diseases were all denied. Cerebral angiography performed 22 days after the onset showed a segmental, irregular narrowing of the left A2 segment and an aneurysmal outpouching immediately proximal to the stenosis. CT scan revealed a low density area in the left frontal lobe, corresponding to the territory of the involved left anterior cerebral artery. Cerebral angiography was repeated twice in the succeeding 6 months. Each time, the involved A2 segment showed persistence of narrowing, but its shape showed definite changes with the passage of time. A diagnosis of dissecting aneurysm of the anterior cerebral artery was reached by the characteristic angiographic features, and the patient was treated conservatively. Dissecting aneurysm of the cerebral arteries have been reported much less frequently than those of the aorta or other extracranial arteries. Recently, however, such reports are increasing in number, seemingly due to enhancement of knowledge of typical angiographic features, such as string sign, rosette sign, pearl reaction, double lumen and several others. Most of intracranial dissecting aneurysms involve the middle cerebral artery or vertebral-basilar artery, and the ones involving solely the anterior cerebral artery as in this present case are very rare.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Dissecting aneurysm of the anterior cerebral artery: report of a case]. 650 59

A case of nontraumatic dissecting aneurysm of the basilar artery in association with hypertension, smoke, and oral contraceptives is reported in a young female patient with a locked-in syndrome.
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PMID:Nontraumatic dissecting aneurysm of the basilar artery. 688 95


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