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 147,016 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

Dissecting aneurysm and stroke are a rare complication of polymyositis. The present report describes an autopsy case of a 53-year-old woman, who suffered from polymyositis accompanied by dissecting aneurysms of right external iliac and right renal arteries, and furthermore, intracerebral hemorrhage. The latter was caused by necrotizing angiitis. The patient had no abnormal anatomical changes such as coarctation of aorta, aortic stenosis, bicuspid aortic valve or Marfan's syndrome. Atherosclerosis in the patient was mild, and cystic medial necrosis of aorta and arteries was not found. Since the patient was attacked by dissections of arteries following long-term steroid therapy, a possibility can be raised that arterial dissection was attributable to steroid treatment besides necrotizing angiitis complicating in polymyositis.
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PMID:Polymyositis associated with dissecting aneurysm of arteries and intracerebral hemorrhage. 377 35

Nine patients who have died of giant cell arteritis (GCA) are described. Two patients died of myocardial infarction caused by GCA in the coronary arteries. Another two patients died of dissecting aneurysm of the aorta where GCA were found in the lesions of the aorta wall. Giant cell arteritis causing cerebral stroke was the cause of death in five patients. None of the cases were receiving adequate corticosteroid treatment when symptoms of the ischemic catastrophies started. These cases illustrate that GCA is a generalized arteritis that can involve arteries of vital importance.
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PMID:Giant cell arteritis as a cause of death. Report of nine cases. 394 32

An otherwise healthy 35-year-old woman suffered spontaneous dissections of both internal carotid arteries. She made an excellent recovery but was left with occlusion of the left internal carotid artery and a residual subcranial dissecting aneurysm of the right artery--both were asymptomatic. Eight years later, spontaneous dissections of both renal arteries occurred. The exact nature of the underlying arterial disease is not clear. Although fibromuscular dysplasia is suspected, other undetermined arteriopathy cannot be excluded.
Stroke
PMID:Spontaneous dissections of the renal arteries in a patient with previous spontaneous dissections of the internal carotid arteries. 408 28

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

Fourteen patients with a spontaneous dissecting aneurysm of an internal carotid artery (ICA) have been admitted in our service since 1979 (incidence of 0,5 per 100,000 inhabitants per year). All these patients have been prospectively followed in order to determine their functional prognosis and a possible recanalization of the ICA. Three patients quickly died from an extensive middle cerebral artery infarct with brainstem compression. Among the 11 survivors, 7 completely recovered their functional ability or were left with very minor sequelae, and could go back to work. The 4 other patients remained with severe sequelae and could not work anymore. In the latter patients Doppler ultrasonographic study showed a persisting occlusion of the ICA, whereas a complete recanalization occurred in the former 7, usually as soon as the first month, on anticoagulant treatment. The presence on admission of a minor or moderate neurological deficit, a normal state of consciousness, an age above 45 years, and a patent collateral circulation allows to predict a favorable evolution (p less than 0.05). The same is true for the development of a partial or complete recanalization of the ICA on Doppler ultrasonography performed 2 to 4 weeks after admission. Sex, angiographic aspects of the dissection, and occurrence of headache or warning transient ischemic attacks had no prognostic significance in our study. Spontaneous dissecting aneurysms of the ICA can be a very serious disease, though nearly 50 p. 100 of the patients completely recover during the first months. Immediate anticoagulant therapy is still the treatment of choice and surgery is indicated only in those patients with recurrent episodes or a progressing stroke despite adequate anticoagulation.
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PMID:[Spontaneous dissecting aneurysms of the internal carotid artery. Prospective evaluation of the prognosis and arterial repermeation in 14 cases]. 639 Jun 25

A young man with cerebral infarction, skeletal, cardiac and renal malformations was found to have on angiography a rare lesion involving the cervical left internal carotid artery, formed by the superposition of two arterial lumina. Anti-platelet therapy did not prevent thrombosis of the lesion and reinfarction. Extracranial-intracranial bypass graft was performed, followed by excision of the arterial lesion. Pathological examination revealed fibromuscular dysplasia and dissecting aneurysm. The few reported cases associating fibromuscular dysplasia of the internal carotid artery with dissecting aneurysm are reviewed. Surgical therapy is recommended in such cases when symptomatology progresses. Fibromuscular dysplasia occasionally coexists with somatic malformations, suggesting a congenital origin of this condition.
Stroke
PMID:Double lumen dissecting aneurysms of the internal carotid artery in fibromuscular dysplasia: case report. 665 71

Ninety-two thrombi and/or thromboemboli of cervico-cephalic arteries were confirmed histopathologically in 16 out of 22 patients with moyamoya disease. Included were 74 white thrombi mainly composed of fibrin and platelets, 9 organized thrombi and 9 mixed thrombi containing red blood cells. Thirteen microthrombi and one organized thrombus were located in the cervical arteries. Seventy-eight thrombi were present in the intracranial major arteries. Sixty-five were white microthrombi attached to the luminal surface of the arteries. The intracranial microthrombi were most frequently observed at the distal ends of the internal carotid arteries (29 thrombi). The fibrous thickening of the intima and edema in the innermost luminal surface were the most common vascular alterations associated with the thrombus formation. In two patients, thrombus formation was associated with fissure of the thickened intima and a dissecting aneurysm. We concluded that in patients with moyamoya disease the thrombi may be closely related to the development of intimal thickening in the intracranial arteries, particularly at the distal ends of the internal carotid arteries.
Stroke
PMID:Cervico-cephalic arterial thrombi and thromboemboli in moyamoya disease--possible correlation with progressive intimal thickening in the intracranial major arteries. 670 35

A patient with sudden apoplexy and coma was found to have hydrocephalus on computed tomographic scan, and metrizamide was instilled into the ventricles. Subsequent autopsy disclosed a brainstem infarct secondary to a primary dissecting aneurysm of the basilar artery, and a histologic picture of encephalitis in the walls of the lateral and third ventricles. Metrizamide may cause pathologic changes that must be recognized for the correct interpretation by the pathologist of tissue sections previously exposed to metrizamide. In the present case, the changes were seen 11 days after exposure of the tissue to metrizamide, consonant with the time course of similar changes observed in animals. The localization of the cellular infiltrates to the Virchow-Robin spaces corroborates evidence from the literature that metrizamide enters brain parenchyma via these spaces.
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PMID:The histologic effect of intraventricular injection of metrizamide. 705 52

Children presenting after trauma with headache, seizures, hemiplegia and coma may have an intracranial dissecting aneurysm. Specific angiographic findings provide confirmation of this diagnosis. The dissection occurs subintimally and differs clinically and pathologically from dissecting aneurysms of extracranial arteries. The course in children beyond infancy is catastrophic, justifying consideration of potentially life saving surgical intervention.
Stroke
PMID:Intracranial dissecting aneurysms in childhood. 706 92


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