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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A rare case of duplication of the middle cerebral artery with a ruptured aneurysm on its origin during pregnancy was reported. A 29-year-old woman, primipara, was admitted to our clinic at 17 weeks' gestation on June 26, 1979 with a history of sudden onset of severe headache and vomiting, followed by unconsciousness fit for 30 minutes. The patient displayed typical features of subarachnoid hemorrhage. Lumbar puncture revealed bloody CSF. Right carotid angiogram 20 days after admission demonstrated duplication of the middle cerebral artery arising from the terminal internal carotid artery and a small aneurysm at its origin. There was evidence of associated spasm in the internal carotid artery, M1 and A1 portion without hematoma. The patient was treated conservatively for 2 months and then aneurysm surgery was performed. At operation, under the hypotensive anesthesia, on August 21, 1979, the presence of duplication of the middle cerebral artery on the right side and ruptured aneurysm on its origin were confirmed. The neck of aneurysm was completely clipped. Fetal heart rates were monitored by Doptone monitor during the operation. Postoperative course was excellent. Three months postoperatively, the patient went into spontaneous labor, at 40 week's gestation, and delivered a healthy infant. Clinical management of subarachnoid hemorrhage in pregnancy and the relationship between anomaly of the middle cerebral artery and aneurysm were discussed with the literature.
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PMID:[A case of duplication of the middle cerebral artery with ruptured aneurysm on its origin during pregnancy (author's transl)]. 724 17

The occurrence of hemorrhage from pituitary adenoma (so-called "pituitary apoplexy") was investigated in a consecutive series of 560 cases operated on during the past 30 years. There were 93 cases (16.6%) in which hemorrhage from pituitary adenomas was confirmed either clinically or surgically. These patients were analyzed in terms of age, sex, symptoms and signs, size of tumor, hormonal function, and histological types of adenomas, and computerized tomography findings. In 90 cases (16.6%), hematoma or old bloody fluid was verified within the tumor tissue at surgery. Three other patients presented with subarachnoid hemorrhage, but there was no detectable intratumor hematoma in any of them. Among these 93 patients, 42 (7.5%) showed no evidence of clinical symptoms related to hemorrhage (asymptomatic hemorrhage). Fifty-one patients (9.1%) had definite histories of an acute episode that suggested sudden bleeding (symptomatic hemorrhage: pituitary apoplexy). Thirty-eight patients (6.8%) had a major attack manifested by disturbances of consciousness, hemiparesis, loss of vision, or ocular palsy. In two acromegalic patients, pituitary apoplexy developed during bromocriptine treatment. There was one case of sudden death due to massive hemorrhage from the tumor 14 months after the completion of postoperative radiation therapy. The other 13 symptomatic patients (2.3%) developed a minor attack which included headache, nausea, vomiting, and vertigo. Bleeding from pituitary adenomas was not statistically correlated with any of the following factors: sex, hormonal function of adenomas, and histological types, but it was correlated with age. The number of asymptomatic cases in the third decade was significantly greater than that of the whole group of pituitary adenoma patients in the same decade. The present investigation revealed that the incidence of pituitary apoplexy was unexpectedly high: a major attack in 6.8% of pituitary adenoma patients, a minor attack in 2.3%, and asymptomatic hemorrhage in 7.5% of the cases. This risk of pituitary apoplexy should be kept in mind in treating pituitary adenomas.
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PMID:Pituitary apoplexy: its incidence and clinical significance. 725 41

Acute extradural hematoma, a collection of blood between the inner table of the skull and the dura, generally occurs in coup craniocerebral trauma with skull fracture. We report here a case of a 52-year-old female who had had a traffic accident. She suffered a serious wound consisting of a subcutaneous hematoma with skull fracture and so called Battle's sign on the left occipital region but not wounded in any other region. CT scan obtained shortly after the injury demonstrated a thin acute extradural hematoma with intracranial air under the subcutaneous hematoma in the left occipital region, and another hematoma with subarachnoid hemorrhage due to contrecoup head trauma in the right frontal region. We treated her conservatively with a common drip. She sometimes vomited during the several hours after admission. CT scan six hours later showed that the contrecoup extradural hematoma had enlarged. Immediately, we carried out the evacuation of the hematoma with decompressive craniectomy. Her scalp, cranium and frontal skull base over the extradural hematoma were without injury, and multiple small haemorrhages were found to have occurred on the surface of the dura that had been separated from the inner table of the skull. After the operation, the patient recovered consciousness. Contrecoup acute extradural hematoma is very rare. It seems that the appearance of hematoma in our case resulted from the frontal dural separation due to distortion of the cranium brought on by the force of the impact and the subsequent gradual growth of the hematoma under the stimulation of several bouts of vomiting.
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PMID:[Frontal acute extradural hematoma due to contrecoup injury: a case report]. 747 2

A 38-year-old female presented with vertigo, right hearing disturbance, and slight headache which were treated medically. However, she suddenly developed severe headache with vomiting and vertigo. Computed tomography revealed subarachnoid hemorrhage, and right vertebral angiography disclosed a rare aneurysm at the distal portion of the anterior inferior cerebellar artery. She underwent a right suboccipital craniectomy in the lateral position. The aneurysm could not be clipped because the aneurysm was tightly adhered to the brainstem, so it was trapped. Postoperatively, she showed slight VIIIth to Xth cranial nerve disturbances. Three months postoperatively, the IXth and Xth cranial nerve disturbances had disappeared, but the tinnitus and right hearing disturbance were still present. The initial symptoms were probably caused by minor bleeding from the aneurysm.
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PMID:Aneurysm of the distal anterior inferior cerebellar artery--case report. 756 90

We present here an interesting case of multiple dural arteriovenous shunts (dAVS) in different locations at the same time. There have been very few reports on multiple dAVS. A 63-year-old man was admitted with a sudden onset of headache and vomiting. CT scan showed a typical subarachnoid hemorrhage (Fisher Group 3). Cerebral angiogram (6 vessel study) revealed two dural arteriovenous shunts at the same time. One was located on the anterior fossa fed by the anterior ethmoidal artery, and the other was located on the posterior fossa near the marginal sinus fed by the left ascending pharyngeal and occipital arteries. At first, transarterial embolization was performed for dAVS located on the posterior fossa. Radical operation was performed for both anterior and posterior fossa dAVS. Both dAVS had disappeared on postoperative angiograms.
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PMID:[Multiple dural arteriovenous shunts presenting as subarachnoid hemorrhage: a case report]. 756 30

This is a report of unruptured aneurysms with occlusion of the basilar artery. A 61-year-old female was admitted to our hospital because of dysarthria and numbness of her left face. Angiography revealed occlusion of the basilar artery and severe arteriosclerosis of the bilateral cerebral carotid arteries. Pcom was not visualized on bilateral carotid angiogram. These neurological signs were considered to be derived from vertebrobasilar insufficiency by occlusion of the basilar artery. Right STA-SCA anatomosis was performed to prevent brain stem infarction. Postoperative angiography showed a good filling of both PCA and SCA by collateral circulation via a right STA and an unruptured basilar top aneurysm. Seven months after the bypass surgery, angiography disclosed that the basilar top aneurysm was visualized clearly, and its size was unchanged. The fact that there was no thrombus formation in the aneurysm was considered to be due to ticlopidine, and the hemodynamic changes after the bypass surgery were suspected to have increased the intraaneurysmal pressure. Therefore we performed neck clipping of the basilar top aneurysm by using a right pterional approach. Two years after the second operation, the patient complained of severe headache and vomiting. CT scan showed subarachnoid hemorrhage, and angiography demonstrated a newly developed aneurysm which might have ruptured on left internal carotid anterior choroidal artery bifurcation. Emergency neck clipping of the second aneurysm was performed, and the patient showed a good postoperative course. The newly developed second aneurysm might have been caused by severe arteriosclerosis and hypertension in addition to hemodynamic stress.
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PMID:[A case of growing up aneurysms with occlusion of basilar artery]. 766 40

An extremely rare case of ruptured cerebral aneurysm associated with a fenestrated vertebral artery in osteogenesis imperfecta (OI) is presented. A 33-year-old female suffering from OI was admitted to our hospital with severe headache and vomiting. A CT scan revealed subarachnoid hemorrhage. Cerebral angiography with four vessel study showed a fenestration in the V3 portion of the left vertebral artery and a dilatation in its V4 portion, but no cerebral aneurysm was detected. After conservative treatment for three weeks, repeated angiography demonstrated an aneurysm of the anterior communicating artery. A neck clipping of the aneurysm was performed successfully. The patient was discharged with no neurological deficits. OI is a hereditary connective tissue disease characterized by bone fragility. From her family history and clinical findings, the patient was suspected to have OI type I of Sillence's classification. Among the connective tissue diseases, OI does not have complications in the cerebrovascular system as frequently as other connective tissue diseases do, for example, Marfan's syndrome, Ehlers-Danlos syndrome, or pseudoxanthoma elasticum. Carotid-cavernous fistula and moyamoya disease have been the only complications reported in OI. However, dilatation of the aortic root and increased vascular fragility have been reported recently in OI. Although this is the first reported case of a ruptured aneurysm accompanied by a fenestration and a dilatation of the vertebral artery associated with OI, it was suggested that vascular fragility caused by collagen abnormality might affect the cerebral vasculature.
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PMID:[A case of ruptured cerebral aneurysm associated with fenestrated vertebral artery in osteogenesis imperfecta]. 775 27

Headache is a common complaint. In most patients, it is usually a problem of migrainous or tension-type headache. It is crucial that a physician is able to differentiate sinister causes of headache from the more benign ones. Six cases are presented to illustrate the fact that there are clues in the history to suggest a sinister cause of headache even though there are minimal or no neurological deficits on physical examination. At some point of time, these cases were examined by a senior physician but they were diagnosed as migrainous or tension-type headaches. The first case is a 41-year-old labourer with cryptococcal meningitis. He presented with severe headaches at a relatively late age. A 20-year-old female complained of the worst headache she ever had and this was due to a subarachnoid haemorrhage. The third case was a young woman with a large parietal meningioma. Her headaches had recently assumed a different character. The fourth case involved an investment manager who developed headaches with transient diplopia and projectile vomiting and investigations revealed an ependymoma. A shipyard worker complained of a constant headache which disturbed his sleep. Two weeks after medical consultation, the character of his headache changed and he developed diplopia in all directions of gaze. He succumbed to pituitary apoplexy. The final case is a 28-year-old woman who had a complicated migraine. CT scan of the brain showed a large arterio-venous malformation.
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PMID:Warning symptoms of sinister headache. 799 8

The authors described the case of a normotensive 40-year-old female with severe headache and vomiting. Neurological findings on admission to our hospital revealed no deficits, but plain CT findings indicated subarachnoid hemorrhage in the ambient, supracerebellar, quadrigeminal, and right lateral pontine cisterns. Left vertebral angiograms made through a transfemoral catheter revealed a saccular aneurysm (6 x 4mm) arising from the medical hemispheric branch of the right superior cerebellar artery (SCA). On the 34th day after onset of her symptoms, the aneurysm was successfully clipped by using an infratentorial supracerebellar approach. She was discharged with no deficits. Based on our experience and a review of the literature, a peripheral SCA aneurysm is best clipped by using one of the following surgical approaches: (1) a subtemporal transtentorial approach for an aneurysm arising from the anterior or lateral pontomesencephalic segment, (2) a subtemporal or occipital transtentorial approach for an aneurysm arising from the cerebellomesencephalic segment or the proximal cortical branch, or (3) an infratentorial supracerebellar approach for an aneurysm arising from the distal cortical branch.
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PMID:[A ruptured peripheral, superior cerebellar artery aneurysm: a case report and a review of the literature as to surgical approaches]. 813 72

We report a ruptured anterior communicating artery (ACoA) aneurysm in a patient whose anterior cerebral artery (ACA) arose from the left C3 portion and ascended between the optic nerves. A 50 year-old woman was admitted to our department with complaints of headache and vomiting. CT scan showed thick subarachnoid hemorrhage. Left carotid angiography revealed a saccular aneurysm of the anterior communicating artery and an abnormal vessel which arose from the left C3 portion and terminated in the territory of the ACoA. Surgery was performed about eight hours after subarachnoid hemorrhage. The abnormal vessel was identified as it ascended between the optic nerves. There are only 25 reported cases of this abnormality including our own case. The right carotid artery was the most frequent origin of the abnormal artery (18 cases). 13 aneurysms were associated in 11 cases, in which seven were located in the anterior communicating artery. It was the most frequent site of the aneurysm. There were various explanations for this anomalous ACA. Because of the angiographical and operative findings, we prefer to use "inter-optic course of ACA" as the medical terminology better suited to describe this condition.
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PMID:[Ruptured anterior communicating artery aneurysm associated with inter-optic course of anterior cerebral artery: report of a case and review of the literature]. 819 40


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