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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 simultaneous rupture of multiple aneurysms is reported. A 68-year-old man presented severe headache and vomiting and was transferred to our hospital. CT scan showed subarachnoid hemorrhage (SAH) in the interhemispheric fissure, the right basal cistern, the right sylvian fissure and intracerebral hemorrhage (ICH) in the paraventricle area. Continuation of the hemorrhage could not be detected between SAH and ICH on CT scan. Multiple aneurysms were detected by angiograms on the anterior communicating artery (A-com) and the bifurcation and the distal portion of the left middle cerebral artery (MCA). These findings suggested that SAH was due to a ruptured aneurysm of A-com, and ICH was due to a ruptured aneurysm of the distal portion of MCA. Simultaneous rupture of multiple aneurysms was confirmed by surgical findings. This case indicates that the usual assumption of a single aneurysm rupture in a patient with multiple aneurysms may be erroneous.
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PMID:[Simultaneous rupture of multiple intracranial aneurysms: a case report]. 893 94

The case reported here was a 50-year-old woman with the onset of generalized convulsions and vomiting on November 22, 1993. At admission, her neurological sings and symptoms were classified as Hund & Hess grade IV, and precise examination revealed subarachnoid hemorrhage by rupture of aneurysm at the branching of the right superior cerebellar artery. Thus neck clipping was performed on the same day. Although her consciousness level gradually improved after operation, she complained of left vision disturbance on December 5 (14 days after onset). The visual acuity of the left eye was manual valve of 30 cm. It was precisely examined using fundoscopic examination and B mode ultrasonography making the diagnosis of left vitreous hemorrhage (Terson's syndrome). The visual acuity of the left eye began to improve on December 12, and was found to be 1.0 on November 18, 1994, about 1 year after onset. The hemorrhage was also determined to be almost completely absorbed by fundoscopic examination. In this report, the results of statistical analysis of 32 previous cases, in addition to our case, are described, together with the discussion on the pathogenesis of Terson's syndrome.
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PMID:[Terson's syndrome which arose from ruptured right superior cerebellar artery aneurysm: a case report and 32 series investigations]. 905 34

Cerebral hyperperfusion syndrome after carotid endarterectomy (CEA) is a rare but well-known phenomenon. Percutaneous transluminal angioplasty (PTA) is being widely evaluated for treatment of selected stenoses of the extracranial arteries. Its benefits and risks still need to be established. Hyperperfusion injury (HI) after PTA of cerebral arteries has not been reported. We describe two patients with severe HI, one with a small putaminal haemorrhage and the other with diffuse basal subarachnoid haemorrhage. In both cases, a typical clinical hyperperfusion syndrome with headache, confusion, vomiting and seizures occurred. Patient 1 underwent PTA of the left carotid artery, both subclavian arteries and proximal vertebral arteries, patient 2 had carotid angioplasty only. Transcranial Doppler ultrasound displayed markedly elevated blood-flow velocities. HI may occur after PTA of extracranial arteries. The pathogenesis might be similar to reperfusion injury after CEA. Our findings suggest that: (1) HI may occur after PTA; (2) patients should be monitored after PTA for HI; (3) further risk factors for HI need to be identified.
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PMID:Cerebral hyperperfusion injury after percutaneous transluminal angioplasty of extracranial arteries. 912 Apr 91

A 59-year-old man presented with an internal carotid artery (ICA) bacterial aneurysm which ruptured during surgery for treatment of another bacterial aneurysm. He had been admitted to our hospital because of the recurrence of colon cancer. He had undergone aortic and mitral valve replacement because of closure incompetence due to bacterial endocarditis two months previously. Two months after treatment for colon cancer, he developed fever, and arterial blood culture demonstrated. Staphylococcus epidermidis. A few days later, he suddenly suffered severe headache and vomiting, followed by deterioration of consciousness. CT showed subarachnoid hemorrhage and angiography showed a saccular aneurysm at the opercular portion of the left middle cerebral artery (MCA). Immediate clipping of the aneurysm was attempted. The carotid cistern was opened via a left frontotemporal craniotomy, but an ICA aneurysm, which had not been previously recognized, ruptured suddenly. The ICA aneurysm was wrapped with Vascwrap with some difficulty. The MCA aneurysm was then trapped. Postoperatively, the patient continued to be stuporous for a few days. Two weeks later, he died of complications caused by pneumonia. Bacterial aneurysm is more likely to be located in the distribution of the distal arterial tree, mainly in the distribution of the MCA. The difficulty of preoperative diagnosis and the unpredictable clinical course of bacterial aneurysms are emphasized.
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PMID:[Multiple bacterial aneurysms: case report]. 959 17

A P4 segment aneurysm of the posterior cerebral artery has rarely been described. A case of ruptured P4 segment aneurysm, which re-ruptured after clipping procedure for unruptured internal carotid artery aneurysm, was reported. A 57-old-man had sudden onset of severe headache and vomiting and was transferred to our hospital. CT scan on admission showed diffuse subarachnoid hemorrhage dominantly extending to the tentorial surface and the occipital interhemispheric tissue. Four-vessel angiography demonstrated a right internal carotid-posterior communicating artery junction aneurysm, and its neck clipping was performed on day 5. Intraoperative inspection of the whole appearance of the aneurysm was difficult because of the aneurysm existing on the ventral portion of the internal carotid artery and definite diagnosis of the bleeding source was not obtained. On day 23, he complained of severe headache and restricted vision and CT scan showed intracerebral hematoma in the left occipital lobe with intraventricular hemorrhage. The angiograms and CT scan on admission were reexamined, and another aneurysm on the left parieto-occipital artery (P4 segment) was retrospectively identified. The ruptured P4 segment aneurysm was obliterated via the interhemispheric approach and the patient enjoyed an uneventful postoperative course. When a thick subarachnoid hemorrhage distributed in the occipital interhemispheric fissure, quadrigeminal cistern, and ambient cistern is encountered, the existence of a possible P4 segment aneurysm should be suspected. Correct initial diagnosis and definite treatment of the ruptured lesion in the acute stage is essential in dealing with SAH-patient with multiple aneurysms. When they are unruptured lesions at a common aneurysm site, the existence of an unusually located aneurysm should not be overlooked as the possible source responsible for symptoms.
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PMID:[A case of ruptured P4 segment aneurysm of the posteior cerebral artery: therapeutic pitfalls encountered when dealing with the multiple intracranial aneurysms]. 966 99

A case of conus medullaris tumour (ependymoma) is reported in which the presenting symptom was subarachnoid haemorrhage, which has left bladder dysfunction. 70-year-old patient was admitted to the Department of Neurology due to symptoms of conus medullaris lesion with retention of urine and diminished pain sensitivity in perianal zona. He had been hospitalized 30 years ago due to vomiting, headache and pain in lumbar region. The cerebrospinal fluid examination confirmed the diagnosis of subarachnoid haemorrhage. Cerebral angiography failed to show the source of bleeding. Myelography and spinal arteriography showed nor tumour neither vascular malformation. Only MRI examination performed after 30 years following the first symptoms of tumour made possible the correct diagnosis--tumour in vertebral canal at L1-L2 level compressing conus medullaris. Surgical procedure confirmed the diagnosis. Histopathological examination--ependymoma myxopapillare.
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PMID:[Subarachnoid hemorrhage due to conus medullaris ependymoma]. 976 May 60

One third of patients with aneurysmal subarachnoid haemorrhage (ASAH) present with headache only. A prompt diagnosis is crucial, but these patients must be distinguished from patients with non-haemorrhagic benign thunderclap headache (BTH). The headache characteristics and associated features at onset in subarachnoid haemorrhage and benign thunderclap headache were studied to delineate the range of early features in these conditions. In this prospective study, one of two observers interviewed 102 patients with acute severe headache by means of a standard questionnaire. The patients were alert on admission and had no focal deficits. ASAH was subsequently diagnosed in 42 patients, non-aneurysmal perimesencephalic haemorrhage (PMH) in 23 patients, and BTH in 37 patients. Headache developed almost instantaneously in 50% of patients with ASAH, 35% of patients with PMH, and 68% of patients with BTH and within 1 to 5 minutes in 19%, 35%, and 19%, respectively. Loss of consciousness was reported in 26% of patients with ASAH, 4% of patients with PMH and 16% of patients with BTH, and transient focal symptoms in 33%, 9%, and 22% respectively. Seizures and double vision had occurred only in ASAH. Vomiting and physical exertion preceding the onset of headache were more frequent in patients with ASAH (69% and 50%) and those with PMH (83% and 39%) than in those with BTH (43% and 22%). Headache developed almost instantaneously in only half the patients with aneurysmal rupture and in two thirds of patients with benign thunderclap headache. In patients with acute severe headache, female sex, the presence of seizures, a history of loss of consciousness or focal symptoms, vomiting, or exertion increases the probability of ASAH, but these characteristics are of limited value in distinguishing ASAH from BTH. Aneurysmal rupture should be considered even if focal signs are absent and the headache starts within minutes.
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PMID:Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache. 981 Sep 61

We report on a 13-year old girl with severe aplastic anemia and hypertrophic cranial pachymeningitis. She was admitted to our hospital with severe headache and vomiting. A computerized tomographic (CT) scan of the brain on the third day of symptoms showed a hyperdense area in the tentorial region. Magnetic resonance imaging (MRI) showed iso-intensity in the same tentorial region in T1- and T2-weighted images, and gadolinium enhancement of this region suggested a thickened dura mater. Initially, a diagnosis of subdural or subarachnoid hemorrhage was made. Since her platelet count was low (3000/microl) making the patient a poor-risk candidate for surgery, and the area was limited to the dura mater, conservative therapy, including glycerol administration and platelet transfusion, was carried out. Despite clinical improvement 10 days after admission without specific therapy, the iso-intense region on the left side of the tentorial region remained unchanged on MRI. On the other hand, the iso-intense area on the right side of the tentorial region became hyperdense on T1-weighted MRI images and was also enhanced by gadolinium. Cerebrospinal fluid findings were normal except for slightly elevated protein at 62 mg/dl. A diagnosis of hypertrophic cranial pachymeningitis of the tentorial dura mater with hemorrhage on the right side was made. Although hypertrophic cranial pachymeningitis is a rare disease, it must be considered in the differential diagnosis of severe headache in a case of aplastic anemia.
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PMID:Hypertrophic cranial pachymeningitis in a patient with aplastic anemia. 987 65

A case with unusual type of aneurysms in the distal posterior inferior cerebellar artery (PICA) is reported here. Though only two cases with a single aneurysm of the PICA communicating artery have been reported previously, the present case is the first one with multiple aneurysms in the PICA communicating artery. A 61-year-old woman with a sudden onset of severe headache, vomiting and unconsciousness was transferred to our hospital. CT scan revealed a hematoma in the fourth, third, and lateral ventricles, and a mild subarachnoid hemorrhage at the posterior fossa. Cerebral angiogram showed the right PICA supplying the hypoplastic left PICA territory through an anastomotic vessel. Two small aneurysms were seen at the tips of hairpin curves of an anastomotic vessel, "the PICA communicating artery". Suboccipital craniotomy was performed, and the ruptured aneurysm was clipped and the unruptured one was wrapped with cotton-sheet. After the operation, her clinical recovery went well and she was discharged on foot.
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PMID:[Multiple aneurysms of the PICA communicating artery: a case report]. 1006 51

A 27-year-old male presented with a rare association of a ruptured orbitofrontal artery aneurysm and a dural arteriovenous malformation (DAVM) fed by both ethmoidal arteries, manifestation as severe headache, nausea, and vomiting. Computed tomography revealed a hematoma within the right frontal lobe and diffuse subarachnoid hemorrhage. The aneurysm was clipped successfully and the hematoma was evacuated. After an uneventful postoperative course, the patient was referred for gamma knife radiosurgery to treat the DAVM. In this case, the DAVM was asymptomatic and pathogenetically unrelated to the aneurysm, which demanded urgent treatment.
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PMID:Ruptured aneurysm of the orbitofrontal artery associated with dural arteriovenous malformation in the anterior cranial fossa--case report. 1019 50


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