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

A case of a de novo aneurysm leading to subdural hemorrhage after right extracranial-intracranial bypass surgery is described. After an uneventful 2-month postoperative course, the patient experienced sudden onset of occipital headache with vomiting. Radiological study disclosed an acute subdural hematoma in the right temporo-occipital region and a newly formed aneurysm at the site of patent superficial temporal artery-middle cerebral artery anastomosis. The anastomotic portion with the ruptured aneurysm was resected en bloc after alternative occipital artery-middle cerebral artery bypass, and the cut end of the superficial temporal artery was successfully used for end-to-side reanastomosis to the other middle cerebral artery branch. The histological examination of the ruptured aneurysm revealed the features of a true aneurysm.
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PMID:Subdural hemorrhage caused by de novo aneurysm complicating extracranial-intracranial bypass surgery: case report. 872 35

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

Two cases involving a ruptured aneurysm in a choroidal branch of the posterior inferior cerebellar artery are reported here. Case 1: A 61-year-old woman was admitted after an episode of severe headache with persistent vomiting. A CT revealed an intraventricular hemorrhage within the fourth ventricle. An angiography showed an aneurysmal shadow in the choroidal artery branching from the telovelotonsillar segment of the distal posterior inferior cerebellar artery (PICA). The operation disclosed a fusiform aneurysm in the choroidal artery which was successfully trapped using Yasargil's mini-clips. The postoperative course was uneventful and the patient was discharged without any neurological deficit. Case 2: A 64-year-old woman became unresponsive after complaining of a severe headache. On admission, she was semicomatose with positive bilateral Babinski's sign. A CT scan showed that the fourth and third ventricles were packed and dilated by a massive hematoma. An angiography demonstrated an aneurysmal shadow in a branch from the PICA with an occlusion of the right vertebral artery. Furthermore, the left vertebral artery was also occluded and the basilar artery was fed by collateral circulation. The patient underwent an operation immediately. The fusiform aneurysm was resected after ligation. Her postoperative course was satisfactory. She was able to go home without neurological deficit. There has been only one article about "pure" choroidal artery aneurysm, reported by Uranishi, et. al in 1994. They suggested that the pathogenesis of this lesion could be due to hemodynamic stress. Our two cases also present the same characteristics, in the shape of the aneurysms as well as in the anomalous structures in the posterior circulation. Our results offer further evidence concerning the pathogenesis of that type of lesion.
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PMID:[Choroidal artery aneurysms of the posterior inferior cerebellar artery presented with fourth ventricular hemorrhage: report of 2 cases]. 974 3

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

This case report describes a ruptured pancreaticoduodenal artery aneurysm (PDAA) causing pancreatic pseudotumour and duodenal obstruction. A 59-year-old man was referred to our hospital with a chief complaint of frequent vomiting without abdominal pain. Because a mass lesion 10 cm in diameter was palpated in the right para-umbilical region and found in the head of the pancreas on computerized tomography (CT) and ultrasonography, malignant tumour of the pancreas or tumour-forming pancreatitis was strongly suspected, and further examination was performed.Magnetic resonance imaging (MRI) results suggested subacute haematoma inside the mass. On angiography, an aneurysm 8 mm in diameter was found in the posterior superior pancreaticoduodenal artery (PSPD). Since an ultrasound-guided percutaneous needle biopsy from the solid part of the mass indicated no malignancy, the lesion was considered an inflammatory pseudotumour in the head of pancreas due to ruptured aneurysm. Bypass surgery was planned, but the tumour shrank significantly with conservative treatment. Obstruction disappeared completely without surgery 4 weeks after the first symptom.
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PMID:A case of pancreaticoduodenal artery aneurysm causing pancreatic pseudotumour and duodenal obstruction. 1194 65

We reviewed the haemorrhagic complications of the endovascular treatment of intracranial aneurysms, in terms of frequency, pre-embolisation clinical status, clinical and radiological manifestations, management and prognosis. In 275 patients treated for 303 aneurysms over 7 years we had seven (one man and six women--2.3%) with haemorrhage during or immediately after endovascular treatment. All procedures were performed with a standardised protocol of heparinisation and anaesthesia. Four had ruptured aneurysms, two at the tip of the basilar artery, and one ach on the internal carotid and posterior cerebral artery, treated after 12, 5, 14, and 2 days, respectively, three were in Hunt and Hess grade 2 and one in grade 1. Bleeding occurred during coiling in three, after placement of at least four coils, and during manipulation of the guidewire to enter the aneurysm in the fourth. Haemorrhage was manifest as extravasation of contrast medium, with a sudden rise in systolic blood pressure in three patients. The other three patients had unruptured aneurysms; they had stable blood pressure and angiographic findings during the procedure, but one, under sedation, had seizures immediately after insertion of four coils, and the other two had seizures, headache and vomiting on the day following the procedure. Heparin reversal with protamine sulphate was started promptly started when bleeding was detected in four patients, and the embolisation was completed with additional coils in three. Emergency ventricular drainage was performed in the two patients with ruptured aneurysm and one with an unruptured aneurysm who had abnormal neurological responses or hydrocephalus. The bleeding caused a third nerve palsy in one patient, which might have been due to ischaemia and progressively improved.
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PMID:Procedure-related haemorrhage in embolisation of intracranial aneurysms with Guglielmi detachable coils. 1285

We report a rare case of a ruptured aneurysm at the cortical segment of the posterior inferior cerebellar artery (PICA) with a branching complex that was feeding the bilateral cerebellar hemispheres. A 70-year-old woman suddenly sustained a severe headache and vomiting. CT scan revealed diffuse subarachnoid haemorrhage with fourth and lateral ventricular haemorrhage, which suggested typical aneurysmal bleeding in the posterior circulation. No aneurysm was detected on the initial angiogram. This angiogram also showed no significant evidence of other lesions that could be the origin of the bleeding. A third angiogram was performed 15 days from the ictus and revealed a distal PICA saccular aneurysm. The aneurysm was located at the cortical segment, and the artery was branching to both of the cerebellar hemispheres. This could be more clearly visualised during the ensuing operation, and neck clipping was performed. The patient recovered without neurological deterioration. Subarachnoid haemorrhage with blood in the fourth ventricle may indicate a ruptured aneurysm on the distal segment of the PICA with a branching variation, feeding the contra-lateral hemisphere, which is rarely located in this position.
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PMID:Ruptured aneurysm at the cortical segment of the posterior inferior cerebellar artery. 1678 Nov 56

We report an unusual case of subarachnoid hemorrhage (SAH) due to ruptured aneurysm originating at the caudal loop of posterior inferior cerebellar artery (PICA). The patient was a 77-year-old female presented with a sudden onset of headache and vomiting. Initial CT scan demonstrated a SAH with thick hematoma mainly in the cisterna magna. Vertebral angiogram revealed a saccular aneurysm arising from the tonsillomedullary segment of the left PICA, and communicating artery with supplying a territory of contralateral vermis as an anastmotic vessel. At surgery, no vessel branches were confirmed in the vicinity of the aneurysm, and this aneurysm was successfully clipped. In the fetus, numerous basilar and vertebral arteries are organized in plexiform formations around the brain stem. It has been suggested that the pathogenesis of such aneurysm or communicating artery could be related with a remnant of a primitive vertebrobasilar anastomosis. Based on these considerations, congenital vessel-wall weakness and hemodynamic stress associated with communicating artery may contribute to the development of distal PICA aneurysms.
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PMID:[Ruptured aneurysm of distal posterior inferior cerebellar artery located at caudal loop]. 1731 60

We report an unusual case of subarachnoid hemorrhage (SAH) due to ruptured aneurysm originating at the caudal loop of posterior inferior cerebellar artery (PICA). The patient was a 77-year-old female presented with a sudden onset of headache and vomiting. Initial CT scan demonstrated a SAH with thick hematoma mainly in the cisterna magna. Vertebral angiogram revealed a saccular aneurysm arising from the tonsillomedullary segment of the left PICA, and communicating artery with supplying a territory of contralateral vermis as an anastmotic vessel. At surgery, no vessel branches were confirmed in the vicinity of the aneurysm, and this aneurysm was successfully clipped. In the fetus, numerous basilar and vertebral arteries are organized in plexiform formations around the brain stem. It has been suggested that the pathogenesis of such aneurysm or communicating artery could be related with a remnant of a primitive vertebrobasilar anastomosis. Based on these considerations, congenital vessel-wall weakness and hemodynamic stress associated with communicating artery may contribute to the development of distal PICA aneurysms.
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PMID:[Ruptured aneurysm of distal posterior inferior cerebellar artery located at caudal loop]. 1738 Jul 83

Distal posterior inferior cerebellar artery (dPICA) aneurysms are rare with an incidence of approximately 1% of all intracranial aneurysms. The frequent reports of the non-branching aneurysms or tandem aneurysms in an identical artery may be related to the embryology of dPICA and the anterior inferior cerebellar artery which is distinct from other cerebral arteries, as characterized by a thin vessel wall and tortuous course. In this paper, the authors present a case of a 67-year-old man with a ruptured de novo dPICA aneurysm in the tonsillomedullary segment, which occurred 3 years after clipping of a ruptured aneurysm in the identical segment of the dPICA. The patient had a history of smoking and uncontrolled hypertension. He presented with a sudden onset of severe headache and vomiting. On admission computed tomography demonstrated subarachnoid hemorrhage in the left cerebello-medullary cistern with intra-forth ventricular clots. Vertebral angiography demonstrated a saccular dPICA aneurysm just distal from the previous clip. Based on the angiographic characteristics of the aneurysm and the potential difficulty of a second clipping operation, coil embolization of the parent artery was performed. The postoperative course was uneventful except for the presence of hoarseness. The unusual development and location of ruptured de novo dPICA aneurysm may be explainable by uncontrollable risk factors, as well as by the embryological features of dPICA. Careful follow-up neuroimaging studies and management of risk factors should be continued even after complete neck clipping or coil embolization in cases of dPICA aneurysm.
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PMID:[A de novo distal PICA aneurysm occurring 3 years after clipping of another distal PICA aneurysm: a case report]. 1976 26


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