Delayed Intracerebral Hemorrhage from a Pseudoaneurysm Following a Depressed Skull Fracture / 신경중재치료의학

A 26-year-old male presented with delayed intracerebral hemorrhage from a ruptured distal middle cerebral artery pseudoaneurysm that followed a compound depressed skull fracture from years ago. The brain protrusion through the skull defect likely resulted in stretching and subsequent tearing of the arterial wall resulting in the pseudoaneurysm formation. No prior report of such a clinical occurrence exists in the literature. We highlight an unusual but treatable cause for intracerebral hemorrhage following surgery for traumatic brain injury.

Persistent Aneurysm Growth Following Pipeline Embolization Device Assisted Coiling of a Fusiform Vertebral Artery Aneurysm: A Word of Caution! / 신경중재치료의학

The complex morphology of vertebrobasilar fusiform aneurysms makes them one of the most challenging lesions treated by neurointerventionists. Different management strategies in the past included parent vessel occlusion with or without extra-intracranial bypass surgery and endovascular reconstruction by conventional stents. Use of flow diversion has emerged as a promising alternative option with various studies documenting its efficacy and safety. However, there are various caveats associated with use of flow diversion in patients with fusiform vertibrobasilar aneurysms especially in patients presenting with acute subarachnoid hemorrhage (SAH). We report a rare case of persistent aneurysmal growth after coiling and placement of the Pipeline Embolization Device (PED; ev3, Irvine, California, USA) for SAH from a fusiform vertebral artery aneurysm. As consequences of aneurysm rupture can be devastating especially in patients with a prior SAH, the clinical relevance of recognizing and understanding such patterns of failure cannot be overemphasized as highlighted in the present case.

Delayed Vascular Claudication Following Diagnostic Cerebral Angiography: A Rare Complication of the AngioSeal Arteriotomy Closure Device

With rapidly increasing numbers of neuroendovascular procedures performed annually in recent years, use of arterial closure devices after femoral artery access has been exceedingly common secondary to reduced time to hemostasis, decreased patient discomfort, earlier mobilization, and shortened hospital stay. Although uncommon, use of these devices can lead to a different spectrum of complications, as compared to manual compression. Ischemic symptoms following the use of these devices can have unexpected clinical sequelae and can occur in a delayed fashion. Awareness and recognition of such complications is important with the dramatically increased use of these devices in recent years. We report on a case of delayed vascular complication manifesting as vascular claudication following use of the AngioSeal closure device.

Unilateral Paramedian Transpedicular Approach for Repair of Anterior Transdural Spinal Cord Herniation: Report of a Case and Literature Review

Idiopathic spinal cord herniation is a rare but potentially treatable cause of thoracic myelopathy. The rarity and variable clinical presentation often results in missed diagnosis and delay in treatment. Posterior midline approach with laminectomy has been the most common approach performed for spinal cord herniation in cases described in the literature. A posterior approach is limited by the danger of retracting the spinal cord and difficulty visualizing the dural defect. Considering the anterior location of the dural defect, a posterolateral allows for a more ventral view without spinal cord manipulation. We report a rare case of idiopathic spinal cord herniation which was managed by unilateral paramedian transpedicular approach with an excellent clinical outcome.

Spinal subdural haematoma following traumatic lumbar puncture in a patient with normal coagulation profile

Spinal subdural haematoma following lumbar puncture is a rare cause of spinal cord compression with very few cases reported in the literature. It is usually associated with some predisposing factors like haemorrhagic diathesis, anticoagulant therapy, vascular malformation, tumour or trauma. The authors report a case of spinal subdural haematoma in a 30-year-old male following a traumatic lumbar puncture with no obvious coagulation disorder. The patient had a poor outcome with minimal improvement in paraparesis at last follow-up, even after timely decompression. Although coagulation abnormalities are commonly found in most of these cases, our case illustrates the fact that spinal subdural haematoma can occur even in the presence of normal coagulation profile and a high index of suspicion with early diagnosis and intervention is warranted to prevent irreversible neurological deterioration, especially following a traumatic lumbar puncture

Intracerebral haematoma after lumbar cerebrospinal fluid drainage

Cerebrospinal fluid [CSF] leak is a well recognized complication of basilar skull fracture, skull base surgery and neurootological procedures. Continuous CSF drainage has been a widely accepted procedure to prevent and treat such leaks. Though generally the procedure is innocuous, it can cause complications like headache, nausea, vomiting, subdural bleeding, infection and tension pneumocephalus. Though the development of intracranial subdural haematomas have been reported in a number of cases after deliberate lumbar CSF drainage or inadvertent CSF leak following spine surgery; lumbar CSF drain causing an intracerebral haemorrhage has not been reported previously as per the authors' review of literature. We report a rare case of intracerebral haematoma following lumbar CSF drainage which was managed by timely diagnosis and early evacuation. The authors recommend close neurological monitoring of patients who require continuous lumbar drainage to detect any life-threatening complications