Intracranial Unruptured Right Internal Carotid Artery Aneurysm in A Cadaver: A Case Report

Background: Dilatations of localised segments of the artery are called ‘aneurysms. Approximately 80% of aneurysms form in anterior circulation of circle of Willis. While 20% form in the posterior circulation of the brain. All aneurysms can cause symptoms because of compression of surrounding structures, thrombosis, rupture of emboli. Material and Methods: During routine dissection for I MBBS students in Department of Anatomy, JSS Medical College during intracranial dissection we encountered unruptured saccular aneurysm of intracranial internal carotid artery on right side Case report: Aneurysm of intracranial internal carotid artery was seen on right side of middle cranial fossa in a male cadaver. The aneurysm was close to right optic nerve and measured about 2.2 cm in width and 1.8 cm antero-posteriorly. No other intracranial pathology or anatomical variations were noted. Conclusion: The anatomical knowledge of aneurysm is important to Neurosurgeons, Endovascular surgeons, ENT surgeons and interventional Radiologists.

Role of External Ventricular Drainage (EVD) in Treating Spontaneous Intraventricular Haemorrhage

Background: There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral haemorrhage (ICH) and the benefits of external ventricular drainage (EVD). This study is planned to describe the role of external ventricular drainage in treating patients of spontaneous, either primary or secondary, intraventricular haemorrhage with hydrocephalus.Material & Methods:A hospital based prospective interventional study was conducted in the Department of Neurosurgery of Dhaka Medical College Hospital, which is a tertiary level hospital, from April 2016 to September 2017.Total 42 patients of spontaneous intraventricular haemorrhage, either primary or secondary, with hydrocephalus were selected for this study. All the collected data were entered into IBM SPSS software, Version 24. For statistical analysis, paired t-test to compare the preoperative GCS with postoperative GCS at 24 hours was done.Results:Among 42 patients, age range was 26-75 years with the mean age 65.2 � 10.87 years. Male were 26 (61.9%) and female were 16 (38.1%). Male-Female ratio was 1.625:1. No patient needed conversion of EVD into VP shunt. EVD drain became blocked in 5 cases which were managed accordingly. 5 patients developed ventriculitis among which 2 patients died and rest 3 improved with antibiotics.Conclusions:The results of present study shows that EVD has a good role in the treatment of spontaneous IVH with hydrocephalus when ICH volume is low (<30ml) and modified Graeb Score is low (?10 found in this in this study. Preoperative higher GCS or initial improvement in GCS or initial improvement in GCS at 24 hours positively correlates with Glasgow outcome scale which is an indication of good function outcome.

Antepartum cerebral angiopathy presenting as middle cerebral artery aneurysm rupture – A rare case report from India

The incidence of middle cerebral artery aneurysm rupture in pregnancy is rare. Rupture of an intracranial aneurysm is the most common cause of subarachnoid hemorrhage in pregnancy and during puerperium. Intracranial aneurysm rupture during pregnancy is disastrous for the mother as well as the fetus. We report a case of a dissecting left middle cerebral artery aneurysm in a 25-year-old woman, G2P1L1, at 18 weeks of gestation, who presented with a 1-day history of giddiness, slurring of speech, and facial deviation to the left.

Scorpion Bite Atypically Presenting As Acute Transverse Myelitis And Sub Arachnoid Hemorrhage: A Case Report And Review

Scorpion bite is an important health issue as it has been reportedthatabout tenpersons are killed by a venomous scorpion for each killed by a venomous snake.Scorpion venom may be cardiotoxic, hemotoxic, nephrotoxic or even neurotoxic. It acts on the autonomic nervous system producing parasympathetic and sympathetic manifestations.However, few have reported sub arachnoid haemorrhage and transverse myelitis occurring due to scorpion venom.Case Report:We are reporting a case of 50year old male who prese nted three days after an episode of scorpion bitewith paraplegia and inability to pass urine and stool due to transverse myelitis and subarachnoid hemorrhage. He was investigatedand treated accordingly. Clinical improvement was seen within tendays after the initiation of therapy. Conclusion:Scorpion sting,though rarely may present as SAH and transverse myelitis which are reversible and easily treatable.Clinical Significance:As scorpion bite is treatable,having high index of suspicion for scorpion sting inpatients of SAH and acute transverse myelitis in whom the cause of their clinical features could not be recognised may help in improving the outcome considerably in these cases.

Endovascular Coil Occlusion of a Traumatic Pseudoaneurysm of the Posterior Cerebral Artery: A Case Report

ABSTRACT A 51-year-old male developed traumatic pseudoaneurysms of the right- and left-posterior cerebral arteries following endoscopic resection of a pituitary adenoma. The right-sided aneurysm resolved spontaneously but the left progressed in size. This was treated endovascularly, with successful embolization of the sac. This is the first report of this approach to the management of a pseudoaneurysm of the posterior cerebral arteries to our knowledge.

Hypopituitorism happened in patients with aneurysmal subarachnoid haemorrhage in acute stage / 中华内分泌外科杂志

Objective:To explore the risk factors of hypopituitorism after aneurysmal subarachnoid haemorrhage (aSAH) in the acute phase and analysis the effect of hypopituitorism on prognosis.Methods:Patients with aSAH that were diagnosed and treated in China-Japan Union Hospital from Sep. 2017 to Sep. 2018 and undergoing pituitary function evaluation within 3 to 7 days were retrospectively analyzed. 72 patients were enrolled, including 31 males and 41 females. The average age was 50.1 years old (36-71) . The WFNS gradings were Ⅰ, 24; Ⅱ, 20; Ⅲ, 15; Ⅳ, 10; Ⅴ, 3. The Fisher gradings were 2, 21; 3, 38; 4, 13. Acute hydrocephalus happened in 13 cases. Aneurysm located in the Willis circle in 56 cases and not in the Willis circle in 16 cases. 37 cases were treated by microsurgical clipped and 35 cases were treated by embolism. Patients with hypocortisolism were treated by hydrocortisone replacement, and patients with hypothyroidism were given levothyroxine replacement therapy. Patients were followed up at 3 months and their recovery was evaluated by GOS score.Results:Hypopituitorism was detected in 34 patients; the incidence of hypopituitorism was 47.2%. There was no significant correlation between the occurrence of hypopituitorism and age, gender, and hydrocephalus ( P>0.05) . Patients with WFNS grade ≥Ⅳ, Fisher grade 4, aneurysm located in the Willis circle, and treated by clipping were more likely to undergo hypopituitorism. The proportion of patients with good recovery (GOS ≥4) in the hypopituitorism group was smaller than that in the normal pituitary function group at the 3-month follow-up. Conclusions:Patients with WFNS grade ≥Ⅳ, Fisher grade 4, aneurysm located in the Willis circle, and treated by clipping are more likely to undergo hypopituitorism. Hypopituitorism in acute stage affects the prognosis of aSAH patients. Patients with hypocortisolism and hypothyroidism should be treated actively.

Vasospasm and delayed cerebral ischaemia in patients with spontaneous subarachnoid haemorrhage (aneurysmal and pretruncal non-aneurysmal): a centre’s perspective

@#Spontaneous subarachnoid haemorrhage (SAH) is a significant cause of stroke and may lead to severe neurological deficit or death. It is also associated with high morbidity and mortality for patients despite optimal medical and surgical treatment. Based on the World Health Organization the annual incidence of spontaneous SAH varies in different regions of the world between 2.0-22.5 per 100,000 populations with Finland and Japan having the highest incidence and South and Central America with lowest incidence.1

Clinical Analysis of Subarachnoid Haemorrhage of Unknown Aetiology (SAHUE).

Spontaneous subarachnoid haemorrhage accounts for 15 cases per lakh population. There are few reports of patients with perimesencephalic haemorrhage and few reports with limited number of patients. Therefore, the aim of the present study was to investigate the clinical course and outcome in patients with SAH. METHODSIn our study, we identified a total of 55 patients admitted to the Neurosurgery department of Sri Ramachandra Institute of Higher Study and Research with subarachnoid haemorrhage between 2018 and 2019. Medical records of all patients who underwent treatment for subarachnoid haemorrhage from July 2018 to April 2019 in the tertiary-care center were reviewed from a prospectively collected database. A detailed analysis was performed on potential predictors of post-operative complications, including age, gender, and type of admission. RESULTSNegative sub-arachnoid haemorrhage angiogram exhibited very mild prognosis than with aneurysmal sub-arachnoid haemorrhage. All patients had presence of blood either in perimesencephalic cisterns and in the lateral cisterns. The prognosis of patient varies based on the thickness of hematoma and people with hydrocephalus had poor prognosis. CONCLUSIONSEach patient with subarachnoid haemorrhage should be monitored as an individual case and to prevent death it is important to identify patients to reduce the aneurysms and modify the risk factors associated with.

Manejo clínico de hemorragia subaracnoidea por aneurisma intracraneal en una mujer embarazada en Quito, Ecuador: reporte de caso / Clinical management of subarachnoid haemorrhage due to intracranial aneurysm in a pregnant woman in Quito, Ecuador: Case report

RESUMEN Objetivo: describir el diagnóstico y manejo de la hemorragia subaracnoidea secundaria a un aneurisma arterial cerebral accidentado en la primera mitad del embarazo. Materiales y métodos: se presenta el caso de una mujer de 26 años en su segundo embarazo, sin abortos previos y con una cesárea anterior, que fue atendida en un centro de referencia de atención materno perinatal ubicado en Quito, Ecuador, por diagnóstico de hemorragia subaracnoidea durante la decimoséptima semana de gestación. En la panangiografía cerebral se observó un aneurisma cerebral de cuello ancho en la arteria temporal anterior con sangrado. Resultados: se realizó un tratamiento con prótesis endovascular y microespirales, con control de la hemorragia. Posteriormente, la paciente requirió doble antiagregación plaquetaria con clopidogrel y ácido acetilsalicílico que se mantuvo hasta una semana antes del parto. A la paciente se le realizó una cesárea electiva en la que nació un niño sano de 37,2 semanas. Conclusión: el tratamiento endovascular con la colocación de microespirales, asociado al uso de antiagregantes plaquetarios, es una alternativa por considerar en gestantes en la primera mitad del embarazo. Se requieren más estudios clínicos para establecer conductas terapéuticas bien fundamentadas en el manejo de estos casos.

ABSTRACT Objective: To describe the diagnosis and management of a case of subarachnoid haemorrhage secondary to arterial cerebral aneurysm during the first half of gestation. Materials and methods: A 26-year-old woman during a second pregnancy, with no prior miscarriages, and one previous cesarean section seen at a maternal and perinatal care referral centre located in Quito, Ecuador, with a diagnosis of subarachnoid haemorrhage at seventeen weeks of pregnancy. Cerebral pan-angiography showed a wide-neck cerebral aneurysm of the anterior temporal artery with bleeding. Results: Treatment was performed using endovascular stenting and coiling. Later, the patient required dual anti-platelet therapy with clopidogrel and acetylsalicylic acid, maintained up to a week before delivery. Elective cesarean section was performed and the patient was delivered of a healthy baby at 37.2 weeks of gestation. Conclusion: Endovascular treatment with the use of micro-coils, associated with anti-platelet aggregation therapy is an option to consider in pregnant women during the first half of gestation. Further clinical studies are needed in order to identify more fundamental therapeutic approaches for the management of these cases.

Risk factors for ruptured intracranial aneurysms

Background & objectives: The treatment of unruptured intracranial aneurysms (IAs) remains controversial; the ability to predict the risk of rupture for an aneurysm would be of clinical value. The aim of this study was to determine and evaluate the predictive value of the risk factors of IA rupture. Methods: This retrospective study involved 379 consecutive patients with 441 aneurysms between August 2011 and July 2014. Based on clinical data and computed tomography angiography findings, the potential of risk factors to predict the aneurysmal rupture was assessed using statistical methods. Results: Age, hypertension, heart disease, diabetes mellitus, cerebral atherosclerosis, aneurysms located at the internal carotid artery (ICA) and neck width (N) correlated negatively with rupture risk. Aneurysms located at the anterior communicating artery, bifurcation, irregularity, with a daughter sac, aneurysm height, maximum size, aspect ratio (AR), height-to-width ratio and bottleneck factor were significantly and positively correlated with rupture risk. The multivariate logistic regression model revealed that bifurcation aneurysm, irregular aneurysm and high AR increased the rupture risk, while cerebral atherosclerosis, aneurysm located on the ICA and greater N decreased the risk. Receiver operating characteristic analysis of AR curve values differed according to circumstances. Interpretation & conclusions: Cerebral atherosclerosis, location in the ICA and larger N were the protective factors against aneurysm rupture, and IAs located at bifurcations, irregular shape and increased AR indicated a greater rupture risk.

Ruptured basilar top aneurysm presenting with status epilepticus in an infant: A Rare Case Report.

Seizures are one of the most common neurological emergencies seen in pediatric age group. Rupture of intracranial aeurysm is one of the rare causes of seizures in children. Rupture of basilar top aneurysm causing seizures in pediatric age group is rarely reported in litrature. Here we report a case of 5 months old baby who presented with status epilepticus. Neuroimaging showed a ruptured basilar top aneurysm with subarachnoid haemorrhage and extension of bleed into 3rd and 4th ventricle.

The pathogenic mechanisms of motor weakness following aneurysmal subarachnoid hemorrhage: A review

Motor weakness is one of the neurological complication that can occur after aneurysmal subarachnoid hemorrhage (SAH); incidence of motor weakness of 14~29% has been reported. Detailed information on the pathogenic mechanism of motor weakness is essential for brain rehabilitation because it enables estimation of the severity of injury, establishment of scientific rehabilitative strategies, and prediction of motor outcomes by clinicians. However, the exact pathogenic mechanisms of motor weakness following aneurysmal SAH have not been clearly elucidated. In this article, 14 previous studies on pathogenic mechanisms in patients with aneurysmal SAH were reviewed according to the location of the lesion (cerebral cortex, brainstem, spinal cord, and peripheral nerve). The following pathogenic mechanisms have been suggested: vasospasm, cerebral ischemia, hydrocephalus, compression of cerebral cortex, neural injury, spinal cord infarction, and radiculo-neuropathy. Considering the high incidence of aneurysmal SAH and motor weakness following aneurysmal SAH, we believe that the pathogenic mechanisms of motor weakness have been relatively understudied. More effort should be taken to investigate this important topic.

Intervenciones de enfermería en la persona con vasoespasmo cerebral secundario a hemorragia subaracnoidea aneurismática / Nursing interventions in the person with a secondary cerebral vasospasm aneurysmal subarachnoid haemorrhage

Introducción. El vasoespasmo cerebral como complicación de la Hemorragia subaracnoidea aneurismática, es considerado como una vasoconstricción patológica de las arterias principales de la base del encéfalo; es una condición reversible, que se caracteriza con la reducción del calibre de la luz de las arterias y por lo consiguiente una disminución del flujo sanguíneo al área perfundida por el vaso comprometido. Objetivo. Desarrollar un proceso enfermero basado en la taxonomía Nanda, Noc, Nic a una persona con vasoespasmo cerebral. Metodología. Se realizó la elección de un caso clínico, con la metodología del proceso de atención de enfermería estableciendo un plan de cuidados en el área de recuperación y terapia intermedia del Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez durante el periodo postquirúrgico inmediato. Se detectaron las necesidades básicas alteradas al realizar la valoración neurológica de enfermería. Se procedió a formular los diagnósticos de enfermería reales y de riesgo y con base en estos se planearon las intervenciones de enfermería. Conclusión. El realizar las intervenciones de enfermería de forma sistematizada a partir del proceso enfermero, se establece un método científico, en donde cada intervención se fundamenta y da pauta a la aplicación de un cuidado especializado, dirigido hacia la mejora de la persona desde el punto de vista individual y con ello detectar oportunamente signos y síntomas de alarma así como posibles complicaciones.

Introduction. The cerebral vasospasm as complication of the Haemorrhage subarachnoid aneurismática, is considered to be a pathological vasoconstriction of the main arteries of the base of the brain; it is a reversible condition, which is characterized by the reduction of the caliber of the light of the arteries and for consequent a decrease of the blood flow to the area perfundida for the awkward glass. Target. To develop a process nurse based on the taxonomy Nanda, NOC, NIC to a person with vasospasm cerebral. Methodology. There was realized the election of a clinical case, with the methodology of the process of attention of infirmary establishing a care plan in the field of recovery and intermediate therapy of the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez during the immediate postsurgical period. The basic needs were detected altered on having realized the neurological infirmary evaluation. One proceeded to formulate the real diagnoses of infirmary and of risk and with base in these the infirmary interventions were planned. Conclusion. Realizing the interventions of infirmary of form systematized from the process nurse, establishes a scientific method, where every intervention is based and gives rule to the application of a specializing care, directed to the progress of the person from the individual point of view and with it to detect opportunely signs and symptoms of alarm as well as possible complication.

The Relationship between Clinical Outcome in Subarachnoidal Hemorrhage Patients with Emergency Medical Service Usage and Interhospital Transfer

Prompt diagnosis and appropriate transport of patients with subarachnoid hemorrhage (SAH) is critical. We aimed to study differences in clinical outcomes by emergency medical services (EMS) usage and interhospital transfer in patients with SAH. We analyzed the CAVAS (CArdioVAscular disease Surveillance) database which is an emergency department-based, national cohort of cardiovascular disease in Korea. Eligible patients were adults with non-traumatic SAH diagnosed between January 2007 and December 2012. We excluded those whose EMS use and intershopital transfer data was unknown. The primary and secondary outcomes were mortality and neurologic status at discharge respectively. We compared the outcomes between each group using multivariable logistic regressions, adjusting for sex, age, underlying disease, visit time and social history. Of 5,461 patients with SAH, a total of 2,645 were enrolled. Among those, 258 used EMS and were transferred from another hospital, 686 used EMS only, 1,244 were transferred only, and 457 did not use EMS nor were transferred. In the regression analysis, mortality was higher in patients who used EMS and were transferred (OR 1.40, 95% CI 1.02-1.92), but neurologic disability was not meaningfully different by EMS usage and interhospital transfer. In Korea, SAH patients' mortality is higher in the case of EMS use or receiving interhospital transfer.

Hemorragia subaracnoidea no aneurismática / Non-aneurysmal subarachnoid hemorrhage

Objetivo: determinar las características clínicas de hemorragia subaracnoidea aneurismática (HSA-A). Métodos: estudio descriptivo basado en serie prospectiva de 204 pacientes con hemorragia subaracnoidea espontánea admitidos de forma consecutiva en la Unidad de Ictus del Hospital Hermanos Ameijeiras de La Habana, entre octubre de 2005 y diciembre de 2009. Resultados: 165 pacientes tenían aneurismas cerebrales, 157 identificados por angiografía (155 en primer estudio y 2, en segundo) y 8 por necropsia. En 39 casos la causa fue no aneurismática. En 8 pacientes se reconocieron las causas: moya moya (2 casos), angioma venoso cerebral (2 casos), malformación arteriovenosa (MAV) espinal, MAV dural, disección arterial del sistema vertebro-basilar y apoplejía pituitaria. En 31 enfermos (15,2 por ciento) la hemorragia fue criptogénica, se encontraron variantes anómalas de drenaje venoso en 4 de ellos. La HSA-NA se asoció a menor frecuencia de hipertensión (p= 0,029) y tabaquismo (p= 0,025). Se observó vasospasmo angiográfico en 55 casos (33,3 por ciento) con aneurismas y en 1 con HSA-NA (2,6 por ciento) (p< 0,001), vasospasmo sintomático en 25 casos con aneurismas (15,2 por ciento) y en ninguno con HSA-NA (p= 0,063). Hubo resangrado en 31 casos (18,8 por ciento) con HSA-A y solo en 1 con HSA-NA (2,6 por ciento) (p= 0,024). El resultado final al egreso medido por la escala de Rankin modificada fue mejor en la HSA-NA (p= 0,002). Hubo 25 fallecidos (15,2 por ciento) con aneurismas y ninguno con HSA-NA (p= 0,02). Conclusiones: la HSA-NA tiene buen pronóstico. Las investigaciones neurovasculares no permiten identificar su causa en la mayoría de los casos...

Objective: determine the clinical characteristics of nonaneurysmal subarachnoid hemorrhage (ASH-A). Methods: a descriptive study was conducted of a prospective series of 204 patients with spontaneous subarachnoid hemorrhage consecutively admitted to the Stroke Unit at Hermanos Ameijeiras Hospital in Havana from October 2005 to December 2009. Results: 165 patients had cerebral aneurysms, of which 157 were identified by angiography (155 in the first study and 2 in the second), and 8 by necropsy. In 39 cases the cause was non-aneurysmatic. The following causes were identified in 8 patients: moyamoya disease (2 cases), cerebral venous angioma (2 cases), spinal arteriovenous malformation (AVM), dural AVM, artery dissection of the vertebrobasilar system and pituitary apoplexy. 31 patients (15.2 percent) had cryptogenic hemorrhage, and four presented anomalous venous drainage. NA-SAH was associated with a lower frequency of hypertension (p= 0.029) and smoking (p= 0.025). Angiographic vasospasm was observed in 55 cases with aneurysms (33.3 percent) and in one case with NA-SAH (2.6 percent) (p< 0.001). Symptomatic vasospasm was observed in 25 cases with aneurysms (15.2 percent) and in none with NA-SAH (p= 0.063). There was rebleeding in 31 cases with A-SAH (18.8 percent) and in only one case with NA-SAH (2.6 percent) (p= 0.024). The final outcome at discharge measured with the modified Rankin scale was better for NA-SAH (p= 0.002). There were 25 deaths with aneurysms (15.2 percent) and none with NA-SAH (p= 0.02). Conclusions: NA-SAH has a good prognosis. In most cases neurovascular research is unable to identify its cause...

Tratamiento de la hemorragia subaracnoidea aneurismática en el Hospital Clínico de la Universidad de Chile / Subarachnoid hemorrhage caused by intracranial aneurysms, experience in 82 patients

Background: One third of patients with subarachnoid hemorrhage caused by intracranial aneurysms, die. Aim: Review of medical records of patients with subarachnoid hemorrhage treated at a clinical hospital. Material and Methods: Review of medical records of patients discharged from the hospital between 2006 and 2011 with the diagnosis of subarachnoid hemorrhage. Patients initially or subsequently treated elsewhere were not analyzed. Results: The medical records of 82 patients aged 24 to 100 years (77% females), were analyzed. The clinical diagnosis at the onset of the condition was correct in 82% of cases. In 95% of patients, an angiographic study and subsequent surgical intervention of the aneurysm were carried out within 24 hours of diagnosis. Global mortality was 23%. Twelve patients died prior to any possible treatment, due to the severity of the disease. Seventy six aneurysms in 70 patients were treated with clips or coils in 37 and 39 cases, respectively. Seven patients died. Forty seven patients had a Rankin disability score of two or less. Conclusions: The presence of an intracranial hematoma or acute hydrocephaly on admission and clinical vasospasm during evolution were associated with a bad prognosis.

Functional Outcome of Microsurgical Clipping Compared to Endovascular Coiling

Endovascular coiling has been used increasingly as an alternative to neurosurgical clipping for treating subarachnoid hemorrhage secondary to aneurysm rupture. In a retrospective cohort review on the treatment methods of aneurysm rupture in Hospital Kuala Lumpur over the period of five years (2005-2009) a total of 268 patients were treated. These patients were broadly categorized into two groups based on their treatment mode for ruptured aneurysms. Statistical analysis was determined using Chi- Square tests to study these associations. In our study, 67.5% of patients presented with Good World Federation of Neurosurgical Societies (WFNS) grade (WFNS1-2) while 32.5% patients presented with Poor WFNS prior to intervention. In our outcome, it was noted that 60.4% had good functional outcome (mRS grade 0-2) as compared to 39.6% patients who had poor mRS(modified rankin scale) outcome (mRS 3-6). In the good WFNS group, 76% of patients in clipping group had a good mRS outcome while, 86.5% patients in coiling group had good mRS outcome (p=0.114). In poor WFNS presentation, it was noted that in 77.3% patients in clipping group, had poor mRS outcome. Similarly with poor WFNS presentation, 83.3% of patient in coiling group had poor outcome. (p=1.00). Hence when we control the WFNS group, there was no significant association between treatment group (clipping and coiling) and mRS outcome at 6 months. The outcome of patient is determined by initial clinical presentation (WFNS grade) and influenced by requirement of Extraventricular drain (EVD) in presence of hydrocephalus, CSF infection and pneumonia. Therefore the decision regarding treatment option needs to be individualized based on the presentation of the patient.

Hemodinâmica do vasoespasmo: [revisão] / Cerebral hemodynamic alterations due to vasospasm: [review]

Os autores descrevem as alterações hemodinâmicas encefálicas que ocorrem na vigência do vasoespasmo após a hemorragia subaracnoidea por aneurismas. O conhecimento dessas alterações facilita o entendimento das medidas terapêuticas.

The authors describe the hemodynamic encephalic alterations that occur during the vasospasm after aneurysmal subarachnoid hemorrhage. The knowledge of these alterations promotes better understanding of the therapeutic procedures.

Hemorragia cerebelosa neonatal. A propósito de un caso / Neonatal cerebellar hemorrhage. A case report

Teniendo en cuenta que las lesiones del sistema nervioso central ocupan un lugar importante en la morbimortalidad neonatal, presentamos el caso de un recién nacido a término, sexo masculino, nacido en parto distócico, con hipoxia severa al nacer, que presentó manifestaciones clínicas de una hemorragia intracraneal. En ultrasonido transfontanelar se observó una imagen compatible con una hemorragia de cerebelo, la cual se corroboró con la TAC de cráneo. Es egresado vivo los 17 días.

Taking into account that damages of the Central Nervous System play an important role in neonatal morbidity and mortality, a case of a term neonato is presented: A male newborn from a dystocic delivery, with severe hypoxia, presenting clinical manifestatins o fan intracraneal haemorrhage. Transfontanel ultrasound whowed an image consistent with a cerebellar haemorrhage which could be proved through a Craneal comuterized Axial Tomography. The patient was discharged from the hospital at 17 days old.

Meningitis Due to Bacillus Anthracis

The first case of haemorrhagic meningitis due to Bacillus anthracis in the European part of Turkey is reported here. B. anthracis, sensitive to penicillin, was isolated from the cerebrospinal fluid and blood cultures. Although appropriate therapy was administered, the patient died two days after hospitalization.