ABSTRACT
This case series aimed to review the significance of revisiting papilledema after successful cerebral venous sinus thrombosis (CVST) management with sinus angioplasty. Four patients presented with blurring and transient obscuration of vision with papilledema, headache, tinnitus, and vomiting. On magnetic resonance venography and digital subtraction angiography, chronic transverse sinus thrombosis was diagnosed for which patients underwent endovascular intervention (stenting). After the resolution of CVST, patients developed the recurrence of symptoms which on digital subtraction angiography revealed dural arteriovenous malformation (DAVM). DAVM and papilledema resolved with endovascular embolization. This case series highlights a need of constant monitoring of CVST cases after the endovascular intervention.
ABSTRACT
Gastric variceal bleeding has relatively low incidence rate compared to esophageal variceal bleeding. However, gastric variceal bleeding tends to lead to a massive bleeding and rebleeding which in turn leads to high mortality rate. In cases where endoscopic approach is limited, Ballon-occluded retrograde transvenous obliteration (BRTO) could be considered as a next modality of seizing acute bleeding. Venous catheterization should be preceded to perform venous embolization, however, in cases of hypovolemic shock status, alternative approaches are required. We are reporting a case of 60-year old female with hypovolemic status due to a massive hematemesis, who went through a percutaneous transhepatic glue embolization to control gastric variceal bleeding.
Subject(s)
Female , Humans , Adhesives , Catheterization , Catheters , Esophageal and Gastric Varices , Hematemesis , Hemorrhage , Hypovolemia , Incidence , Mortality , ShockABSTRACT
Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.