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Article in English | WPRIM | ID: wpr-880644


In recent years, in the absence of venous component, dilated, overlapping, and tortuous arteries forming a mass of arterial loops with a coil-like appearance have been defined as pure arterial malformation (PAM). It is extremely rare, and its etiology and treatment have not yet been fully elucidated. Here, we reported 2 cases of PAM with associated aneurysmal subarachnoid hemorrhage in this paper. Both patients had severe headache as the first symptom. Subarachnoid hemorrhage was found by CT and computed tomography angiography (CTA) and PAM with associated aneurysm was found by digital subtraction angiography (DSA). In view of the distribution of blood and the location of aneurysms, the aneurysm rupture was the most likely to be considered. Based on the involvement of the lesion in the distal blood supply, only the aneurysm was clamped during the operation. It used to be consider that PAM is safety, because of the presentation and natural history of previously reported cases. Through the cases we reported, we have doubted about "the benign natural history" and discussed its treatment. PAM can promote the formation of aneurysms and should be reviewed regularly. The surgical indications for PAM patients with aneurysm formation need to be further clarified. Management of PAM patients with ruptured aneurysm is the same as that of ruptured aneurysm. Whether there are indications needed to treat simple arterial malformations remains to be further elucidated with the multicenter, randomized controlled studies on this disease.

Aneurysm, Ruptured/surgery , Angiography, Digital Subtraction , Cerebral Angiography , Humans , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/etiology
Rev. chil. cardiol ; 37(2): 104-109, ago. 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-959347


Resumen Paciente de sexo femenino de 65 años, con antecedentes de hipertensión arterial crónica, resistencia a la insulina, histerectomía total y fractura tibioperonea antigua, es hospitalizada por cuadro febril, sin foco, de 2 meses de evolución, con sospecha de endocarditis por parámetros inflamatorios elevados y soplo diastólico en foco aórtico 2/6. Se estudia con ecocardiograma, transtorácico (ETT) y transesofágico (ETE), que muestra vegetación en velo aórtico coronario izquierdo de 9 mm por 7 mm e insuficiencia aórtica leve, motivo por el cual se toma hemocultivo resultando positivo para Rothia aeria. La paciente evoluciona con embolia de riñón derecho y bazo, y posteriormente, con hemorragia subaracnoidea. Inicia tratamiento antibiótico con ampicilina, vancomicina y gentamicina, con lo cual presenta una evolución satisfactoria y es dada de alta luego de 28 días de hospitalización. Al revisar la literatura, se puede llegar a la conclusión de que la endocarditis por Rothia es extremadamente infrecuente y que, en cuanto al cuadro clínico, tiene tendencia a una forma de presentación subaguda, con presencia de vegetaciones grandes mayores a 10mm y un alto grado de complicaciones neurológicas.

Abstract A 65-year-old female patient, with a history of chronic hypertension, insulin resistance, total histerectomy, and tibioperoneal fracture, is hospitalized for fever of unknown etiology. Basterial endocarditis was suspected due to elevated inflammatory parameters and a 2/6 diastolic murmur present in the aortic focus. Transthoracic and transesophageal echocardiography, showed a 9 mm by 7 mm vegetation in the left coronary aortic leaflet of and mild aortic insufficiency, Blood cultures were positive for Rothia aeria. She developed embolism of the right kidney and spleen, and subsequently, a subarachnoid hemorrhage. Antibiotic therapy was initiated with ampicillin, vancomycin and gentamicin, with a satisfactory evolution being discharged after 28 days of hospitalization. When reviewing the literature, it can be concluded that Rothia endocarditis is extremely rare and that, tends to have a subacute presentation with large vegetations, larger than 10 mm, and a high incidence of neurological complications.

Humans , Female , Aged , Actinomycetales Infections/complications , Actinomycetales Infections/microbiology , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/microbiology , Subarachnoid Hemorrhage/etiology , Actinomycetales Infections/drug therapy , Actinomycetales Infections/diagnostic imaging , Echocardiography , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/diagnostic imaging , Ampicillin/therapeutic use , Micrococcaceae , Anti-Bacterial Agents/therapeutic use
Rev. chil. radiol ; 24(3): 94-104, jul. 2018. ilus
Article in Spanish | LILACS | ID: biblio-978162


La hemorragia subaracnoidea (HSA) no traumática es un subtipo de ictus hemorrágico que representa aproximadamente el 5% de todos los accidentes vasculares encefálicos (AVE). El 85% de los casos de HSA espontánea (no traumática) son secundarios a un aneurisma intracraneano roto, el 10% a hemorragia perimesencefálica no aneurismática y el otro 5% a otras causas. Entre estas se incluyen malformaciones arterio-venosas, fístulas durales, vasculits, trombosis de vena cortical, síndrome de vasoconstricción reversible, angiopatía amiloidea y síndrome de encefalopatía posterior reversible. La aproximación inicial a una HSA no traumática requiere un estudio angiográfico no invasivo con tomografía computada para la toma de decisiones terapéuticas. Si no se detecta un aneurisma sacular intradural que explique el sangrado, las conductas a seguir dependerán del patrón de distribución de la sangre. En esta revisión sugerimos una aproximación basada en 1) revisar el estudio inicial tomando en cuenta los puntos ciegos para la detección de aneurismas, 2) analizar el patrón de distribución de la sangre y 3) analizar los hallazgos en imágenes de acuerdo a las posibles causas según patrón.

Non-traumatic subarachnoid hemorrhage represents approximately 5% of strokes. From these, 85% of nontraumatic subarachnoid hemorrhage are secondary to a ruptured aneurysm, 10% to nonaneurysmal perimesencephalic hemorrhage and the other 5% to other causes. These include but are not limited to arteriovenous malformations, dural fistulae, vasculitis, cortical vein thrombosis, reversible cerebral vasoconstriction syndrome, amyloid angiopathy and posterior reversible encephalopathy syndrome. Initial workup of nontraumatic subarachnoid hemorrhage requires a non-enhanced CT and CT angiography for decision making and management. If there is no aneurysm as a source of hemorrhage, subsequent imaging studies will depend on blood distribution pattern. In this review we suggest an approach: 1) review blind spots for aneurysm detection in the initial CT angiography, 2) analyze blood distribution pattern and 3) evaluate imaging findings and possible causes according to each pattern.

Humans , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/diagnostic imaging , Vasculitis/complications , Intracranial Aneurysm/complications , Cerebral Amyloid Angiopathy/complications , Venous Thrombosis/complications , Computed Tomography Angiography
Ethiop. med. j. (Online) ; 56(2): 155-160, 2018. tab
Article in English | AIM | ID: biblio-1262002


Introduction: Subarachnoid hemorrhage is a devastating neurological emergency associated with high mortality and disability. Little is known about its occurrence and clinical profile in Ethiopia. We, therefore, studied the clinical presentation, causes and outcome of the condition among in a tertiary facility.Methods: A retrospective analysis of records of patients admitted with the diagnosis of subarachnoid hemorrhage to Tikur Anbassa Specialized Hospital over a period of 12 years, January 2001 to January 2012, was undertaken.Results: Of 725 patients admitted with the diagnosis of stroke 52 (7.1%) patients were diagnosed to have subarachnoid hemorrhage. Death was registered in 18(34.6%) and disability in seven (13.4%).Hypertension was the most common risk factor, observed in 36 (69.21 %) of the patients, and seizure disorder and electrolyte abnormalities-hyponatremia were the most common complications. Conclusion: The outcome of subarachnoid hemorrhage in this study is comparable with reports from elsewhere. A prospective and well-designed epidemiological study is recommended. There is a need to improve the diagnostic and interventional capacity of the hospital

Ethiopia , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/etiology , Treatment Outcome
Arq. neuropsiquiatr ; 75(12): 858-861, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-888282


ABSTRACT Nontraumatic convexity subarachnoid hemorrhage is an increasingly recognized subtype of subarachnoid bleeding. Objective: Our aim was to describe the etiology and clinical features of a cohort of patients with convexity subarachnoid hemorrhage. Methods: We retrospectively analyzed all cases of convexity subarachnoid hemorrhage admitted to our hospital between January 2012 and April 2017. Demographic features, clinical characteristics, complementary investigations, etiology and mortality were assessed. Twenty patients (65% females) were identified. Mean age: 53 years (range, 15-86 years). Results: Symptoms on admission: headache (65%), sensory and/or motor symptoms (50%) and seizures (35%). Commonest causes: cerebral vein thrombosis (20%), reversible cerebral vasoconstriction syndrome (20%) and cerebral amyloid angiopathy (20%). Two patients died. Conclusion: Convexity subarachnoid hemorrhage may be related to a wide spectrum of etiologies. In our patients, an increased prevalence of cerebral vein thrombosis was observed. Mortality was low and not related to the bleeding itself.

RESUMO A hemorragia subaracnóidea não traumática da convexidade é um subtipo cada vez mais reconhecido de sangramento subaracnóideo. Objetivo: Nosso objetivo foi descrever a etiologia e as características clínicas de uma coorte de pacientes com hemorragia subaracnóidea da convexidade. Métodos: Foram analisados retrospectivamente todos os casos de hemorragia subaracnóidea da convexidade admitidos em nosso hospital entre janeiro de 2012 e abril de 2017. Foram avaliados os aspectos demográficos, características clínicas, investigações complementares, etiologia e mortalidade. Vinte pacientes (65% mulheres) foram identificados. Média de idade: 53 anos (intervalo, 15-86). Resultados: Sintomas na admissão: dor de cabeça (65%), sintomas sensitivos e/ou motores (50%) e convulsões (35%). Causas mais comuns: trombose venosa cerebral (20%), síndrome de vasoconstrição cerebral reversível (20%) e angiopatia amilóide cerebral (20%). Dois pacientes morreram. Conclusão: A hemorragia subaracnóidea da convexidade pode estar relacionada a um amplo espectro de etiologias. Em nossos pacientes, observou-se uma maior prevalência de trombose venosa cerebral. A mortalidade foi baixa e não relacionada à própria hemorragia.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Subarachnoid Hemorrhage/etiology , Argentina , Subarachnoid Hemorrhage/diagnostic imaging , Cerebral Angiography , Retrospective Studies , Cohort Studies
[Santiago]; Chile. Ministerio de Salud. División de Planificación Sanitaria; 2017. tab, ilus, graf.
Non-conventional in Spanish | LILACS, BIGG | ID: biblio-948192


Objetivo: Generar recomendaciones basadas en la mejor evidencia disponible acerca del manejo de personas con hemorragia subaracnoidea a rotura de aneurismas cerebrales. Tipo de pacientes y escenario clínico: Personas con hemorragia subaracnoidea a rotura de aneurismas cerebrales que reciben atención en el nivel secundario y terciario de salud en el sector público y privado de salud.

Humans , Subarachnoid Hemorrhage , Intracranial Aneurysm/complications , Aneurysm, Ruptured/complications , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/therapy , Subarachnoid Hemorrhage/diagnostic imaging
Rev. bras. anestesiol ; 66(5): 533-535, Sept.-Oct. 2016. graf
Article in English | LILACS | ID: lil-794800


Abstract Subarachnoid haematoma after spinal anaesthesia is known to be very rare. In the majority of these cases, spinal anaesthesia was difficult to perform and/or unsuccessful; other risk factors included antiplatelet or anticoagulation therapy, and direct spinal cord trauma. We report a case of subarachnoid haematoma after spinal anaesthesia in a young patient without risk factors.

Resumo Hematoma subaracnoideo após anestesia espinal é conhecido por ser muito raro. Na maioria desses casos, a anestesia espinal foi difícil de executar e/ou malsucedida; outros fatores de risco incluem terapia anticoagulante ou antiplaquetária e trauma medular direto. Relatamos um caso de hematoma subaracnoideo após raquianestesia em paciente jovem sem fatores de risco.

Humans , Male , Adult , Spinal Diseases/etiology , Subarachnoid Hemorrhage/etiology , Anesthesia, Spinal/adverse effects , Postoperative Complications , Postoperative Complications/etiology , Spinal Diseases/diagnostic imaging , Subarachnoid Hemorrhage/diagnostic imaging , Magnetic Resonance Imaging
Arq. neuropsiquiatr ; 74(6): 478-481, June 2016. tab
Article in English | LILACS | ID: lil-784187


ABSTRACT We retrospectively evaluated the records of 49 grade 4 and 5 patients with 42 intracranial aneurysms treated within 72 h of subarachnoid hemorrhage (SAH). In total, 35 patients (71%) were grade 4, and 14 (29%) were grade 5. A total of 42 (85%) patients had one aneurysm, 6 (12%) had two aneurysms, and 1 (3%) had three aneurysms. Out of 49 patients, one technical (2%) and one clinical (2%) complication occurred at surgery. Twenty-one (43%) patients recovered well, including 7 with postoperative hematoma requiring an immediate evacuation of a clot. Fourteen (29%) patients had hydrocephalus and required a ventriculo-peritoneal shunt; 12 patients underwent tracheotomy postoperatively due to coma and pulmonary infection. We found that patients with Hunt and Hess grade 4 and 5 aneurysms can undergo successful neurosurgical clipping of the aneurysms after SAH. However, the morbidity and mortality rates remain high because of their poor clinical condition and a high incidence of vasospasm during treatment.

RESUMO Avaliamos retrospectivamente os registros de 49 pacientes com 42 aneurismas intracranianos de graus 4 e 5, tratados nas primeiras 72 horas após uma hemorragia subaracnóidea (HSA). Trinta e cinco pacientes (71%) apresentavam grau 4 e catorze (29%) grau 5. Quarenta e dois pacientes (85%) tinham um único aneurisma, seis (12%) tinham dois aneurismas, e um paciente (3%) tinha três aneurismas. Dos 49 pacientes, uma complicação técnica (2%) e uma complicação clínica (2%) ocorreram durante a cirurgia. Vinte e um pacientes (43%) recuperaram-se bem, incluindo sete que tiveram hematomas pós-operatórios que requereram a imediata evacuação do coágulo. Catorze pacientes (29%) tiveram hidrocefalia e submeteram-se à derivação ventrículo-peritoneal; doze pacientes submeteram-se à traqueostomia no pós-operatório, devido a coma e infecção pulmonar. Pacientes com aneurismas de graus 4 e 5, segundo a escala de Hunt & Hess podem submeter-se com sucesso à clipagem dos aneurismas após HSA. Entretanto, as taxas de morbidade e mortalidade ainda são altas, devido à condição clínica precária e à alta incidência de vasoespasmo durante o tratamento.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Subarachnoid Hemorrhage/surgery , Surgical Instruments/adverse effects , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/etiology , Severity of Illness Index , Intracranial Aneurysm/complications , Retrospective Studies , Treatment Outcome
CoDAS ; 28(1): 81-88, jan.-fev. 2016. tab, graf
Article in Portuguese | LILACS | ID: lil-779120


RESUMO Objetivos: Revisar de forma sistemática os métodos para avaliação do olfato em vítimas de hemorragia subaracnóidea aneurismática, e identificar as alterações encontradas com a utilização desses métodos. Estratégia de pesquisa: A pesquisa bibliográfica foi realizada na plataforma de busca PubMed e nas bases de dados Web of Science, Scopus, PsycINFO, CINAHL e ScienceDirect, tendo a busca de dados ocorrida em agosto e setembro de 2014. Critérios de seleção: Artigos originais publicados em qualquer língua que abordassem as alterações de olfato na hemorragia subaracnóidea aneurismática, com objetivo de avaliar essa função através de métodos específicos. Foram excluídos estudos de revisão; estudos de caso; capítulos de livro; editoriais e estudos que abordassem a hemorragia subaracnóidea não aneurismática. Análise dos dados: Foram consideradas como variáveis na análise dos dados: autor/ano, país, amostra/idade, tratamento, método utilizado, momento da avaliação do olfato e resultados. Resultados: A busca de artigos resultou em 1.763 artigos, desses, 9 artigos originais foram selecionados para esta revisão. Foi observado que todos os artigos foram desenvolvidos em países europeus e asiáticos e na avaliação do olfato utilizou-se desde testes padronizados e não padronizados a questionários, cujos objetivos variaram entre avaliar o olfato antes e/ou após o tratamento cirúrgico nessa população. Conclusão: Foi observada heterogeneidade nos métodos utilizados para avaliação do olfato na hemorragia subaracnóidea aneurismática, como também no momento selecionado para aplicação das avaliações. Além disso, os estudos evidenciaram a existência de déficit olfatório nos pacientes, e a relação entre o tratamento cirúrgico e a disfunção olfatória.

ABSTRACT Purpose: To systematically review the methods for evaluation of smell in aneurysmal subarachnoid hemorrhage victims and to identify the changes found with the use of these methods. Research strategy: The literature search was performed in PubMed search platform and in the databases Web of Science, Scopus, PsycINFO, CINAHL, and ScienceDirect in August and September 2014. Selection criteria: Original articles published in any language, which addressed smell changes in aneurysmal subarachnoid hemorrhage and addressed to evaluate this function through specific methods were included. Review studies, case studies, book chapters, editorial, and studies that address the nonaneurysmal subarachnoid hemorrhage were excluded. Data analysis: The following variables were considered in data analysis: author/year, country, sample/age, treatment, method, the moment of smell evaluation, and results. Results: The search for articles resulted in 1,763 articles, of which, 9 original articles were selected for this review. It was observed that all articles were from European and Asian countries. Standardized and nonstandardized tests and questionnaires were used in olfactory assessment, and the goals ranged from assessing the smell before and/or after surgery in this population. Conclusion: Heterogeneity was observed in the methods used to evaluate the smell in aneurysmal subarachnoid hemorrhage and in the methods selected for application of evaluations. In addition, studies have demonstrated the existence of olfactory deficits in patients and the relationship between surgery and olfactory dysfunction.

Female , Humans , Male , Smell/physiology , Subarachnoid Hemorrhage/physiopathology , Aneurysm, Ruptured/complications , Intracranial Aneurysm/complications , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/surgery
Arq. bras. neurocir ; 34(3): 175-178, ago. 2015. tab, ilus
Article in Portuguese | LILACS | ID: biblio-2040


Objetivos Hidrocefalia tardia que requer implante de derivação liquórica é frequente após hemorragia subaracnóidea por aneurisma cerebral roto, e contribui para amorbimortalidade tardia. Alguns autores reportam que a fenestração microcirúrgica da Lâmina Terminal, durante a cirurgia do aneurisma diminui a incidência de hidrocefalia tardia. Material e Método No período de Janeiro de 2010 a Janeiro de 2012 realizamos a fenestração da Lâmina Terminal associada à fenestração da Membrana de Liliequist, em 17 pacientes operados na fase aguda por aneurisma roto. Monitoramos por tomografia a presença de hidrocefalia após 6 e 16 meses. Resultados Nenhum paciente apresentou hidrocefalia tardia. Conclusão A fenestração da Lâmina Terminal associada à fenestração da Membrana de Liliequist é eficaz na prevenção da hidrocefalia tardia pós hemorragia subaracnóidea por aneurisma roto.

Objectives Chronic hydrocephalus requiring shunt placement is common following aneurysm subarachnoid hemorrhage, and contributes to the late morbidity and mortality Some authors report that microsurgery fenestration of Lamina Terminalis during aneurysm surgery affords a reduction in the development shunt-dependent hydrocephalus. Methods From January 2010 to January 2012 we performed microsurgery fenestration of Lamina Terminalis and Liliequist's Membrane, in 17 patients operated in the acute phase. CT scans were performed after 6 and 16 months Result There was no development of hydrocephalus in this series. Conclusion Microsurgery fenestration of Lamina Terminalis associated with Liliequist's Membrane fenestration is effective in preventing late hydrocephalus after subarachnoid hemorrhage due to ruptured aneurysm.

Humans , Hydrocephalus/prevention & control , Intracranial Aneurysm/complications , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/etiology
Arq. bras. neurocir ; 34(3): 179-184, ago. 2015.
Article in Portuguese | LILACS | ID: biblio-2043


A avaliação da função hipofisária na fase aguda ou tardia dos pacientes que sofrem hemorragia subaracnóidea (HSA) é infrequente; entretanto, a HSA apresenta um risco significante de disfunção pituitária, principalmente devido à vulnerabilidade da sua suplência vascular. Há poucos estudos tratando do tema, mas os existentes sugerem que distúrbios hormonais pós-hemorragia subaracnóidea são mais prevalentes do que inicialmente se suspeitava. Não somente a hipófise anterior parece estar envolvida nessas alterações; a hiponatremia no estágio agudo pode ser uma manifestação de disfunção da hipófise posterior. As alterações hormonais após HSA ainda recebem pouca atenção das equipes assistenciais, podendo ser uma das complicações potencialmentegraves sendo tratável quando há suspeição pelo diagnóstico clínico e laboratorial.

The evaluation of pituitary function in the acute and at late time in the patients with subarachnoid hemorrhage (SAH) is unusual. Meanwhile the SAH present with a high risc of pituitary disfunction primarily by the vulnerability of the vascular feeding vessels. Few studies about this subject suggest that hormonal disturbance are more prevalent that were suspected before. Both the anterior and posterior pituitary areinvolved. The hormonal changes after SAH are not well recognized by the physicians and can be treated even been a critical medical situation with clinical and laboratorial findings.

Humans , Endocrine System Diseases , Intracranial Aneurysm/complications , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/etiology
Rev. méd. Chile ; 142(8): 982-988, ago. 2014. tab
Article in Spanish | LILACS | ID: lil-728346


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.

Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Intracranial Aneurysm , Subarachnoid Hemorrhage , Intracranial Aneurysm/complications , Intracranial Aneurysm/mortality , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/mortality , Subarachnoid Hemorrhage/surgery
Rev. bras. anestesiol ; 63(2): 223-226, mar.-abr. 2013. ilus
Article in Portuguese | LILACS | ID: lil-671566


JUSTIFICATIVA E OBJETIVOS: A ocorrência de hemorragia subaracnoidea (HSA) durante a gravidez é rara, sendo que cerca de metade é devida a malformações arteriovenosas (MAV). Os autores descrevem a abordagem anestésica de uma grávida de 39 semanas proposta para cesárea, com história de HSA por MAV às 22 semanas. RELATO DO CASO: Grávida de 39 semanas, saudável previamente à gravidez, com antecedentes de HSA às 22 semanas de gestação, manifestada por cefaleias, vômitos e tonturas, sem perda de consciência ou outros déficits à admissão no serviço de urgência. A ressonância magnética (RM) revelou MAV frontal esquerda. Após curto internamento para estabilização e diagnóstico, decidiu-se manter a gravidez e o seguimento ambulatorial multidisciplinar por neurocirurgia e obstetrícia em consulta de alto risco. Optou-se por fazer cesárea eletiva às 39 semanas sob anestesia peridural lombar. No intraoperatório ocorreu um episódio de hipotensão rapidamente revertida com fenilefrina. O Índice de Apgar do recém-nascido foi de 10/10. O cateter peridural foi usado para analgesia pós-operatória, também sem intercorrências. CONCLUSÕES: São muito raros os casos publicados de abordagem anestésica de grávidas com MAV sintomáticas. Todas as decisões tomadas pela equipe multidisciplinar, desde optar por continuar a gravidez ao momento ideal para intervir na MAV, passando pelo tipo de anestesia e analgesia, foram ponderadas em função do risco de dano cerebral. Do ponto de vista anestésico, os autores enfatizam a necessidade de estabilidade hemodinâmica.

BACKGROUND AND OBJECTIVES: Subarachnoid hemorrhage (SAH) during pregnancy is a rare event, and about half the cases are due to arteriovenous malformations (AVM). The authors describe the anesthetic approach of a 39 week pregnant patient scheduled for cesarean section, with a history of SAH due to AVM at 22 week gestation. CASE REPORT: 39 week pregnant patient, healthy prior to pregnancy, with a history of SAH at 22 week gestation, manifested by headache, vomiting, and dizziness without loss of consciousness or other deficits on admission to the emergency room. Magnetic resonance imaging (MRI) revealed a left frontal AVM. After a short hospital stay for stabilization and diagnosis, the final medical decision was to maintain the pregnancy and a multidisciplinary follow-up by neurosurgery and high-risk obstetric consultation. An elective cesarean section was performed at 39 weeks under epidural anesthesia. During the intraoperative period, an episode of hypotension rapidly reversed with phenylephrine occurred. The newborn Apgar score was 10/10. An epidural catheter was used for postoperative analgesia, also uneventful. CONCLUSIONS: There are very few published cases of anesthetic approach for pregnant women with symptomatic AVM. All decisions made by the multidisciplinary team, from choosing to continue the pregnancy to the ideal time for AVM intervention and type of anesthesia and analgesia, were weighted according to the risk of brain damage. Regarding the anesthetic procedure, the authors emphasize the need for hemodynamic stability.

JUSTIFICATIVA Y OBJETIVOS: El aparecimiento de la hemorragia subaracnoidea (HSA) durante el embarazo es algo raro, siendo que aproximadamente la mitad se debe a malformaciones arteriovenosas (MAV). Los autores describen el abordaje anestésico de una embarazada de 39 semanas programada para cesárea, con un historial de HSA por MAV a las 22 semanas. RELATO DEL CASO: Embarazada de 39 semanas, sana antes del embarazo, con antecedentes de HSA a las 22 semanas de gestación que se manifestó por medio de cefaleas, vómitos y mareos, sin la pérdida de la consciencia u otros déficits a la hora de su entrada en el servicio de urgencia. La resonancia magnética (RM) arrojó MAV frontal izquierda. Después de un breve período de ingreso para la estabilización y el diagnóstico, se decidió mantener el embarazo y el acompañamiento ambulatorio multidisciplinario por neurocirugía y obstetricia en consulta de alto riesgo. Se optó por realizar la cesárea electiva a las 39 semanas bajo anestesia epidural lumbar. En el intraoperatorio ocurrió un episodio de hipotensión que fue rápidamente revertido con fenilefrina. El Índice de Apgar del recién nacido fue de 10/10. El catéter epidural fue usado para la analgesia postoperatoria, que también cursó sin intercurrencias. CONCLUSIONES: Son muy raros los casos publicados de abordaje anestésico de embarazadas con MAV sintomáticas. Todas las decisiones tomadas por el equipo multidisciplinario, desde optar por continuar con el embarazo, hasta el momento ideal para intervenir la MAV, pasando por el tipo de anestesia y analgesia, fueron sopesadas en función del riesgo de daño cerebral. Desde el punto de vista anestésico, los autores enfatizan la necesidad de estabilidad hemodinámica.

Adult , Female , Humans , Pregnancy , Anesthesia, Obstetrical/methods , Intracranial Arteriovenous Malformations/complications , Pregnancy Complications, Cardiovascular , Subarachnoid Hemorrhage/etiology
Article in English | WPRIM | ID: wpr-202307


Neurogenic pulmonary edema (NPE) leading to cardiopulmonary dysfunction is a potentially life-threatening complication in patients with central nervous system lesions. This case report describes a 28-yr woman with life-threatening fulminant NPE, which was refractory to conventional respiratory treatment, following the rupture of an aneurysm. She was treated successfully with extracorporeal membrane oxygenation (ECMO), although ECMO therapy is generally contraindicated in neurological injuries such as brain trauma and diseases that are likely to require surgical intervention. The success of this treatment suggests that ECMO therapy should not be withheld from patients with life-threatening fulminant NPE after subarachnoid hemorrhage.

Adult , Brain/diagnostic imaging , Decompressive Craniectomy , Extracorporeal Membrane Oxygenation , Female , Humans , Intracranial Aneurysm/complications , Pulmonary Edema/diagnosis , Subarachnoid Hemorrhage/etiology , Tomography, X-Ray Computed
KMJ-Kuwait Medical Journal. 2012; 44 (1): 50-52
in English | IMEMR | ID: emr-118246


Cerebral [Dural] venous thrombosis can present with a variety of symptoms ranging from mild headache to altered level of consciousness and coma. Cerebral venous thrombosis is an uncommon clinical condition. It often affects young to middle aged patients and more commonly women. Subarachnoid hemorrhage is a rare presentation. In this report, we describe a case of cerebral venous thrombosis presenting with Subarachnoid hemorrhage

Humans , Male , Adult , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/diagnosis , Magnetic Resonance Imaging , Tomography, X-Ray Computed
IJMS-Iranian Journal of Medical Sciences. 2012; 37 (3): 205-207
in English | IMEMR | ID: emr-146147


A 22-year-old female patient presented to the Emergency Department of a tertiary care hospital with symptoms of headache and nausea. She has been on a regular follow-up for the preceding three and a half years after being diagnosed as systemic lupus erythematosus [SLE]. She had been treated earlier for SLE nephritis in the same institution, and had two relapses of nephrotic syndrome in the last three and a half years for which she had been treated and had achieved complete remission. All possibilities of headaches in background of SLE were considered. CNS examination was inconclusive. There was no nuchal rigidity or no cranial nerve deficits. Fundoscopy and Plain CT scan of brain were normal. The possibility of CNS-lupus was considered considering the high values of antiphospholipid antibodies [APLA]. Treatment was initiated accordingly; however, there was no improvement in her symptoms. Although being rare in a patient with SLE, the possibility of an aneurysm was considered. Four vessel digital substraction angiography revealed two unruptured aneurysms of 7.2 mm and 3.9 mm in the left middle cerebral artery [MCA] territory. Craniotomy and aneurysmal clipping was done successfully, and the patient was relieved of her symptoms. A high degree of suspicion towards a rarer cause clinched the diagnosis of a left MCA territory stem artery aneurysm. This rationale of strong suspicion and discussion of differential diagnosis brought a change in the management of the patient

Humans , Female , Intracranial Aneurysm/diagnosis , Cerebral Arterial Diseases/complications , Middle Cerebral Artery/injuries , Lupus Erythematosus, Systemic/complications , Rupture, Spontaneous , Subarachnoid Hemorrhage/etiology
Article in English | IMSEAR | ID: sea-134588


Choroid plexus papilloma (CPP) is a rare, benign neoplasm, relatively more common in childhood. It is associated with signs and symptoms of increased intracranial pressure, frequently in association with obstructive hydrocephalus. CT and MRI are the investigations of choice and are diagnostic. Sudden deaths have been reported, but are very unusual. A 41 year old male was brought for medico-legal autopsy examination on ground of sudden death. He was reported to have headaches over a long period of time. On autopsy examination, massive sub-arachnoid hemorrhage was seen on both the cerebral hemispheres and cerebellum. A cyst measuring about 1 cm diameter was found in choroid plexus of right lateral ventricle. On histopathological examination, it was found to be a choroid plexus papilloma. Calcification was also evident in the papilloma. From medico-legal aspect, the present case reveals an unusual cause for sudden death in an adult male. The pathology could have been diagnosed easily by CT scan or MRI. When diagnosed, it has good survival rate, the morbidity depending on the extent of pathological effects. The present case was likely to have survived having minimal effects with appropriate treatment had he been diagnosed. The pathology is rare and a suspicion for this pathology in the adult male was not expected, but a CT scan to investigate chronic headache was warranted. Absence of such a suggestion leading to death, which could have been preventable, is sufficient ground for charge of professional negligence.

Adult , Cause of Death , Death, Sudden/etiology , Death, Sudden/legislation & jurisprudence , Humans , Male , Papilloma, Choroid Plexus/complications , Papilloma, Choroid Plexus/etiology , Papilloma, Choroid Plexus/mortality , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/mortality
Yonsei Medical Journal ; : 475-477, 2010.
Article in English | WPRIM | ID: wpr-114976


A patient received combined spinal-epidural anesthesia for a scheduled total knee arthroplasty. After an injection of spinal anesthetic and ephedrine due to a decrease in blood pressure, the patient developed a severe headache. The patient did not respond to verbal command at the completion of the operation. A brain CT scan revealed massive subarachnoid and intraventricular hemorrhages, and a CT angiogram showed a ruptured aneurysm. Severe headaches should not be overlooked in an uncontrolled hypertensive patient during spinal anesthesia because it may imply an intracranial and intraventricular hemorrhage due to the rupture of a hidden aneurysm.

Aged , Anesthesia, Epidural/adverse effects , Anesthesia, Spinal/adverse effects , Aneurysm, Ruptured/chemically induced , Cerebral Ventricles/physiopathology , Humans , Intracranial Hemorrhages/etiology , Male , Subarachnoid Hemorrhage/etiology