ABSTRACT
Background. Aneurysms of the extracranial vertebral artery are rare and can provide a diagnostic and therapeutic challenge. Methods. We reviewed the clinical history of a patient presenting with cervical radiculopathy, who harboured an extracranial vertebral artery aneurysm eroding the cervical spine. Results. CT Angiography and MR Angiography set the diagnosis, by revealing a left C5-C6 vertebral artery aneurysm with cervical root impingement. Bony reconstruction depicted enlargement of the C6 transverse foramen and a marked enlargement of the C6-C7 intravertebral foramen. The lesion was treated by intravascular proximal vertebral artery occlusion. Conclusions. Extracranial vertebral artery aneurysms require a high index of clinical suspicion. This is the first report of a vertebral artery pseudoaneurysm presenting with bony erosion, which supports a less minacious portrayal of vertebral artery aneurysms.
ABSTRACT
We present the case of a young male with severe head injury, cervico-thoracic fractures, and an initially unrecognized brainstem infarct due to unilateral dissection of vertebral artery, who made an unusually excellent recovery. This report stresses the importance of prompt clinico-imaging diagnosis and prophylactic anticoagulant treatment in such cases.
Subject(s)
Accidents, Traffic , Brain Stem Infarctions/diagnosis , Craniocerebral Trauma/etiology , Vertebral Artery Dissection/diagnosis , Adult , Anticoagulants/therapeutic use , Brain Stem Infarctions/drug therapy , Brain Stem Infarctions/etiology , Cervical Vertebrae/injuries , Early Diagnosis , Humans , Magnetic Resonance Imaging/methods , Male , Motorcycles , Thoracic Vertebrae/injuries , Treatment Outcome , Vertebral Artery Dissection/etiology , Warfarin/therapeutic useABSTRACT
To augment information at digital subtraction angiography, 17 patients with 22 intracranial aneurysms underwent three-dimensional-display magnetic resonance (MR) angiography. Reconstructions created to simulate vascular endoscopy provided additional information in 18 aneurysms about the aneurysmal sac, its orifice and neck, and/or its relation to the parent vessel and nearby vasculature. No additional information was provided in two aneurysms, and two aneurysms were not depicted.
Subject(s)
Image Enhancement/methods , Intracranial Aneurysm/diagnosis , Magnetic Resonance Angiography/methods , Adult , Aged , Angiography, Digital Subtraction , Basilar Artery , Carotid Artery Diseases/diagnosis , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/pathology , Carotid Artery, Internal , Cerebral Arteries , Data Display , Endoscopy , Female , Humans , Image Processing, Computer-Assisted , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/pathology , Male , Middle Aged , Radiology, InterventionalABSTRACT
Our aim was to demonstrate the orifice of intracranial aneurysms by magnetic resonance angiography (MRA). The aneurysmal orifice is that part of its lumen that communicates with the parent vessel. We studied 12 patients with 17 intracranial aneurysms using three-dimensional display (3DD) MRA; 15 of the aneurysms had previously been shown by digital subtraction angiography (DSA). The overall image quality of 3DD MRA was excellent in 10 patients. The orifice was clearly demonstrated in 13 aneurysms (76%) providing unique information about its size, shape and orientation. The orifice of 2 aneurysms (12%) was not demonstrated. Two aneurysms (12%) were not detected on MRA. Although 3DD MRA has limitations, this study suggests that it can accurately define the orifice of aneurysms and could be used to provide information crucial for endovascular treatment.
Subject(s)
Image Processing, Computer-Assisted , Intracranial Aneurysm/diagnosis , Magnetic Resonance Angiography , Aged , Female , Humans , Male , Middle AgedABSTRACT
The authors describe the magnetic resonance (MR) findings in seven patients who developed severe cerebellar symptoms and atrophy of the contralateral red nucleus following removal of unilateral neoplasms in the deep nuclei of the cerebellum. For most patients, pre- and postoperative spin-echo MR images were obtained with long repetition times (TRs) at 1.5 T. The long TR images obtained before surgery demonstrated unilateral masses involving the dentate nucleus. Long TR images obtained after surgical resection of the dentate nucleus showed increased signal intensity in all of seven contralateral red nuclei, three of seven ipsilateral superior cerebellar peduncles, and two of seven contralateral inferior olivary nuclei. Three other patients who underwent surgery for cerebellar neoplasms without resection of the dentate nuclei showed no postoperative brain stem changes on MR images. The authors speculate that the changes in the contralateral red nuclei are due to cerebellorubral degeneration (since well-described neural tracts interconnect the dentate nucleus and the contralateral red nucleus). Injury of the dentate nucleus may result in degeneration of distant neural connections.
