ABSTRACT
A young man with Fisher grade IV subarachnoid haemorrhage (SAH) underwent aneurysm coiling following external ventriculostomy. Coiling was complicated by thrombus formation and parent vessel occlusion necessitating anti-platelet therapy. Several hours after anti-platelet therapy, catastrophic haemorrhage associated with the ventriculostomy tract occurred. Timing and location of haemorrhage suggest combined anti-platelet therapy and ventriculostomy may have been causal. The literature on ventriculostomy haemorrhage rates and risks with concomitant anti-platelet therapy are reviewed. Where endovascular coiling is being considered, the possibility of ventriculostomy-related haemorrhage should be considered and should influence subsequent treatment decisions.
Subject(s)
Endovascular Procedures/adverse effects , Hematoma, Subdural/etiology , Platelet Aggregation Inhibitors/adverse effects , Subarachnoid Hemorrhage/surgery , Ventriculostomy/adverse effects , Adult , Hematoma, Subdural/chemically induced , Humans , Male , Subarachnoid Hemorrhage/drug therapyABSTRACT
BACKGROUND: A transorbital intracranial injury with a wooden foreign body can be very difficult to diagnose and manage. The orbit forms an easy path for low-velocity foreign bodies into the intracranial space. The severity of the injury is often masked by unobtrusive superficial wounds. Computed tomography (CT) findings may be misinterpreted as pneumocephalus. CASE DESCRIPTION: We present a young gentleman who had a fall under the influence of alcohol near a bush and, on clinical presentation, had very little signs of a penetrating injury in the skin. There was some numbness in the V1 distribution of the trigeminal nerve. Further investigation and management are described. CONCLUSION: Although magnetic resonance imaging is more sensitive and specific, a CT angiogram with 3-dimensional reconstruction will provide much insight into the mode of intervention required. We present an anatomical classification for such injuries.
Subject(s)
Foreign Bodies/diagnosis , Head Injuries, Penetrating/diagnosis , Orbit/injuries , Adult , Foreign Bodies/etiology , Foreign Bodies/surgery , Head Injuries, Penetrating/etiology , Head Injuries, Penetrating/surgery , Humans , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Male , Tomography, X-Ray ComputedABSTRACT
Spontaneous bilateral carotid and vertebral artery dissections (CADs and VADs) are rare. A 29-year-old female presented with a collapse, 4 weeks after a sudden onset of severe neck and shoulder pain. CT scan revealed diffuse subarachnoid hemorrhage (SAH) and early hydrocephalus. Angiography revealed bilateral CADs and VADs, along with multiple fusiform and saccular aneurysms. Systemic vessels - including the renal arteries - were normal, and no risk factors or underlying vasculopathy were apparent. The presumed source of SAH (a posterior cerebral artery aneurysm) was successfully clipped. Each dissection, by contrast, was managed conservatively with heparin prophylaxis; and spontaneous CAD and VAD resolution occurred within 6 months. We present a unique case of four-vessel dissection associated with multiple disparate saccular and fusiform aneurysms. We suspect that underlying vasculopathy - perhaps novel - may become apparent with time.
Subject(s)
Carotid Artery, Internal, Dissection/etiology , Intracranial Aneurysm/complications , Subarachnoid Hemorrhage/etiology , Vertebral Artery Dissection/etiology , Adult , Carotid Artery, Internal, Dissection/diagnosis , Female , Humans , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/surgery , Remission, Spontaneous , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/surgery , Vertebral Artery Dissection/diagnosisABSTRACT
OBJECTIVE: We evaluated the use of MDCT in the diagnosis and management of lower gastrointestinal bleeding (hematochezia). CONCLUSION: MDCT is proposed as an alternative first-line investigation to locate lower gastrointestinal bleeding before placing the patient under observation or performing embolization or surgery.
