ABSTRACT
BACKGROUND: Atherosclerotic stenosis of the middle cerebral artery (MCA) is uncommon and long-term prognosis is not well defined. Methods of treating stenosis of the MCA range from the administration of anticoagulants to endarterectomy. METHODS: We present two cases of patients with focal symptomatic stenosis of the MCA with evidence of focally decreased cerebral blood flow and compromise of cerebral blood flow reserves on xenon-enhanced computed tomography (Xe CT) scanning. Endarterectomies were performed after unsuccessful anticoagulation therapy. RESULTS: Both patients underwent successful endarterectomies of the MCA. Improvement in cerebral blood flow postoperatively was documented for both patients. At last follow-up neither patient had demonstrated any additional ischemic episodes. CONCLUSIONS: Atherosclerotic stenosis of the MCA may be responsible for distal emboli and compromised hemodynamics, and endarterectomy of this vessel may provide definitive therapy.
Subject(s)
Brain Ischemia/surgery , Cerebral Arteries/surgery , Cerebral Infarction/surgery , Endarterectomy , Aged , Brain Ischemia/diagnostic imaging , Brain Ischemia/physiopathology , Cerebral Angiography , Cerebral Arteries/diagnostic imaging , Cerebral Arteries/physiopathology , Cerebral Infarction/diagnostic imaging , Cerebral Infarction/physiopathology , Cerebrovascular Circulation , Female , Humans , Male , Tomography, X-Ray ComputedABSTRACT
A 27-year-old woman presented with a ruptured giant aneurysm of the right middle cerebral artery, occlusion of the artery distal to the aneurysm, and an intraparenchymal hematoma. Before emergent surgery, her condition deteriorated to a Glasgow Coma Scale score of 4 and a Hunt and Hess grade of V. Electroencephalographic response on the right, initially absent, was present toward the end of the surgery. Postoperative angiography demonstrated good filling of the previously occluded distal middle cerebral artery. The simultaneous occurrence of hemorrhage from a giant intracranial aneurysm and occlusion of the parent artery is extremely rare, and this is the first case we found in the literature in which the patient survived. The treatment strategy and outcome are discussed.
Subject(s)
Aneurysm, Ruptured/surgery , Cerebral Hemorrhage/surgery , Cerebral Infarction/surgery , Intracranial Aneurysm/surgery , Adult , Aneurysm, Ruptured/pathology , Aneurysm, Ruptured/physiopathology , Brain Damage, Chronic/diagnosis , Brain Damage, Chronic/physiopathology , Cerebral Angiography , Cerebral Cortex/physiopathology , Cerebral Hemorrhage/pathology , Cerebral Hemorrhage/physiopathology , Cerebral Infarction/pathology , Cerebral Infarction/physiopathology , Craniotomy , Electroencephalography , Evoked Potentials, Somatosensory/physiology , Female , Glasgow Coma Scale , Humans , Intracranial Aneurysm/pathology , Intracranial Aneurysm/physiopathology , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Thrombectomy , Tomography, X-Ray ComputedABSTRACT
Brain tumors are histologically heterogeneous. A technique for three-dimensional fusing of computed tomography (CT) or magnetic resonance images (MRI) with positron emission tomography (PET) images is described. This allows the anatomic detail provided by CT or MRI scans to be combined with the information about metabolic activity provided by PET scans. The fused images allowed selection of the most metabolically active portions of tumors. Fusion of CT and MRI images with PET scans has allowed first-pass diagnostic yield by providing the surgeon with a map of anatomical as well as functional (metabolic) detail. We describe a technique to allow routine fusion of MRI, CT, and PET information to help guide the neurosurgeon.
Subject(s)
Brain Neoplasms/diagnosis , Brain Neoplasms/surgery , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Tomography, Emission-Computed , Tomography, X-Ray Computed , Adult , Aged , Biopsy/methods , Female , Humans , Male , Middle Aged , Stereotaxic TechniquesABSTRACT
The case of a giant posterior communicating artery (PCoA) aneurysm is reported in which the initial presentation was coma secondary to obstructive hydrocephalus. The primary radiological diagnosis was a probable craniopharyngioma. A cerebral angiogram revealed a partially thrombosed giant PCoA aneurysm on the right side. The patient underwent pterional craniotomy with aneurysm clipping and thrombectomy to relieve mass effect, and has made a good recovery. Review of the literature documents that giant PCoA aneurysms are rare. This is believed to be the first reported case of a PCoA aneurysm presenting as a third ventricle mass with obstructive hydrocephalus. The magnetic resonance imaging characteristics of those third ventricle masses that mandate vascular workup are discussed.
Subject(s)
Carotid Artery Diseases/diagnosis , Carotid Artery, Internal/pathology , Cerebral Arteries/pathology , Cerebral Ventricle Neoplasms/diagnosis , Hydrocephalus/diagnosis , Intracranial Aneurysm/diagnosis , Basilar Artery/pathology , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Middle AgedABSTRACT
A case of esthesioneuroblastoma with an unusual clinical and radiographic presentation is reported. The presenting symptoms as well as the computed tomographic examination were compatible with a primary intracranial mass.
Subject(s)
Brain Neoplasms/diagnostic imaging , Neuroectodermal Tumors, Primitive, Peripheral/diagnostic imaging , Nose Neoplasms/diagnostic imaging , Diagnosis, Differential , Female , Humans , Middle Aged , Tomography, X-Ray ComputedABSTRACT
A case of an open depressed skull fracture that was missed on standard computed tomographic (CT) scan is presented. The fracture was seen on a CT generated lateral scout film, and after repositioning the gantry, further CT images clearly showed the fracture and underlying brain injury. The authors recommend that all patients with head trauma undergoing head CT have either a CT generated lateral scout film or a lateral skull radiograph to assess the vertex of the skull, an area poorly visualized on standard axial images.
Subject(s)
Fractures, Open/diagnostic imaging , Skull Fractures/diagnostic imaging , Tomography, X-Ray Computed , Adult , Brain Concussion/complications , Brain Concussion/diagnostic imaging , Fractures, Open/complications , Humans , Male , Osteomyelitis/etiology , Skull/diagnostic imaging , Skull Fractures/complicationsABSTRACT
Endothelins are a family of structurally related, potent, long-lasting vasoconstrictor peptides. There are no established normal human levels of endothelin-1 or endothelin-3 in the cerebrospinal fluid. We measured cerebrospinal fluid endothelin-1 and endothelin-3 levels in five groups of patients: normal controls, patients with subarachnoid hemorrhage and cerebral vasospasm, patients with severe head injuries, patients undergoing temporal lobectomy for intractable epilepsy, and a patient with a gunshot injury to the thoracic spine. Endothelin-3 levels were significantly elevated in patients with subarachnoid hemorrhage and may participate in cerebral vasospasm and subsequent neurologic deterioration.
Subject(s)
Craniocerebral Trauma/cerebrospinal fluid , Endothelins/cerebrospinal fluid , Epilepsy/cerebrospinal fluid , Spinal Injuries/cerebrospinal fluid , Subarachnoid Hemorrhage/cerebrospinal fluid , Adult , Aged , Animals , Craniocerebral Trauma/surgery , Endothelins/biosynthesis , Endothelins/physiology , Epilepsy/surgery , Female , Humans , Male , Middle Aged , Radioimmunoassay , Reference Values , Spinal Injuries/surgery , Subarachnoid Hemorrhage/surgeryABSTRACT
We have previously utilized the technique of transcranial Doppler (TCD) ultrasound to determine cerebral perfusion in patients undergoing cardiopulmonary resuscitation (CPR). In order to assess if TCD can reliably measure alterations in cerebral perfusion under conditions of normal and low cardiac outputs, we compared TCD measured blood flow velocities in the middle cerebral artery (MCA) of six piglets with radioactive microsphere determinations of total cerebral perfusion at baseline normal sinus rhythm (NSR), during CPR, and following return of spontaneous circulation (ROSC). Peak systolic and mean blood flow velocities were compared to the microsphere perfusion results on 15 different occasions; six during NSR, five during CPR, and four following ROSC. Although qualitative alterations in TCD measurements reflected changes in microsphere perfusion, we could not find a statistically significant correlation between either peak systolic or mean MCA blood flow velocities and microsphere perfusion measurements either overall or in any subgroup. The possible reasons which may explain the findings are discussed.
Subject(s)
Cerebrovascular Circulation/physiology , Ultrasonography , Animals , Blood Flow Velocity/physiology , Cerebral Arteries/physiology , Microspheres , Radioisotopes , Resuscitation , Swine , UltrasonicsABSTRACT
Spinal cord arteriovenous malformations (AVM's), like other vascular anomalies of the central nervous system, can be associated with similar vascular lesions of the skin and viscera. A 7-year-old girl, who presented with rapidly progressing paraplegia, was found to have a spinal cord AVM, cutaneous angioma, and a chylous malformation of the lymphatic system. She had previously undergone treatment for a posterior thoracic cutaneous angioma. At surgery, upon incision of the paravertebral muscle fascia, viscous pale fluid was encountered emanating from a foramen in the thoracic lamina. The spinal AVM was resected in spite of concern that the abnormality represented spinal osteomyelitis. Postoperatively, there was full return of function in the lower extremities, along with recurrent episodes of chylothorax, which slowly came under control with dietary manipulation. A review of the anatomy of the thoracic duct and nontraumatic causes of chylothorax is presented, and the association of cutaneous and central angiomas is discussed. Finally, the treatment of chylothorax is delineated.
Subject(s)
Arteriovenous Malformations/complications , Lymphatic Diseases/complications , Spinal Cord/blood supply , Arteriovenous Malformations/surgery , Child , Chylothorax/complications , Chylothorax/surgery , Female , Humans , Lymphatic Diseases/surgeryABSTRACT
The availability of transcranial Doppler sonography has resulted in an easy, noninvasive, reproducible, and highly reliable method for evaluating the flow characteristics of carotid-cavernous sinus fistulas. It also allows the follow-up of the effect of different interventional measures, specifically, embolization with detachable balloons. An illustrative case is reported, in which the findings of serial transcranial Doppler sonograms are correlated with findings on computed tomographic scans and angiograms. The impact of our findings on future approaches to the hemodynamic classification of these acquired vascular shunts is discussed.