RESUMO
A 52-year-old woman presented with a partially thrombosed giant aneurysm of the vertebral artery (VA) manifesting as a 3-month history of left hemiparesis. She developed subarachnoid hemorrhage during hospitalization and underwent emergency surgery for surgical proximal clipping and ventricular drainage with decompressive suboccipital craniectomy. She underwent additional surgery for endovascular coil embolization of the aneurysm and the affected distal VA on the 7th postoperative day. Although she suffered transient lower cranial nerve pareses and respiratory failure, her neurological condition improved gradually and she returned home with only slight ataxia and hoarseness 3 months after surgery. Magnetic resonance imaging obtained 28 months postoperatively revealed a remarkable decrease in the size of the aneurysm as well as reduction of the mass effect on the brainstem. Combined proximal clipping and internal trapping can solve the problems associated with treatment of giant aneurysms of VA by either direct surgery or endovascular surgery, and should be considered as a therapeutic option for giant aneurysms of the VA.
Assuntos
Aneurisma Roto/cirurgia , Aneurisma Intracraniano/cirurgia , Trombose Intracraniana/cirurgia , Artéria Vertebral/cirurgia , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Angiografia Cerebral , Terapia Combinada , Doenças dos Nervos Cranianos/etiologia , Craniotomia , Drenagem , Embolização Terapêutica , Emergências , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/etiologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Paresia/etiologia , Reoperação , Respiração Artificial , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Hemorragia Subaracnóidea/etiologia , Artéria Vertebral/diagnóstico por imagemRESUMO
A 63-year-old man presented with hypoglycemia-induced hemiparesis manifesting as diffusion-weighted magnetic resonance (MR) imaging changes in the splenium of the corpus callosum and internal capsule which disappeared after glucose administration. Clinicians should be aware that hypoglycemia can cause reversible splenium abnormalities on MR imaging, although the underlying mechanism still remains unclear, as this may be helpful in the differential diagnosis of hypoglycemia-induced hemiparesis and stroke.
