[A case of unruptured fusiform aneurysm in a middle cerebral artery branch].

We report a case of a 55-year-old female presenting with headache. Neuroradiological investigations revealed a fusiform aneurysm at the M3 part of the right middle cerebral artery. The aneurysm rapidly developed in the course of one year. She underwent a craniotomy for superficial temporal artery middle cerebral artery bypass (STA-MCA bypass) and resection of the aneurysm. Pathological examination suggested that atherosclerosis was a predisposing factor for aneurysm formation. Although she had developed transient dysarthria and left-hand clumsiness after the operation, she was able to be discharged after 26 days with no neurological deficits. On reviewing the literature, fusiform aneurysms seem to be an important cause of subarachnoid hemorrhage and cerebral infarction of unverified origin. Etiology and treatment of spontaneous fusiform aneurysms in a branch of the middle cerebral artery are also discussed.

Transvenous embolization for a purely intraorbital arteriovenous fistula. Case report.

Purely intraorbital arteriovenous fistulas (AVFs) are rare, and their clinical management is controversial. The authors successfully treated a patient with an intraorbital AVF by transvenous embolization alone. An accurate distinction between an arteriovenous malformation (AVM), which is characterized by the existence of a nidus, and an AVF, which has no nidus, is important and requires superselective ophthalmic artery angiography. Treatment of an intraorbital AVF by transvenous embolization can improve visual function.

Aphasia following left putaminal hemorrhage. Statistical analysis of factors affecting prognosis.

Multivariate and single variable analyses were employed to investigate the recovery mode of aphasia in right-handed patients with putaminal hemorrhage on the left side. Speech disturbance was evaluated using the standard language test for aphasia (SLTA) at intervals of 1, 3 and 6 months after the ictus. Recovery was assessed in relation to age, gender, volume and location of hematoma, and treatment modalities. Extension of the hematoma into the corona radiata was the factor that dominated the prognosis of aphasia at all intervals during the follow-up period. Good recovery was documented in patients with less than 2 cm2 of the hematoma volume located in the corona radiata. Recovery was poor, however, in patients with more than 12 cm2 of the hematoma in the corona radiata. While aphasia continued to improve over 6 months after the ictus, recovery was more prominent in the first 3 months. Our study precisely demonstrated that the extension into the corona radiata independently and strongly influenced the outcome of aphasia in patients with left putaminal hemorrhage.