Brain Hemorrhages最新文献

Traumatic intracranial pseudoaneurysm (TIP) after head trauma is rare, but it frequently ruptures in early phase. Although early detection and prompt treatment is important, the details are still unknown. Here, we report a case who was diagnosed with TIP in early phase after trauma and underwent endovascular treatment with parent artery occlusion (PAO), resulted in a good outcome.

A 17-year-old boy hospitalized for severe head trauma. Computed tomography (CT) revealed an acute epidural hematoma (AEDH) in the right middle fossa along with the fracture from the right lateral optic canal to the right superior orbital fissure, and CT angiography showed no obvious aneurysm at that time. CT angiography on 5 days showed an irregular shaped aneurysm at a C2-C3 posterior wall in the right internal carotid artery (ICA). As balloon occlusion test revealed complete ischemic tolerance, endovascular PAO was performed without any bypass. Postoperative imaging showed no hypoperfusion area.

Prompt diagnosis for TIP is important and the patients with skull fracture around ICA area are considered to provide cerebral angiography in early phase. In addition, TIP in early phase has a risk of rupture, suitable treatment strategy using BOT is important for the favorable outcome in those patients.

Objective

To establish a new animal model of lobar cerebral microbleeds (CMBs), we examined whether intranasal administration of collagenase induced CMBs in young mice which did not have hypertensive pathologic features.

Methods

We used thirty-two male CD1 mice (8–10 weeks old), which were received either phosphate-buffered saline (PBS) or collagenase by intranasal administration twice a day for 5 days. A dose response study was conducted, and motor function and number of CMBs was evaluated at one day after completing the intranasal administration. Temporal profile of cognitive impairment and number of CMBs through 7 days was evaluated after completing intranasal administration of 3.6U collagenase.

Results

The number of CMBs showed an increasing trend in a dose-dependent manner and higher number of CMBs were observed with 3.6U collagenase. Cognitive impairment and CMBs was observed in 3.6U collagenase groups up to 7 days after administration. In addition, successful brain delivery via intranasal route was comfirmed by administering fluorescein isothiocyanate-labeled bovine serum albumin.

Conclusions

Intranasal collagenase administration is a feasible and minimally invasive method to produce CMBs and cognitive impairment in mice. This model has potential for producing CMBs in animals with cerebral amyloid angiopathy such as transgenic mice models of Alzheimer’s disease.

Objective

To investigate the efficacy and safety of MMA embolization in patients with CSDH who failed atorvastatin treatment.

Methods

Seventeen CSDH patients who failed atorvastatin treatment from Jan 1, 2021 to Dec 31, 2021 were included in the study. All patients were treated with MMA embolization using polyvinyl alcohol (PVA) particles.

Results

Twenty-six MMAs (unilateral embolization in 8 patients and bilateral embolization in 9 patients) were successfully embolized in all patients. Hematoma re-accumulated in only one patient (5.9%) after MMA embolization and was surgically evacuated. Procedural adverse events, mortality, or complications were not observed. At the last follow-up of an average of 51.5 days post MMA embolization, maximum hematoma thickness improved in 95.2% of CSDHs with a mean reduction of 52.1%, while mRS score improved in 94.1% of patients. In addition, 5 (29.4%) patients with unilateral hematoma underwent bilateral MMA embolization and hematoma absorbed completely in all 5 cases.

Conclusions

MMA embolization may be a minimally invasive alternative to surgical evacuation for CSDH patients resistant to atorvastatin. In unilateral CSDH, bilateral superselective angiography and bilateral MMA embolization could be a useful and effective treatment strategy.

Sixty-three patients admitted to 5 hospitals in 2014–2020 for the treatment of severe hypertensive brainstem hemorrhage by CT-guided and bone marker-oriented transcerebellar aspiration were enrolled in this study. The puncture accuracy, duration of hematoma removal, tracheal decannulation, postoperative complications, postoperative consciousness recovery time, Glasgow Outcome Scale (GOS) score, and prognosis outcome at follow-up were retrospectively analyzed. Additionally, the relationship between admission Glasgow Coma Scale (GCS) score and GOS score, and between hematoma volume and prognosis of patients was analyzed at follow-up. Results showed that CT localization–based and bone marker oriented transcerebellar hematoma aspiration in the treatment of severe hypertensive brainstem hemorrhage ensures high puncture accuracy, relatively low surgery risk, and good prognosis. The prognosis relates to the state of consciousness and hematoma volume.

An intrasaccular flow diverter, the Woven EndoBridge device has emerged as an alternate intervention for complex aneurysms of the ACA, MCA, ICA, and basilar artery. However, few studies report the use of the WEB device in off-label locations. This case report aims to contribute to this limited collection of data. We present a case of a 53-year-old male presenting with occipital headaches, found to have vertebrobasilar junction aneurysm. The WEB device was successfully used to embolize a large aneurysm of the vertebrobasilar junction, a current off-label location. This represents a new use of the WEB device, as well as an approach that addresses the limitations of other techniques used for vertebrobasilar junction aneurysms.

Objective

Craniocervical junction arteriovenous fistula (CCJ-AVF) is a rare disease, and preoperative imaging evaluation is important in developing treatment strategies due to the complexity of the vascular architecture, such as the feeding vessels, shunt points, and draining veins. In the present study, we report a case of hemorrhagic perimedullary CCJ-AVF with multiple feeding vessels in which the common single draining vein was dissected by craniotomy and completely treated.

Case presentation

A 71-year-old woman presented with subarachnoid hemorrhage (Hunt & Kosnik, grade II). Cerebrovascular CTA showed no intracranial cerebral aneurysm and findings suggestive of shunt disease at the CCJ. Based on cerebral angiography, the patient was diagnosed with perimedullary CCJ AVF, with the right radicular and the left anterior spinal arteries as feeders which drain into a common dilated coronary vein through a shunt located on the ventral side of the spinal cord and then drain into the ascending and descending anterior spinal veins. Ventricular drainage was performed for acute hydrocephalus, and arteriovenous fistula was dissected electively by craniotomy on day 17 after onset. A clip was applied to the single draining vein, which had been evaluated using preoperative imaging diagnosis. Intraoperative digital subtraction angiography (DSA) confirmed the disappearance of shunt blood flow, and the surgery was completed. The follow-up DSA did not show shunt blood flow, and the patient was transferred to a rehabilitation hospital with a modified Rankin scale score of 2.

Conclusion

CCJ-AVF cases often have a complex vascular architecture, and it is important to use various modalities to understand the vascular anatomy in detail and develop an appropriate treatment strategy.

A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China. The new coronavirus disease (COVID-19) was declared a global pandemic by the World Health Organization (WHO) in March 2020. SARS-CoV-2 can invade the nervous system aside from infecting the respiratory system as its primary target. The most common nervous system symptoms of COVID-19 are stated as headache, myalgia, fatigue, nausea, vomiting, sudden and unexplained anosmia, and ageusia. More severe conditions such as encephalomyelitis, acute myelitis, thromboembolic events, ischemic stroke, intracerebral hemorrhage, Guillain-Barré-syndrome, Bell's palsy, rhabdomyolysis, and even coma have also been reported. Cohort studies revealed that neurological findings are associated with higher morbidity and mortality. The neurological symptoms and manifestations caused by SARS-CoV-2 and COVID-19 are examined and summarized in this article.