Diffuse subarachnoid and intraventricular hemorrhage as the presenting sign of a conus medullaris arteriovenous malformation: Case report

Spinal arteriovenous malformations (AVMs) are rare vascular lesions that usually present with progressive myelopathy or less frequently, with acute neurological deficit due to hematomyelia or spinal subarachnoid hemorrhage (SAH). There are few reports of concomitant cerebral SAH and intraventricular hemorrhage (IVH) following rupture of a spinal AVM. Herein, we present a rare case of conus medullaris arteriovenous malformation, out-breaking with loss of consciousness due to SAH and IVH

Cardiac Complication Following Subarachnoid Hemorrhage

Besides its severe neurological injuries, spontaneous subarachnoid hemorrhage (SAH) commonly causes cardiac complications. These complications could include three different aspects of cardiac diseases, that is, electrocardiographic abnormalities, myocardial injuries, and left ventricular dysfunction. These complications not only may lead to misdiagnosis of SAH as myocardial infarction, but also it may complicate the management of SAH. In this review, we described all cardiac complications during SAH and explained the appropriate monitoring and management of these problem

The effect of fresh frozen plasma in severe closed head injury

Objective: Traumatic brain injury (TBI) is one of the most common causes of morbidity and mortality. Coagulopathy, commonly occurring after severe TBI, is associated with poor outcome and secondary complications, especially delayed traumatic intracerebral hematoma (DTICH). In this study we evaluated the effect of fresh frozen plasma (FFP) on the reduction in the incidence of DTICH in severe closed head injury victims. Methods: This study was carried out as a double-blind randomized clinical trial. Ninety patients were entered in two parallel groups taking either FFP or normal saline (N/S). Patients' selection criteria for both groups were: severe closed head injury (Glasgow coma scale �8), no mass lesion required evacuation and no history of coagulopathy. The clinical findings, laboratory data, computed tomography (CT) scans and Glasgow outcome scale after 1 month were assessed and compared in two groups. Results: Out of 90 patients, 44 received FFP and 46 received N/S. The development of new intracerebral hematoma in follow-up CT scans were more common in the FFP group than the N/S group (p = 0.012). Both groups showed similar frequency of poor outcome (p = 0.343). The mortality was significantly more common in the FFP group than in the N/S group (63 versus 35, p = 0.006). Conclusion: The result of this study revealed that early empirical infusion of FFP in patients with severe head injury may lead to adverse effects, such as an increase in the frequency of DTICH and an increase in the mortality. © 2006 Elsevier B.V. All rights reserved

Unilateral Oculomotor Nerve Palsy as a Rare Manifestation of Isolated Pre-Communicating Segment of Posterior Cerebral Artery Thrombosis

Ipsilateral mydriasis (IM) is usually not acute. However, the acute occurrence of unilateral dilated pupil may result in acute ischemic stroke. Herein, we present 3 patients with IM, lateral eye deviation, ptosis, and contralateral hemiparesis due to isolated occlusion of the pre-communicating segment of the posterior cerebral artery with preservation of the posterior communicating artery, which was successfully treated by emergent mechanical thrombectomy. In a 3-month follow-up, all patients were independent without any neurological deficits

Role of Magnesium Sulfate in Preventing Vasospasm and Maintaining Hemodynamic Stability in Patients Undergoing Endovascular Coiling for Brain Aneurysm

Introduction: Themaintenance of hemodynamic stability in brain aneurysm surgery has paramount clinical significance in order to prevent vasospasm in the patients with aneurysmal subarachnoid hemorrhage. Regarding this, the present study was conducted to assess the role of magnesium sulfate in preventing vasospasm and maintaining hemodynamic stability during endovascular coiling procedure for brain aneurysm. Materials and Methods: This double-blind clinical trial was conducted on 60 patients who were candidates for undergoing endovascular coiling for brain aneurysm. The patients were subjected to angiography through femoral artery catheterization. Then, they were randomly assigned into two treatment groups of case receiving magnesium sulfate and control administered normal saline. The vasospasm and hemodynamic status were measured and recorded during and following the surgery. Results: According to the results, no significant difference was observed between the two groups in terms of heart rate (p=0.98) and mean arterial pressure =p) 0.89(  one hour post-surgery. Furthermore, there was no statistical difference between the two groups regarding the use of nimodipine ( p=0.11). Nevertheless, the frequency of vasospasm was significantly lower in the patients receiving magnesium sulfate, during surgery (p=0.037) and after surgery (p=0.02), compared to those administered normal saline. Conclusion: As the findings indicated, magnesium sulfate could lower the incidence of vasospasm during and following the endovascular coiling procedure for brain aneurysm. Moreover, it resulted in no adverse effects on the hemodynamic status of the patients

An Epidemiological Investigation on Patients with Non-traumatic Subarachnoid Hemorrhage from 2010 to 2020

Objective: Subarachnoid hemorrhage (SAH) is still considered a life-threatening medical condition witha high mortality rate, particularly in developing countries. Thus, the present study aimed to investigate theangiographic findings of non-traumatic or spontaneous SAH.Methods: This retrospective cohort study included 642 health records of patients with non-traumatic SAH overa 10-year period, from 2010 to 2020. The required data, including demographic information, aneurysm type,size, location, disease severity classification, and secondary complications, were extracted.Results: The study included 642 patients, with 262 (40.8%) being male. The mean age of the participants was54.72±13.51 years. The most prevalent type of aneurysm was saccular (89.1%), while serpentine (0.2%) anddissecting saccular (0.2%) aneurysms had the least prevalence. The most frequently involved arteries were theanterior communicating artery (ACoA; 38%), internal carotid artery (ICA; 27.6%), and middle cerebral artery(MCA; 13.4%). There was a significant correlation between sex and aneurysms occurring at ACoA and ICA(p< 0.0001), and ACoA – A1 (p=0.02). Patient age and sex were also significantly correlated with one another(p<0.0001). There was no statistically significant correlation between sex, aneurysm size, Glasgow coma scale(GCS), and modified Rankin scale (MRS).Conclusion: Based on our findings, the presence of aneurysms at ACoA, ACoA – A1, and ICA should bethoroughly ruled out in patients with severe headaches of sudden onset, particularly male patients of youngerages

Treatment of Traumatic Direct Carotid-Cavernous Fistula with a BeGraft-Covered Stent

The widely accepted option for treating traumatic direct carotid-cavernous fistula (dCCF) has been endovascular treatment using detachable balloons, coils, or embolic agents. Covered stent deployment has been applied by a few operators and has shown promising results. This is a retrospective study on patients with dCCF treated by an endovascular approach using BeGraft, a covered stent. In 4 cases, this device was successfully deployed without any complications. Immediate complete occlusion was achieved in 3 patients (75%) after deployment of the covered stents. One patient required transvenous coiling for occlusion of the remaining endoleak. Follow-up imaging demonstrated 100% fistula occlusion with complete internal carotid artery patency. No early or late complications occurred following treatment. In conclusion, the BeGraft-covered stent could be a promising safe and effective alternative option for the endovascular treatment of dCCF

Carotid angioplasty and stenting in a patient with high grade stenosis of Internal Carotid Artery associated with both vertebral arteries and contralateral carotid occlusion

Severe internal carotid artery (ICA) stenosis is a common cause of cerebrovascular accident (CVA) in middle-aged patients. Contralateral carotid occlusion (CCO) in patients with severe ICA stenosis is associated with high risk of CVA. Carotid endarterectomy (CEA) is associated with more complications in patients with CCO than those without CCO. In this study, we present the case of a 61-year-old patient who presented with multiple transient ischemic attack and severe ICA stenosis associated with CCO and occlusion of vertebral arteries. The patient was treated successfully with carotid angioplasty and stenting

Acute Epidural Hematoma after Ventriculoperitoneal Shunt Insertion: a Case Report

Background & Importance: Acute epidural hematoma is a very rare complication of ventriculoperitoneal shunt insertion. The insertion of a ventriculoperitoneal shunt can cause sudden decompression of the brain, subsequent to which epidural hematoma occurs due to CSF drainage. To our knowledge, there are only a few cases of acute epidural hematoma in the literature which required acute evacuation. Case Presentation: In this report, we present a case of epidural hematoma close to ventriculoperitoneral shunt insertion site in a 30-year-old man after failure of endoscopic surgery for opening of the wall of a suprasellar arachnoid cyst. Secondary to communication between cyst and ventricles and clinical symptoms and sings, the patient underwent the shunt insertion. The patient became comatose two hours following the insertion of the shunt, developing a voluminous right temporo-parietal epidural hematoma that had to be evacuated immediately. Here, we intend to discuss both the pathophysiology and treatment. Conclusion: Development of epidural hematoma after ventriculoperitoneal shunt surgery is a devastating complication. Dehisensce formation between the skull and dura matter, which may be facilitated by lax adhesion between the two, is a common underlying pathology. We recommend a close post-surgical observation for immediate diagnosis and reoperation of this event

Endovascular treatment of an unruptured anterior communicating artery aneurysm presenting with acute altitudinal visual field defect: A case report

Purpose: To describe a case of endovascular occlusion of an unruptured anterior communicating artery aneurysm presenting with acute altitudinal visual field defect is presented here. Methods: A 52-year-old man was evaluated and treated for altitudinal visual field defect in the right eye. Results: In ophthalmic and neuro-imaging, an accompanying anterior communication artery aneurysm was detected as a cause of visual field defect. He underwent endovascular procedure, yielding excellent outcome as full recovery of visual field defect was observed one month following the procedure and sustained when followed at month 24. Conclusions: Visual dysfunction is a rare presentation of unruptured anterior communication artery aneurysm. Endovascular procedure may be a safe treatment in these cases. Keywords: Intracranial aneurysm, Anterior communicating artery, Visual field, Endovascular procedur