Abstract Number ‐ 115: A Case of Post‐Pipeline Headache : New Post‐Flow Diversion Headaches for Intracranial Aneurysm

Introduction Flow diversion using devices such as the “pipeline” stent is now a common treatment for unruptured intracranial aneurysms. Though much is known about the efficacy of the device, less is reported regarding potential side effects. We aimed to describe a case of giant aneurysm with new onset and severe headache Post‐ Pipeline flow diversion stent application. Methods A 70‐year‐old female patient was admitted to the neurology outpatient clinic with complaints of diplopia and drooping of the left eyelid that started three months ago. Neurological examination revealed decreased visual acuity and total ophthalmoplegia in the left eye. In neuroimaging,semi‐thrombosed aneurysm, 20*25*20 mm in size, compressing the optic nerve and cavernous structures was observed in the left internal carotid artery cavernous segment. In digital subtraction angiography, a narrow neck, 20*25*22 mm giant aneurysm was observed in the left ICA C4 segment in three‐dimensional imaging. In premedication, were started seven days ago acetylsalicylic acid 100 mg 1*1 and 48 hours ago ticagrelol 2*90 mg and Pipeline 4.25*30 mm flow diverter was applied to cover the aneurysm neck under general anesthesia. One day after the procedure, the patient developed a new headache behind the left eye, throbbing, sensitive to sound and light, unresponsive to paracetamol and non‐steroidal anti‐inflammatory agents.In contrast‐enhanced cranial MRI, an aneurysm causing a central thrombosed hypointense mass effect was observed in the left cavernous structure neighbor with a peripheral enhanced, hyperintense T2 Flair sequence compatible with peripheral vasogenic edema. Pulse 1 gram/day steroid treatment was applied to the patient for three days.The patient’s headache completely regressed at the end of the third month, and perianeurysmal inflammation disappeared in the same contrast‐enhanced cranial MRI.In the 12th month post‐procedure imaging of the patient, it was observed that the aneurysm was completely occluded. Results In the case, we reporta patient with neurologic worsening after flow‐diverter treatment for unruptured cerebral aneurysms. We found MR imaging evidence of perianeurysmal brain inflammation after the therapeutic thrombosis of the sac to be the main cause explaining clinical aggravation. Consequently, we may consider a perianeurysmal brain inflammation when encountering the association of a postprocedure headache with an increase in previous compressive signs, possibly associated with MR imaging signs of inflammation1,2. We tried pulse steroid therapy, which is accepted as the first‐line treatment for postimplantation syndrome after endovascular repair of aortic aneurysms in the literature for a patient who did not respond dramatically to nonsteroidal anti‐inflammatory therapy3.We experienced a significant improvement in the patient’s clinical findings and contrast‐enhanced MRI findings after steroid treatment. Conclusions An inflammatory reaction may aggravate, transiently, clinical symptoms after aneurysm treatment with a flow‐diverter device. Further research is needed to better understand the underlying mechanisms as well as to achieve better prevention strategies

Fluid-Attenuated Inversion Recovery Vascular Hyperintensity

FLAIR Vascular Hyperintensity (FVH) is a circular or serpentine brightening in brain parenchyma or cortical surface bordering the subarachnoid space. Slow flow and statis cause a high signal on FLAIR in contrast to the normal flow void phenomenon of arteries. Although proximal vessel sign in the MCA territory represent thrombus, distal FVH represent slow blood flow. This article point out the property of FVH and provide information about FVH for utilization of clinical effectiveness

Higher minor hemoglobin A2 levels in multiple sclerosis patients correlate with lesser disease severity

Objective: To define whether minor adult hemoglobin A2 (HbA2, alpha 2 delta 2) exerts any protective activity in multiple sclerosis (MS)

Ulnar nerve entrapment neuropathy at the elbow: relationship between the electrophysiological findings and neuropathic pain

[Purpose] Ulnar nerve neuropathies are the second most commonly seen entrapment neuropathies of the upper extremities after carpal tunnel syndrome. In this study, we aimed to evaluate pain among ulnar neuropathy patients by the Leeds assessment of neuropathic symptoms and signs pain scale and determine if it correlated with the severity of electrophysiologicalfindings. [Subjects and Methods] We studied 34 patients with clinical and electrophysiological ulnar nerve neuropathies at the elbow. After diagnosis of ulnar neuropathy at the elbow, all patients underwent the Turkish version of the Leeds assessment of neuropathic symptoms and signs pain scale. [Results] The ulnar entrapment neuropathy at the elbow was classified as class-2, class-3, class-4, and class-5 (Padua Distal Ulnar Neuropathy classification) for 15, 14, 4, and 1 patient, respectively. No patient included in class-1 was detected. According to Leeds assessment of neuropathic symptoms and signs pain scale, 24 patients scored under 12 points. The number of patients who achieved more than 12 points was 10. Groups were compared by using the chi(2) test, and no difference was detected. There was no correlation between the Leeds assessment of neuropathic symptoms and signs pain scale and electromyographic findings. [Conclusion] We found that the severity of electrophysiologic findings of ulnar nerve entrapment at the elbow did not differ between neuropathic and non-neuropathic groups as assessed by the Leeds assessment of neuropathic symptoms and signs pain scale