Age-associated vasospasm in aneurysmal subarachnoid hemorrhage.

The relationship between age and vasospasm caused by subarachnoid hemorrhage (SAH) is controversial. We evaluated this relationship in a contemporary sample from a single institution. In a retrospective study design, we included patients with SAH caused by ruptured intracranial aneurysms. All patients underwent an evaluation that included head imaging, cerebral angiography, and treatment for the underlying aneurysm. Vasospasm was classified as absent, any vasospasm, or symptomatic vasospasm. Age was classified into 2 categories with a cutoff of 50 years, and also was stratified by decade. All patients had received preventative and therapeutic measures for vasospasm. Logistic regression analysis was used to assess the association between age and the occurrence of vasospasm. A total of 108 patients were included in this analysis, 67 of whom were age ≥50 years. The older patients had a higher incidence of vascular risk factors, and the younger patients had a higher incidence of smoking and illicit substance abuse. The mean age of the patients with any vasospasm (n = 41) was 48.51 ± 11.23 years, compared with 59.67 ± 13.30 years in those without vasospasm (P < .0001). Adjusted analysis found a greater risk of vasospasm in the younger patients compared with the older patients (odds ratio, 5.83; 95% confidence interval, 2.41-14.12 for any vasospasm; odds ratio, 2.66; 95% confidence interval, 1.008-7.052 for symptomatic vasospasm). This risk of vasospasm decreased with advanced age (P < .0001). Our findings suggest that patients age <50 years are at 5-fold greater risk of any vasospasm compared with older patients, and that age-adjusted prevention protocols may need to be considered.

Bilateral Ophthalmic Artery Dissecting Aneurysms Presenting with Recurrent Epistaxis.

We present a rare case of bilateral expanding traumatic pseudoaneurysms of the ophthalmic arteries, due to a gunshot. The aneurysms presented with epistaxis. After a failure of conservative management, coil embolization of the aneurysms resulted in complete occlusion, with preservation of flow in the parent vessels.

Endovascular therapy of a craniocervical pial AVF fed by the anterior spinal artery.

Though pial arteriovenous fistulae (PAVF) are an uncommon cerebrovascular disorder, their presentation with subarachnoid hemorrhage (SAH) is not rare. PAVF near the craniocervical junction are rare and may have a worse outcome. These fistulae are often fed from either the carotid and/or the vertebrobasilar systems, but are rarely fed by the anterior spinal artery. We report the case of a young man presenting with SAH. Cerebral angiography revealed 2 AVF, a symptomatic PAVF located at the craniocervical junction and fed from the anterior spinal artery and incidental dural AVF (DAVF) originate from the left occipital and middle meningeal arteries. These fistulae were treated with different endovascular techniques, including Onyx and platinum coil embolization into the feeding arteries of the DAVF and PAVF, respectively.

Rupture of a cerebral aneurysm following carotid endarterectomy.

Following carotid revascularization with either carotid endarterectomy or stenting, the impaired cerebral autoregulation can lead to cerebral hyperperfusion syndrome. This impaired autoregulation and increased flow may also put patients with unruptured aneurysms at risk for subarachnoid hemorrhage in the perioperative period. A patient is reported who underwent carotid endarterectomy for symptomatic carotid stenosis. A small anterior communicating artery aneurysm was identified preoperatively, which ruptured 2 days after carotid endarterectomy. Screening for cerebral aneurysms prior to carotid revascularization will allow operators to minimize this risk, either through prior treatment of the aneurysm or tight blood pressure control in the perioperative period.

Glossopharyngeal neuralgia responding to pregabalin.

The author reports the use of pregabalin in a patient with glossopharyngeal neuralgia. The patient achieved complete pain relief and tolerated the medication. This is the first published report of the use of this medicine for glossopharyngeal neuralgia.