Bilateral persistent primitive olfactory arteries associated with an accessory anterior cerebral artery.

Persistent primitive olfactory artery (PPOA) is a relatively rare variation of the proximal anterior cerebral artery (ACA) that generally follows an extreme anteroinferior course and takes a hairpin turn before continuing to the A2 segment of the ACA. This variation is usually seen unilaterally, and the anterior communicating artery (ACoA) is usually long or absent. We herein report a case of bilateral persistent PPOAs associated with an accessory ACA. The length of the bilateral A1 segments was normal and the length of the ACoA was normally short. Thus, hypoplasia of the distal A1 segment is important but not necessary for the formation of the PPOA. To our knowledge, no similar cases have been reported in the relevant English language literature.

Persistent primitive olfactory artery without a hairpin turn.

Persistent primitive olfactory artery (POA) is a relatively rare variation of the proximal anterior cerebral artery (ACA) that generally follows an extreme anteroinferior course and takes a hairpin turn before continuing to the A2 segment of the ACA. There are other extremely rare variations, such as (1) that continuing to the ethmoidal artery without a hairpin turn, (2) that continuing to both ethmoidal artery and distal ACA with a hairpin turn, and (3) that continuing to the accessory middle cerebral artery with a hairpin turn. We herein report a case of persistent POA without a hairpin turn continuing to the A3 segment of the ACA. We propose calling this new type of persistent POA Type 5.

Case report: acute subdural hematoma due to angiographically unvisualized ruptured aneurysm.

BACKGROUND: We report a case of acute subdural hematoma (SDH) due to angiographically unvisualized ruptured aneurysm. CASE DESCRIPTION: A 57-year-old man presented with sudden-onset headache and nausea. Computed tomography revealed right acute SDH and cerebral angiography revealed no abnormal vessels, but at operation, we found an aneurysm arising from the precentral artery causing an acute SDH. CONCLUSION: In a case of spontaneous acute SDH, the possibility of a cortical artery aneurysm should be considered even if no aneurysm is recognized at angiography.

[A case of basilar artery occlusion of traumatic vertebral artery dissection successfully managed by endovascular treatment].

The author describes a case of basilar artery occlusion caused by vertebral artery dissection with vertebral fracture. A 61-year-old man was admitted with neck pain after a traffic accident. His symptoms suddenly deteriorated and cerebral angiography revealed an occlusion of the right vertebral artery, and complete occlusion of the basilar artery. Local-arterial fibrinolysis with urokinase for basilar artery occlusion and angioplasty with the use of a self-expandable stent for the site of the vertebral artery dissection was performed, and the basilar artery was partially recanalized. The patient's symptoms gradually improved. It should be emphasized that in cases of acute cervical spine injury after major trauma, vertebral artery dissection should be considered. Local-arterial fibrinolysis and angioplasty using a self-expandable stent was regarded as a useful treatment for basilar artery occlusion caused by vertebral artery dissection, in the acute stage.