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Rev. bras. oftalmol ; 81: e0065, 2022. graf
Article in Portuguese | LILACS | ID: biblio-1407669


RESUMO Os aneurismas intracranianos são dilatações em segmentos arteriais que irrigam o sistema nervoso central. Acometem 2% da população e as alterações oftalmológicas podem ser as primeiras manifestações do quadro. O objetivo deste relato foi descrever um caso de aneurisma de artéria carótida interna que cursou com restrição da movimentação ocular, alteração do reflexo fotomotor, ptose palpebral, dor facial e cervical. O diagnóstico foi confirmado pela identificação do aneurisma por meio do exame de angiografia cerebral. Foi realizado teste de oclusão por balão, cujo resultado positivo possibilitou a oclusão total da artéria carótida interna por meio de ligadura cirúrgica, procedimento este realizado com sucesso.

ABSTRACT Intracranial aneurysms are dilations in segments of the arteries that irrigate the central nervous system. They affect 2% of the population and the ophthalmologic disorders may be the first evidence in the clinical examination. The aim of the report is to describe a case of an internal carotid artery aneurysm that showed restrictions of ocular movements, change of pupillary light reflex, palpebral ptosis, facial, and cervical pain. This diagnosis was confirmed by the identification of the aneurysm through angiography. A balloon occlusion test was performed, and its positive result made a complete occlusion of the Internal Carotid Artery possible through surgery ligation, procedure that was successful.

Humans , Female , Aged , Blepharoptosis/etiology , Carotid Artery Diseases/complications , Carotid Artery, Internal/pathology , Intracranial Aneurysm/complications , Ophthalmoplegia/etiology , Facial Pain/etiology , Cerebral Angiography , Carotid Artery Diseases/surgery , Carotid Artery Diseases/diagnostic imaging , Carotid Artery, Internal/surgery , Carotid Artery, Internal/diagnostic imaging , Tomography, X-Ray Computed , Intracranial Aneurysm/surgery , Intracranial Aneurysm/diagnostic imaging , Neck Pain/etiology , Balloon Occlusion
Arq. bras. neurocir ; 40(4): 339-348, 26/11/2021.
Article in English | LILACS | ID: biblio-1362079


Introduction The middle meningeal artery (MMA) is an important artery in neurosurgery. As the largest branch of the maxillary artery, it provides nutrition to the meninges and to the frontal and parietal regions. Diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (TAVF), Moya-Moya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine, and meningioma,may be related to the MMA. The aim of the present study is to describe the anatomy of the MMA and to correlate it with brain diseases. Methods A literature review was performed using the PubMed, Scielo, Scientific Direct, Ebsco, LILACS, TripDataBase and Cochrane databases, with the following descriptors: neurosurgery, neuroanatomy, meninges and blood supply. Discussion The MMA is embedded in a cranial groove, and traumatic or iatrogenic factors can result in MMA-associated pseudoaneurysms or arteriovenous fistulas (AVFs). In hemodynamic stress, true aneurysms can develop. Arteriovenous fistulas, pseudoaneurysms, and true aneurysms can be effectively treated by endovascular or surgical removal. In MMD, the MMA plays a role in the development and in the improvement of collateral circulation. Finally, in cases of CSDH, when standard surgery and drainage fail, MMA embolization can constitute a great alternative. Conclusion The MMA is a relevant structure for the understanding of neurosurgical diseases. In conclusion, every neurosurgeon must know the anatomy of the MMA sufficiently to correlate it with the diagnosed pathology, thus obtaining treatment effectiveness and preventing brain lesion.

Craniocerebral Trauma/surgery , Meningeal Arteries/anatomy & histology , Meningeal Arteries/physiopathology , Intracranial Aneurysm/complications , Arteriovenous Fistula/surgery , Aneurysm, False/surgery , Embolization, Therapeutic/methods
Arq. neuropsiquiatr ; 79(9): 759-765, Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345343


ABSTRACT Background: Predictors of outcomes following endovascular treatment (ET) for aneurysmal subarachnoid hemorrhage (aSAH) are not well-defined. Identifying them would be beneficial in determining which patients might benefit from ET. Objective: To identify the predictive factors for poor outcomes following ET for aSAH. Methods: 120 patients with ruptured cerebral aneurysms underwent endovascular embolization between January 2017 and December 2018. Blood pressure variability was examined using the standard deviation of the 24-hour systolic blood pressure (24hSSD) and 24-hour diastolic blood pressure (24hDSD). Predictors were identified through univariate and multivariate regression analysis. All patients were followed up for three months. Results: At follow-up, 86 patients (71.7%) had good outcomes and 34 (28.3%) had poor outcomes. Patients with poor outcomes had significantly higher 24hSSD than those with good outcomes (19.3 ± 5.5 vs 14.1 ± 4.8 mmHg; P < 0.001). The 24hDSD did not differ significantly between patients with good outcomes and those with poor outcomes (9.5 ± 2.3 vs 9.9 ± 3.5 mmHg; P = 0.464). The following were significant risk factors for poor outcomes after endovascular embolization: age ≥ 65 years (odds ratio [OR] = 23.0; 95% confidence interval [CI]: 3.0-175.9; P = 0.002); Hunt-Hess grade 3-4 (OR = 6.8; 95% CI: 1.1-33.7; P = 0.039); Fisher grade 3-4 (OR = 47.1; 95% CI: 3.8-586.5; P = 0.003); postoperative complications (OR = 6.1; 95% CI: 1.1-34.8; P = 0.042); and 24hSSD ≥ 15 mmHg (OR = 14.9; 95% CI: 4.0-55.2; P < 0.001). Conclusion: Elevated 24hSSD is a possibly treatable predictive factor for poor outcomes after ET for aSAH.

RESUMO Antecedentes: Fatores preditores de resultados após tratamento endovascular (TE) para hemorragia subaracnóide aneurismática (HSA) não estão bem definidos. Identificá-los seria útil para determinar quais pacientes podem se beneficiar de TE. Objetivo: Identificar os fatores preditivos de resultados ruins após TE para HSA. Métodos: 120 pacientes com aneurismas cerebrais rompidos foram submetidos à embolização endovascular entre janeiro de 2017 e dezembro de 2018. A variabilidade da pressão arterial foi examinada usando-se o desvio padrão da PA sistólica de 24 horas (DPPAS- 24h) e da PA diastólica de 24 horas (DPPAD-24h). Os fatores preditores foram identificados por meio de análises de regressão univariada e multivariada. Todos os pacientes foram acompanhados por três meses. Resultados: No acompanhamento, 86 pacientes (71,7%) tiveram bons resultados e 34 (28,3%) tiveram resultados ruins. Pacientes com resultados ruins apresentaram DPPAS-24h significativamente maior do que aqueles com bons resultados (19,3 ± 5,5 vs 14,1 ± 4,8 mmHg; P <0,001). O DPPAD-24h não diferiu significativamente entre os pacientes com bons resultados e aqueles com resultados ruins (9,5 ± 2,3 vs 9,9 ± 3,5 mmHg; P = 0,464). Os fatores de risco significativos para resultados ruins após embolização endovascular foram os seguintes: idade ≥ 65 anos (razão de probabilidade [OR] = 23,0; intervalo de confiança de 95% [IC]: 3,0-175,9; P = 0,002); escala de Hunt-Hess 3-4 (OR = 6,8; IC 95%: 1,1-33,7; P = 0,039); escala de Fisher 3-4 (OR = 47,1; IC 95%: 3,8-586,5; P = 0,003); complicações pós-operatórias (OR = 6,1; IC 95%: 1,1-34,8; P = 0,042); e DPPAS 24h ≥ 15 mmHg (OR = 14,9; IC 95%: 4,0-55,2; P <0,001). Conclusão: O DPPAS 24h elevado é um fator preditivo possivelmente tratável para resultados ruins após TE para HSA.

Humans , Aged , Subarachnoid Hemorrhage/therapy , Intracranial Aneurysm/complications , Intracranial Aneurysm/therapy , Blood Pressure , Retrospective Studies , Treatment Outcome
Arq. bras. neurocir ; 39(4): 279-283, 15/12/2020.
Article in English | LILACS | ID: biblio-1362324


Subarachnoid hemorrhage (SAH) accounts for 5 to 10% of all types of stroke, with rupture of brain aneurysms being related to deficits in memory, executive functions, and language. Changes in brain functions appear to be related to the presence of blood in the subarachnoid space, and the Fisher Scale (FS) correlates the amount of blood identified on computed tomography (CT). This paper presents a literature review of the association of FS with cognitive deficits secondary to aneurysmal subarachnoid hemorrhage (aSAH), using PubMed. The attempt to correlate the amount of blood identified in the CT with the development of cognitive alterations presents conflicting data. It was evidenced that some of the studies did not perform cognitive tests, or did not show differences between the scores of FS due to sample difficulty. The FS, even with its limitations and imperfections, seems to be a safe and easily reproducible way to predict neurological, cognitive or neuropsychological deficits, in view of its routine use when analyzing patients with aSAH.

Subarachnoid Hemorrhage/complications , Severity of Illness Index , Intracranial Aneurysm/complications , Cognitive Dysfunction/etiology , Subarachnoid Hemorrhage/mortality , Subarachnoid Hemorrhage/diagnostic imaging , Intracranial Aneurysm/surgery , Intracranial Aneurysm/pathology , Language Disorders/etiology
Arq. bras. neurocir ; 39(1): 54-57, 15/03/2020.
Article in English | LILACS | ID: biblio-1362444


Intracranial aneurysm rupture causes subarachnoid hemorrhage in 80% of the cases, and it may be associated with intracerebral hemorrhage and/or intraventricular hemorrhage (IVH) in 34% and 17% of the patients, respectively. However, on rare occasions, aneurysm rupturemay be present causing isolate intracerebral hemorrhage or IVH without subarachnoid hemorrhage. We describe an unusual case of an anterior communicating aneurysm rupture presented with IVH, without subarachnoid hemorrhage. Although isolated IVH is rare, aneurysm rupture is a possible condition. Patients presenting with head computed tomography revealing IVH without subarachnoid hemorrhage should be promptly investigated with contrasted image exam to identify and treat possible causes, even in the absence of subarachnoid hemorrhage.

Humans , Male , Aged , Aortic Rupture/complications , Aneurysm, Ruptured/surgery , Cerebral Intraventricular Hemorrhage/etiology , Cerebral Intraventricular Hemorrhage/diagnostic imaging , Aortic Rupture/diagnostic imaging , Subarachnoid Hemorrhage/epidemiology , Intracranial Aneurysm/complications , Computed Tomography Angiography/methods
Arq. bras. neurocir ; 39(1): 1-4, 15/03/2020.
Article in English | LILACS | ID: biblio-1362401


Objective To analyze the population and the earlymortality rate (up to thirty days) of patients victim of spontaneous subarachnoid hemorrhage (SAH) according to the Hunt-Hess clinical scale and the Fisher and modified Fisher radiological scales. Materials and Methods We analyzed 46 medical records and skull computed tomography (CT) scans of patients with spontaneous SAH admitted between February 2014 and December 2017 at Hospital Universitário Evangélico Mackenzie, in the city of Curitiba, state of Paraná, Brazil. The method of the study was exploratorydescriptive, transversal and retrospective, with a quantitative approach. We analyzed epidemiological (gender, age), clinical (life habits, pathologies, Glasgow coma scale and Hunt-Hess scale) and radiological (Fisher and modified Fisher scales) variables, and the Hunt-Hess and the Fisher scales were correlated with risk of death. The data was submitted to statistical analysis considering values of p<0.05. Result There was a higher prevalence of spontaneous SAH among women (69.5%), as well as among patients aged between 51 and 60 years (34.7%). Regarding the grades on the scales, there was higher prevalence of Fisher 4, Modified Fisher 4 and Hunt-Hess 2. Evolution to death was higher among women (76.4%) and patients aged between 61 and 70 years (35,2%). Conclusion Mortality was higher among patients classified as Fisher 3, Modified Fisher 4 and Hunt-Hess > 3. The Fisher scale is better than the modified Fisher scale to assess the risk of mortality.

Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/mortality , Subarachnoid Hemorrhage/epidemiology , Tomography, X-Ray Computed/methods , Intracranial Aneurysm/complications , Medical Records , Cross-Sectional Studies/methods , Data Interpretation, Statistical
Arq. bras. neurocir ; 38(3): 157-165, 15/09/2019.
Article in English | LILACS | ID: biblio-1362589


Background Delayed cerebral ischemia (DCI) follows a refractory course in a subgroup of patients with aneurysmal subarachnoid hemorrhage (SAH), leading to diffuse ischemic injury. The role of angiographic vasospasm (AV) is unknown. Our goal is to study the angiographic alterations and the clinical profile of refractory DCI patients. Methods Retrospective study of patients with SAH who presented with DCI treated with medical and endovascular therapy, with a refractory evolution, defined asmultiple ischemic infarction and brain death. Results Out of a cohort of 336 patients, 7 (2%) developed refractory DCI. The median age of the patients was 48 (38­60) years old. Five patients had ruptured anterior communicating artery (ACoA) aneurysms. Four patients were treated with coil embolization, and three with microsurgical clipping. Angiographic vasospasm was classified as severe in 5 cases. Compromise of bilateral circulation was detected in six patients. Distal circulation vasospasm occurred in five cases. Slow circulatory transit times were observed in three patients. Conclusion Angiographic findings such as bilateral circulatory compromise and distal vasospasm were frequent alterations. Further studies are required to establish the association of these findings with the clinical outcomes.

Subarachnoid Hemorrhage/complications , Intracranial Aneurysm/complications , Brain Ischemia/complications , Brain Ischemia/therapy , Brain Ischemia/diagnostic imaging , Aortic Valve Stenosis , Cerebral Angiography/methods , Medical Records , Cohort Studies , Endovascular Procedures/methods
Arq. neuropsiquiatr ; 77(5): 300-309, Jun. 2019. graf
Article in English | LILACS | ID: biblio-1011345


ABSTRACT Large multicenter studies have shown that small intracranial aneurysms are associated with a minimal risk of bleeding. Nevertheless, other large series have shown that most ruptured aneurysms are, in fact, the smaller ones. In the present study, we questioned whether small aneurysms are indeed not dangerous. Methods: We enrolled 290 patients with newly-diagnosed aneurysms at our institution over a six-year period (43.7% ruptured). We performed multivariate analyses addressing epidemiological issues, cardiovascular diseases, and three angiographic parameters (largest aneurysm diameter, neck diameter and diameter of the nutrition vessel). Risk estimates were calculated using a logistic regression model. Aneurysm size parameters were stratified according to receiver operating characteristic (ROC) curves. Finally, we calculated odds ratios for rupture based on the ROC analysis. Results: The mean largest diameter for the ruptured versus unruptured groups was 13.3 ± 1.7 mm versus 22.2 ± 2.2 mm (p < 0.001). Multivariate analysis revealed a positive correlation between rupture and arterial hypertension (p < 0.001) and an inverse correlation with all three angiographic measurements (all p < 0.01). Aneurysms from the anterior cerebral artery bled more often (p < 0.05). According to the ROC curves, at the largest diameter of 15 mm, the sensitivity and specificity to predict rupture were 83% and 36%, respectively. Based on this stratification, we calculated the chance of rupture for aneurysms smaller than 15 mm as 46%, which dropped to 25% for larger aneurysms. Conclusion: In the population studied at our institution, small aneurysms were more prone to bleeding. Therefore, the need for intervention for small aneurysms should not be overlooked.

RESUMO Grandes estudos multicêntricos demostram que aneurismas intracranianos pequenos são associados a risco de sangramento mínimo. Outras grandes séries têm evidenciado que aneurismas rotos são em sua maioria os pequenos. Neste estudo questionamos até que ponto os aneurismas pequenos não são perigosos. Métodos: Avaliamos 290 novos casos de aneurismas tratados em nossa instituição durante 6 anos (43,7% rotos). Realizamos análises multivariadas com aspectos epidemiológicos dos pacientes, doenças cardiovasculares e três parâmetros angiográficos: maior diâmetro, diâmetro do colo e diâmetro do vaso nutridor do aneurisma. Estimativas de risco foram calculadas utilizando-se modelo de regressão logística. Parâmetros do tamanho aneurismático foram estratificados de acordo com curvas ROC. Também calculamos a razão de chances (odds ratios) de ruptura baseadas nas análises das curvas ROC. Resultados: O maior diâmetro médio para os grupos de aneurismas rotos e não-rotos foi 13.3 ± 1.7mm e 22.2 ± 2.2 (p < 0.001). Análises multivariadas revelaram uma correlação positiva entre ruptura aneurismática e hipertensão arterial (p < 0.001) e uma correlação inversa entre ruptura e as três medidas angiográficas (p < 0.01). Aneurismas da artéria cerebral anterior foram os que mais sangraram (p < 0.05). Análises das curvas ROC demonstram que no maior diâmetro de 15mm, a sensibilidade e especificidade para se predizer ruptura são de 83% e 36%. Baseando-se nessas estratificações, calculamos uma chance de ruptura para aneurismas menores de 15mm de 46% e de 25% para aneurismas maiores. Conclusão: Na população estudada, aneurismas pequenos são mais propensos a romper. Desta forma, a necessidade de intervenção para aneurismas pequenos não deve ser relevada.

Humans , Male , Female , Adult , Middle Aged , Aged , Intracranial Aneurysm/complications , Aneurysm, Ruptured/complications , Intracranial Hemorrhages/etiology , Reference Values , Time Factors , Cerebral Angiography , Logistic Models , Intracranial Aneurysm/pathology , Intracranial Aneurysm/diagnostic imaging , Multivariate Analysis , Retrospective Studies , Risk Factors , ROC Curve , Aneurysm, Ruptured/pathology , Aneurysm, Ruptured/diagnostic imaging , Risk Assessment/methods , Intracranial Hemorrhages/diagnostic imaging , Hypertension/complications , Neck/pathology
Arq. bras. neurocir ; 38(2): 153-156, 15/06/2019.
Article in English | LILACS | ID: biblio-1362604


A fenestration tube is a clipping reconstruction technique that allows the preservation of critical vessels in aneurysm surgery. A patient with a ruptured anterior communicating artery (ACoA) aneurysm with a posterior projection was admitted to our neurosurgery unit. A right dominant A1 with rotation of the A2 fork was observed on preoperative computed tomography angiography (CTA). During surgery, we observed that the recurrent artery of Heubner branched off the A2 just distal to the neck of the aneurysm. Successful clipping was achieved by building an "A1­A2 fenestration tube," with preservation of the recurrent artery and of the ACoA perforators. Surgical nuances and the advantages of fenestration tubes are discussed.

Humans , Aged , Intracranial Aneurysm/surgery , Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnostic imaging , Anterior Cerebral Artery/abnormalities , Computed Tomography Angiography
Arq. bras. neurocir ; 37(4): 343-348, 15/12/2018.
Article in English | LILACS | ID: biblio-1362646


Introduction Aneurysms of the posterior cerebral artery (PCA) represent 1% of all intracranial aneurysms and usually present with subarachnoid hemorrhage. Objective The aimof the present study is to describe the case of an adult man presenting a saccular aneurysm of the right PCA at the posterior half of the postcommunicating (P2P) segment, and to discuss the technical nuances of the approach and of the clipping process. Case Report An investigation of a chronic headache in a 55-year-old man found a saccular aneurysm located just posterior to the most lateral portion of the right cerebral peduncle. A digital subtraction arteriography revealed a 7.8 mm 5.6 mm 4.8 mm posterior-medial projecting aneurysm of the right PCA at the P2P segment. A subtemporal approach was performed with partial aspiration of the right parahippocampal gyrus for a better exposure of the vascular structures. A proximal temporary occlusion of the PCA was performed at the anterior half of the postcommunicating P2A segment. The aneurysm was clipped with two semi-curved clips. The patient presented an uneventful recovery and was discharged from the hospital on the third postoperative day without any additional neurological deficits. Conclusion Aneurysms of the PCA are an uncommon vascular disease that challenges the ability of the neurosurgeons due to their many anatomical nuances, to their vast number of perforators, and to the risk of bleeding. However, the operative management of aneurysms of the PCA is technically feasible, safe and effective when performed respecting microsurgical principles.

Humans , Male , Middle Aged , Intracranial Aneurysm/surgery , Intracranial Aneurysm/complications , Intracranial Aneurysm/physiopathology , Intracranial Aneurysm/diagnostic imaging , Posterior Cerebral Artery/abnormalities , Subarachnoid Hemorrhage/diagnostic imaging , Angiography/methods , Microsurgery/methods
Rev. chil. radiol ; 24(3): 94-104, jul. 2018. ilus
Article in Spanish | LILACS | ID: biblio-978162


La hemorragia subaracnoidea (HSA) no traumática es un subtipo de ictus hemorrágico que representa aproximadamente el 5% de todos los accidentes vasculares encefálicos (AVE). El 85% de los casos de HSA espontánea (no traumática) son secundarios a un aneurisma intracraneano roto, el 10% a hemorragia perimesencefálica no aneurismática y el otro 5% a otras causas. Entre estas se incluyen malformaciones arterio-venosas, fístulas durales, vasculits, trombosis de vena cortical, síndrome de vasoconstricción reversible, angiopatía amiloidea y síndrome de encefalopatía posterior reversible. La aproximación inicial a una HSA no traumática requiere un estudio angiográfico no invasivo con tomografía computada para la toma de decisiones terapéuticas. Si no se detecta un aneurisma sacular intradural que explique el sangrado, las conductas a seguir dependerán del patrón de distribución de la sangre. En esta revisión sugerimos una aproximación basada en 1) revisar el estudio inicial tomando en cuenta los puntos ciegos para la detección de aneurismas, 2) analizar el patrón de distribución de la sangre y 3) analizar los hallazgos en imágenes de acuerdo a las posibles causas según patrón.

Non-traumatic subarachnoid hemorrhage represents approximately 5% of strokes. From these, 85% of nontraumatic subarachnoid hemorrhage are secondary to a ruptured aneurysm, 10% to nonaneurysmal perimesencephalic hemorrhage and the other 5% to other causes. These include but are not limited to arteriovenous malformations, dural fistulae, vasculitis, cortical vein thrombosis, reversible cerebral vasoconstriction syndrome, amyloid angiopathy and posterior reversible encephalopathy syndrome. Initial workup of nontraumatic subarachnoid hemorrhage requires a non-enhanced CT and CT angiography for decision making and management. If there is no aneurysm as a source of hemorrhage, subsequent imaging studies will depend on blood distribution pattern. In this review we suggest an approach: 1) review blind spots for aneurysm detection in the initial CT angiography, 2) analyze blood distribution pattern and 3) evaluate imaging findings and possible causes according to each pattern.

Humans , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/diagnostic imaging , Vasculitis/complications , Intracranial Aneurysm/complications , Cerebral Amyloid Angiopathy/complications , Venous Thrombosis/complications , Computed Tomography Angiography
J. vasc. bras ; 17(3)jul.-set. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-915878


A agenesia de carótida interna é uma anomalia rara. Na maioria dos casos, é assintomática devido às anastomoses que podem estar presentes, mas pode estar associada a complicações, principalmente quando evidenciada a presença de outras alterações anatômicas ou doença aterosclerótica grave. Relatamos o caso de uma paciente feminina de 63 anos, hipertensa e diabética, com história de cirurgia prévia para clipagem de aneurisma cerebral. Na investigação através de eco-Doppler e angiotomografia de carótidas e vertebrais, foi evidenciada agenesia unilateral da artéria carótida interna esquerda. Este relato objetiva chamar atenção para a importância de se suspeitar de malformações vasculares durante a investigação de quadros neurológicos. A agenesia de carótida interna tem uma importante associação com aneurismas intracerebrais, e é possível poupar o paciente de graves complicações quando estes são identificados a tempo

Agenesis of the internal carotid artery is a rare anomaly. It is usually asymptomatic because of the presence of anastomoses, but it can be associated with complications, especially when there is evidence of other anatomical abnormalities or severe atherosclerotic disease. We report the case of a 63-year-old female patient with hypertension and diabetes and a history of intracranial aneurysm clipping. Doppler ultrasonography and computed tomography angiography of the carotid and vertebral arteries showed unilateral agenesis of the left internal carotid artery. Thisreport aims to highlight the importance of suspecting vascular malformations during investigation of neurological conditions. Internal carotid agenesis has a significant association with intracranial aneurysms and their early detection can spare the patient serious complications

Humans , Female , Middle Aged , Aorta, Thoracic/abnormalities , Carotid Artery, Internal/abnormalities , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnosis , Angiography/methods , Echocardiography/methods , Intracranial Aneurysm/complications , Intracranial Aneurysm/physiopathology , Magnetic Resonance Spectroscopy/methods , Subclavian Artery
CoDAS ; 30(1): e20160255, 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-890817


RESUMO Objetivo Caracterizar o perfil dos quadros afásicos determinados pela hemorragia subaracnóidea aneurismática (HSA) da artéria cerebral média esquerda. Método Estudo analítico, retrospectivo, transversal, tendo como banco de dados as avaliações cognitivas de 193 pacientes do Hospital da Restauração com HSA aneurismática no período de março de 2007 a novembro de 2009. Destes, foram selecionados 26 pacientes com HSA em território da ACM-E, confirmada por angiografia digital. Os quadros afásicos foram classificados através do desempenho da linguagem dos pacientes através do Protocolo Montreal Toulose - Versão Alpha e a tarefa de fluência verbal da bateria CERAD. A pesquisa foi realizada no período de junho a agosto de 2015. Resultados Foi identificado comprometimento da linguagem e fluência verbal nos pacientes com HSA em território de ACM-E quando comparados com a população controle (50 indivíduos). Dos 26 pacientes com HSA, 11 apresentaram quadros afásicos ainda no período pré-operatório. Conclusão Os resultados da pesquisa corroboram com a literatura, mostrando que o quadro da HSA promove comprometimentos cognitivos ainda na fase pré-operatória para oclusão de aneurisma. Tendo em vista os aspectos observados, os quadros afásicos predominantes caracterizam afasia de compreensão por sequelas nas áreas cerebrais posteriores.

ABSTRACT Purpose Characterize the profile of aphasic syndromes determined by aneurysmal subarachnoid hemorrhage (aSAH) of the left middle cerebral artery (LMCA). Methods An analytical, retrospective, cross-sectional study was conducted using a database of cognitive assessments of 193 patients with aSAH admitted to Hospital da Restauração between March 2007 and November 2009. Of these, a total of 26 patients with aSAH in the LMCA territory confirmed by digital angiography were selected. Aphasia was assessed through the Montreal-Toulouse Language Assessment Alpha Version Protocol (Alpha Version) and the CERAD Neuropsychological Test Battery (Verbal fluency). Results Language and verbal fluency impairments were identified in patients with aSAH in the LMCA territory when compared with the control population (50 individuals). Of the 26 patients with aSAH, 11 presented aphasic characteristics preoperatively. Conclusion The results of this research corroborate the literature, showing that the aSAH frame causes cognitive impairments even in the preoperative phase for aneurysm occlusion. Considering the observed aspects, the predominant aphasic syndromes characterize comprehension aphasia due to sequels in the posterior cerebral artery territory.

Humans , Male , Adult , Middle Aged , Aged , Aphasia/etiology , Subarachnoid Hemorrhage/complications , Intracranial Aneurysm/complications , Aphasia/classification , Cross-Sectional Studies , Retrospective Studies , Cognition Disorders/etiology , Educational Status
Arq. neuropsiquiatr ; 75(8): 523-532, Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-888311


ABSTRACT Objective Correlate the middle cerebral artery bifurcation aneurysm morphology with the pre-operative and intra-operative risk of rupture. Methods Forty patients with 46 middle cerebral artery bifurcation aneurysms were treated microsurgically by the same surgeon. Aneurysms were classified according to shape and the Fisher test was applied to analyze the effect of morphology on the pre-operative and intra-operative rupture. Results Pre-operative and intra-operative ruptures were observed in 8/46 patients (17.4%) and 14/46 patients (30.4%) respectively. Thirty-two cases (69.6%) had no symptoms postoperatively, modified Rankin score (MRS) of 0; 6.5% had MRS of 1 (no significant disability); 13% had MRS of 2 (slight disability); 4.3% had moderately severe disability (MRS of 4); and there were 3 deaths (6.5%) post-operatively. The morphology was not directly related to the rupture rate. Conclusion In general, ruptures are not affected by the morphology or the studied variables. Larger series are needed to validate these outcomes.

RESUMO Objetivo Correlacionar a morfologia do aneurisma da bifurcação da artéria cerebral média com o risco de ruptura pré-operatória e intra-operatória. Métodos 40 pacientes com 46 aneurismas de bifurcação da artéria cerebral média receberam tratamento microcirúrgico pelo mesmo cirurgião. Os aneurismas foram classificados de acordo com a morfologia e o teste de Fisher foi aplicado para analisar o efeito da morfologia sobre a ruptura pré-operatória e intra-operatória. Resultados As rupturas pré e intra-operatória foram observadas em 8/46 pacientes (17,4%) e 14/46 (30,4%) respectivamente. Trinta e dois casos (69,6%) não apresentaram sintomas pós-operatórios, pontuação de Rankin modificada (MRS) de 0, 6,5% tinham MRS de 1 (sem incapacidade significativa), 13% tinham MRS de 2 (leve incapacidade), 4,3% moderadamente grave (MRS de 4) e houve 3 óbitos (6,5%) durante o pós-operatório. A morfologia não estava diretamente relacionada à taxa de ruptura pré-operatória ou intra-operatória. Conclusão Em geral, as rupturas não são afetadas pela morfologia ou pelas variáveis estudadas. São necessárias séries maiores para validar esses resultados.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Cerebral Angiography , Intracranial Aneurysm/surgery , Aneurysm, Ruptured/diagnostic imaging , Middle Cerebral Artery/surgery , Intraoperative Complications/surgery , Preoperative Care , Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnostic imaging , Risk Factors , Aneurysm, Ruptured/surgery , Aneurysm, Ruptured/etiology , Middle Cerebral Artery/diagnostic imaging , Intraoperative Complications/diagnostic imaging
[Santiago]; Chile. Ministerio de Salud. División de Planificación Sanitaria; 2017. tab, ilus, graf.
Non-conventional in Spanish | BIGG, LILACS | ID: biblio-948192


Objetivo: Generar recomendaciones basadas en la mejor evidencia disponible acerca del manejo de personas con hemorragia subaracnoidea a rotura de aneurismas cerebrales. Tipo de pacientes y escenario clínico: Personas con hemorragia subaracnoidea a rotura de aneurismas cerebrales que reciben atención en el nivel secundario y terciario de salud en el sector público y privado de salud.

Humans , Subarachnoid Hemorrhage , Intracranial Aneurysm/complications , Aneurysm, Ruptured/complications , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/therapy , Subarachnoid Hemorrhage/diagnostic imaging
Rev. otorrinolaringol. cir. cabeza cuello ; 76(2): 229-230, ago. 2016. ilus
Article in Spanish | LILACS | ID: lil-793972


La epistaxis es un síntoma muy común es muestra práctica diaria, aproximadamente el 60% de la población ha tenido al menos un episodio en algún momento de su vida pero solo 6% precisó atención médica. La mayoría de episodios son limitados y benignos pero, en ocasiones, nos encontramos con casos que pueden resultar fatales.

Nosebleed is a really common symptom, about 60% of the population has had at least one episode at some point in their lives but only 6% required medical attention. Most episodes are limited and benign but in some rare cases, it could be deathly.

Humans , Male , Adult , Embolization, Therapeutic , Epistaxis/etiology , Epistaxis/therapy , Intracranial Aneurysm/complications , Intracranial Aneurysm/therapy
Arq. neuropsiquiatr ; 74(8): 638-643, Aug. 2016. tab
Article in English | LILACS | ID: lil-792509


ABSTRACT Sub-arachnoid hemorrhage (SAH) promotes impairment of upper cortical functions. However, few information is available emphasizing changes in language after aneurismal SAH and aneurysm location influence. Objective To assess the language and verbal fluency performance in aneurismal SAH pre- and post-surgery in patients caused by an aneurysm of the anterior communicating artery (AcomA), left middle cerebral artery (L-MCA) and left posterior comunicating artery (L-PcomA). Methods Assessment in 79 patients with SAH, on two occasions: pre- and post surgical treatment. They were divided into three groups by the aneurysms’ location. Results Deterioration is detected in the performance of all patients during the post-surgical period; L-MCA aneurysm patients displayed a reduction in verbal naming and fluency; L-PcomA patients deteriorated in the written language and fluency tasks. Conclusion After the surgical procedure the patients decreased in various language tasks and these differences in performance being directly related to the location of the aneurysm.

RESUMO Hemorragia subaracnóidea (HSA) proporciona alterações nas altas funções cerebrais. Contudo, há poucos trabalhos enfatizando as alterações da linguagem na HSA aneurismática e a influência da localização do aneurisma. Objetivos Analisar e comparar os desempenhos da linguagem e fluência verbal na HSA nos períodos pré e pós-cirúrgicos nos pacientes com aneurismas da comunicante anterior (AcomA), cerebral média (ACME) e comunicante posterior esquerdas (AcomPE). Métodos A avaliação da linguagem de 79 pacientes com HSA aneurismática foi realizada em duas ocasiões: pré e pós cirurgia. Eles foram divididos em três grupos de acordo com a localização do aneurisma. Resultados Os grupos apresentaram deterioração na avaliação pós-operatória com diferentes características. O grupo da ACME demonstraram deterioração na fluência e nomeação, enquanto o da AcomPE pioraram nos testes de linguagem escrita e fluência. Conclusões Após o tratamento cirúrgico, os pacientes deterioraram em vários itens de linguagem com diferenças relacionadas à localização do aneurisma.

Humans , Male , Female , Middle Aged , Subarachnoid Hemorrhage/complications , Intracranial Aneurysm/complications , Aneurysm, Ruptured/complications , Language Disorders/etiology , Postoperative Period , Subarachnoid Hemorrhage/surgery , Intracranial Aneurysm/surgery , Intracranial Aneurysm/classification , Prospective Studies , Aneurysm, Ruptured/surgery , Aneurysm, Ruptured/classification , Language Disorders/diagnosis , Language Tests
Arq. neuropsiquiatr ; 74(7): 580-586, graf
Article in English | LILACS | ID: lil-787361


ABSTRACT Resection of the anterior clinoid process results in the creation of the clinoid space, an important surgical step in the exposure and clipping of clinoidal and supraclinoidal internal carotid artery aneurysms. Cerebrospinal fluid rhinorrhea is an undesired and potentially serious complication. Conservative measures may be unsuccesful, and there is no consensus on the most appropriate surgical treatment. Two patients with persistent transclinoidal CSF rhinorrhea after aneurysm surgery were successfully treated with a combined endoscopic transnasal/transeptal binostril approach using a fat graft and ipsilateral mucosal nasal septal flap. Anatomical considerations and details of the surgical technique employed are discussed, and a management plan is proposed.

RESUMO A ressecção da clinóide anterior resulta na criação do espaço clinoideo, um passo cirúrgico importante na exposição e clipagem de aneurismas dos segmentos clinoideo e supraclinoideo da artéria carótida interna. Fístula liquórica é uma das complicaçoes mais indesejadas e é potencialmente grave. O manejo com medidas conservadoras pode ser bem sucedido, e não há consenso sobre o tratamento cirúrgico mais adequado. Dois pacientes com rinorréia persistente secundária a fistula liquórica transclinoidal após cirurgia de aneurisma foram tratados com sucesso por uma abordagem endoscópica combinada transnasal/transseptal binostril usando um enxerto de gordura e retalho de mucosa naso-septal ipsilateral. Considerações anatômicas e detalhes da técnica cirúrgica empregada são discutidos, e um plano de manejo destes tipo de fistula líquorica é proposto.

Humans , Female , Adult , Middle Aged , Carotid Artery Diseases/surgery , Intracranial Aneurysm/surgery , Cerebrospinal Fluid Rhinorrhea/surgery , Cerebrospinal Fluid Rhinorrhea/etiology , Craniotomy/adverse effects , Transanal Endoscopic Surgery/methods , Aneurysm/surgery , Postoperative Complications/surgery , Sphenoid Bone/anatomy & histology , Sphenoid Bone/surgery , Surgical Flaps , Carotid Artery Diseases/complications , Intracranial Aneurysm/complications , Reproducibility of Results , Treatment Outcome , Aneurysm/complications , Nasal Septum/surgery
Arq. neuropsiquiatr ; 74(6): 478-481, June 2016. tab
Article in English | LILACS | ID: lil-784187


ABSTRACT We retrospectively evaluated the records of 49 grade 4 and 5 patients with 42 intracranial aneurysms treated within 72 h of subarachnoid hemorrhage (SAH). In total, 35 patients (71%) were grade 4, and 14 (29%) were grade 5. A total of 42 (85%) patients had one aneurysm, 6 (12%) had two aneurysms, and 1 (3%) had three aneurysms. Out of 49 patients, one technical (2%) and one clinical (2%) complication occurred at surgery. Twenty-one (43%) patients recovered well, including 7 with postoperative hematoma requiring an immediate evacuation of a clot. Fourteen (29%) patients had hydrocephalus and required a ventriculo-peritoneal shunt; 12 patients underwent tracheotomy postoperatively due to coma and pulmonary infection. We found that patients with Hunt and Hess grade 4 and 5 aneurysms can undergo successful neurosurgical clipping of the aneurysms after SAH. However, the morbidity and mortality rates remain high because of their poor clinical condition and a high incidence of vasospasm during treatment.

RESUMO Avaliamos retrospectivamente os registros de 49 pacientes com 42 aneurismas intracranianos de graus 4 e 5, tratados nas primeiras 72 horas após uma hemorragia subaracnóidea (HSA). Trinta e cinco pacientes (71%) apresentavam grau 4 e catorze (29%) grau 5. Quarenta e dois pacientes (85%) tinham um único aneurisma, seis (12%) tinham dois aneurismas, e um paciente (3%) tinha três aneurismas. Dos 49 pacientes, uma complicação técnica (2%) e uma complicação clínica (2%) ocorreram durante a cirurgia. Vinte e um pacientes (43%) recuperaram-se bem, incluindo sete que tiveram hematomas pós-operatórios que requereram a imediata evacuação do coágulo. Catorze pacientes (29%) tiveram hidrocefalia e submeteram-se à derivação ventrículo-peritoneal; doze pacientes submeteram-se à traqueostomia no pós-operatório, devido a coma e infecção pulmonar. Pacientes com aneurismas de graus 4 e 5, segundo a escala de Hunt & Hess podem submeter-se com sucesso à clipagem dos aneurismas após HSA. Entretanto, as taxas de morbidade e mortalidade ainda são altas, devido à condição clínica precária e à alta incidência de vasoespasmo durante o tratamento.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Subarachnoid Hemorrhage/surgery , Surgical Instruments/adverse effects , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/etiology , Severity of Illness Index , Intracranial Aneurysm/complications , Retrospective Studies , Treatment Outcome
CoDAS ; 28(1): 81-88, jan.-fev. 2016. tab, graf
Article in Portuguese | LILACS | ID: lil-779120


RESUMO Objetivos: Revisar de forma sistemática os métodos para avaliação do olfato em vítimas de hemorragia subaracnóidea aneurismática, e identificar as alterações encontradas com a utilização desses métodos. Estratégia de pesquisa: A pesquisa bibliográfica foi realizada na plataforma de busca PubMed e nas bases de dados Web of Science, Scopus, PsycINFO, CINAHL e ScienceDirect, tendo a busca de dados ocorrida em agosto e setembro de 2014. Critérios de seleção: Artigos originais publicados em qualquer língua que abordassem as alterações de olfato na hemorragia subaracnóidea aneurismática, com objetivo de avaliar essa função através de métodos específicos. Foram excluídos estudos de revisão; estudos de caso; capítulos de livro; editoriais e estudos que abordassem a hemorragia subaracnóidea não aneurismática. Análise dos dados: Foram consideradas como variáveis na análise dos dados: autor/ano, país, amostra/idade, tratamento, método utilizado, momento da avaliação do olfato e resultados. Resultados: A busca de artigos resultou em 1.763 artigos, desses, 9 artigos originais foram selecionados para esta revisão. Foi observado que todos os artigos foram desenvolvidos em países europeus e asiáticos e na avaliação do olfato utilizou-se desde testes padronizados e não padronizados a questionários, cujos objetivos variaram entre avaliar o olfato antes e/ou após o tratamento cirúrgico nessa população. Conclusão: Foi observada heterogeneidade nos métodos utilizados para avaliação do olfato na hemorragia subaracnóidea aneurismática, como também no momento selecionado para aplicação das avaliações. Além disso, os estudos evidenciaram a existência de déficit olfatório nos pacientes, e a relação entre o tratamento cirúrgico e a disfunção olfatória.

ABSTRACT Purpose: To systematically review the methods for evaluation of smell in aneurysmal subarachnoid hemorrhage victims and to identify the changes found with the use of these methods. Research strategy: The literature search was performed in PubMed search platform and in the databases Web of Science, Scopus, PsycINFO, CINAHL, and ScienceDirect in August and September 2014. Selection criteria: Original articles published in any language, which addressed smell changes in aneurysmal subarachnoid hemorrhage and addressed to evaluate this function through specific methods were included. Review studies, case studies, book chapters, editorial, and studies that address the nonaneurysmal subarachnoid hemorrhage were excluded. Data analysis: The following variables were considered in data analysis: author/year, country, sample/age, treatment, method, the moment of smell evaluation, and results. Results: The search for articles resulted in 1,763 articles, of which, 9 original articles were selected for this review. It was observed that all articles were from European and Asian countries. Standardized and nonstandardized tests and questionnaires were used in olfactory assessment, and the goals ranged from assessing the smell before and/or after surgery in this population. Conclusion: Heterogeneity was observed in the methods used to evaluate the smell in aneurysmal subarachnoid hemorrhage and in the methods selected for application of evaluations. In addition, studies have demonstrated the existence of olfactory deficits in patients and the relationship between surgery and olfactory dysfunction.

Female , Humans , Male , Smell/physiology , Subarachnoid Hemorrhage/physiopathology , Aneurysm, Ruptured/complications , Intracranial Aneurysm/complications , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/surgery