Spontaneous superficial temporal artery pseudoaneurysm in elderly women--three case reports.

Three women older than 75 years presented with spontaneous superficial temporal artery (STA) pseudoaneurysms manifesting as a pulsatile mass in the preauricular region. None of the patients had a history of trauma. Histological examination of the surgically removed masses identified pseudoaneurysms based on the presence of connective tissue and adventitia. Spontaneous STA pseudoaneurysms are extremely rare. We suggest that all 3 aneurysms were associated with latent dissection and external force exerted by the frames of glasses.

Carotid artery stenting in a patient with internal carotid artery stenosis and ipsilateral persistent primitive hypoglossal artery presenting with transient ischemia of the vertebrobasilar system: case report.

A 62-year-old man experienced transient episodes of vertigo associated with left upper extremity weakness. Cerebral angiography showed 75% right internal carotid artery (ICA) stenosis and divergence of a persistent primitive hypoglossal artery (PPHA) distal to the stenosis. The area of stenosis was at a high position and he had a past medical history of congestive heart failure, which contraindicated carotid endarterectomy (CEA). Therefore, carotid artery stenting (CAS) was performed with single distal balloon protection. The stenotic area was restored and he was discharged without suffering recurrent attacks. CAS may be an effective alternative treatment to CEA to prevent further ischemic attacks in the posterior circulation in patients with PPHA. CAS using simple embolic protection devices is possible if the distance between the distal end of the ICA stenosis and the origin of the PPHA is sufficiently long.

Fragmentation of calcified plaque after carotid artery stenting in heavily calcified circumferential stenosis.

INTRODUCTION: We assessed the morphological change of calcified plaque after carotid artery stenting (CAS) in vessels with heavily calcified circumferential lesions and discuss the possible mechanisms of stent expansion in these lesions. METHODS: We performed 18 CAS procedures in 16 patients with severe carotid artery stenosis accompanied by plaque calcification involving more than 75% of the vessel circumference. All patients underwent multidetector-row computed tomography (MDCT) to evaluate lesion calcification before and within 3 months after intervention. The angiographic outcome immediately after CAS and follow-up angiographs obtained 6 months post-CAS were examined. RESULTS: The preoperative mean arc of the calcifications was 320.1 +/- 24.5 degrees (range 278-360 degrees ). In all lesions, CAS procedures were successfully carried out; excellent dilation with residual stenosis

Acute disappearance of ruptured aneurysm located near the origin of the superior cerebellar artery - case report - .

A 63-year-old woman presented with a ruptured aneurysm which apparently spontaneously thrombosed. She was admitted after sudden onset of severe headache. Computed tomography (CT) demonstrated subarachnoid hemorrhage (SAH) in the pontine and interpeduncular cisterns. Initial three-dimensional CT (3D-CT) angiography revealed an aneurysm (diameter, 9 mm) near the origin of the left superior cerebellar artery. However, angiography 3 hours later failed to show the aneurysm. Total thrombosis was thought to have occurred in the aneurysm. The patient returned home with no deficit 1 month after admission. T(1)- and T(2)-weighted magnetic resonance imaging 75 days after the SAH demonstrated the thrombosed aneurysm as an isointense mass lesion. 3D-CT angiography showed no recanalization of the aneurysm 9 months after the SAH.

[An aneurysm located at a fenestration of the vertebrobasilar junction successfully treated with Guglielmi detachable coils].

A 35-year-old female developed a subarachnoid hemorrhage from an aneurysm located at the fenestration of the vertebrobasilar (VB) junction. The patient was treated with Guglielmi detachable coils (GDCs). The aneurysm was successfully occluded using 8 coils despite the fact that 2 major complications occurred during the procedure: perforation of the aneurysm with a coil and thrombosis of the parent artery. The GDC that had perforated the aneurysm was left and remained partially in the subarachnoid space, and embolization was continued. The thrombus was mechanically crushed and dissolved. Forty days postoperatively, the patient was discharged home with minimal sequelae. VB junction fenestration is present in 35.5%-70% of VB junction aneurysms, but fenestration of the VB junction is sometimes overlooked on selective angiography. Careful pre-operative assessment is needed for aneurysms at the VB junction. The international subarachnoid aneurysm trial (ISAT) found that endovascular treatment was superior to surgery in the management of ruptured aneurysms. Nevertheless, thromboembolic complications and perforation are associated with coil embolization. Thus, care should be taken to avoid these complications, and it is indispensable to have appropriate treatment options immediately available to deal with them should they occur.

Obstructive hydrocephalus associated with arachnoid cyst in the elderly.

We present a case of a symptomatic frontal arachnoid cyst associated with hydrocephalus in an elderly patient. It is well known that symptomatic arachnoid cysts usually develop at an early age. This condition is rarely observed in the elderly. The authors hypothesized that compression of the brain and obstructive hydrocephalus caused the arachnoid cyst to become symptomatic.

Lipocalin-type prostaglandin D synthase (beta-trace) in cerebrospinal fluid: a useful marker for the diagnosis of normal pressure hydrocephalus.

Lipocalin-type prostaglandin D synthase (PGDS) is considered to be mainly produced in the leptomeninges and secreted into cerebrospinal fluid (CSF). We found PGDS levels in CSF of patients with normal pressure hydrocephalus (NPH) (8.99+/-2.59 microg/ml, mean+/-S.D., n=14) to be significantly lower than levels in a control (15.29+/-5.17, n=14, P<0.0001) and other dementia group (19.14+/-4.34, n=7, P=0.0003). Thus, PGDS level in CSF is a useful marker for the differential diagnosis of NPH from other diseases with dementia.