An unusual aneurysm of a basilar perforating artery presenting with a subarachnoid haemorrhage.

A 65-year-old man had a perimesencephalic subarachnoid haemorrhage with normal angiography initially. After a rebleed 5 days later, a repeat angiogram revealed a pea-like aneurysm a short distance behind and below the basilar bifurcation. It was not amenable to endovascular treatment and the feeding vessel was coagulated and divided at open surgery via a sub temporal approach. He developed a right hemiparesis and dysphasia, from which he slowly recovered. Basilar perforating artery aneurysms are extremely rare, with only 4 previous cases reported.

Sir Victor Horsley (1857-1916): lessons for the modern clinician.

Sir Victor Horsley is well known for his pioneering work as a neurological surgeon but his vital contributions to the regulation and advancement of the medical profession are less well understood. This archived literature review of The Horsley collection of papers (UCL Special Collections Library) documents Sir Victor's campaign for the autonomy of the stagnating medical profession of over a century ago. These lessons should empower modern clinicians to retain the professionalism they worry about losing.

Management of a comatose patient with multiple intracranial aneurysms--lessons learned.

The perioperative management of a deeply comatose patient (Glasgow Coma Score, GCS 5) following a spontaneous subarachnoid hemorrhage is presented. Six intracranial aneurysms of the anterior circulation were discovered at operation, contrary to angiographic findings. These were successfully clipped by the author (KD). Postoperatively, the patient's cerebral energy metabolism was monitored by bedside cerebral microdialysis in real time. The ICP (volume)-targeted therapy (Lund concept) was utilised in accordance with findings of intrinsic brain biochemistry. Three-month follow-up showed excellent outcome (Glasgow Outcome Score, GOS 5).