Endovascular treatment of ruptured dissecting posterior inferior cerebellar artery aneurysms.

Dissecting aneurysms of the posterior inferior cerebellar artery (PICA) distal to its origin from vertebral artery (VA) are very rare. Although rare, they associated with a high risk of rebleeding and they present a therapeutic challenge. This study reviewed the clinical presentations, angiographic characteristics of dissecting aneurysms of the PICA and to assess the clinical and angiographic outcomes of patients who underwent endovascular treatment. Ten patients with ten dissecting aneurysms who underwent endovascular treatment were identified in the clinical records of a single medical center from January 2000 to December 2010. The mean follow-up duration was 2.8 years. All patients presented with subarachnoid hemorrhage (SAH). They all underwent endovascular treatment, which included occlusion of the dissected segment and the parent artery after detailed angiographic evaluation of the vascular anatomy, and test occlusion of the PICA. In all patients the endovascular treatment was successfully completed without procedure related complications. Long-term follow-up studies in seven out of ten patients showed complete occlusion of the aneurysm with no new neurologic deficits. The clinical outcome was good in eight cases, whereas two patients with poor clinical condition at admission died during their initial hospital stay. Endovascular occlusion of the parent vessel and the dissected segment is relatively safe treatment option for dissecting aneurysms of the PICA distal to its origin.

Reversible cerebral vasoconstriction syndrome: treatment with multiple sessions of intra-arterial nimodipine and angioplasty.

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute severe headache with or without additional neurological symptoms and reversible cerebral vasoconstriction. Unruptured aneurysms have been reported in some cases with RCVS. We describe a severe case of a 50-year-old woman with RCVS presenting as cortical subarachnoid hemorrhage. Cerebral angiogram demonstrated the typical angiographic findings of RCVS and two very small unruptured aneurysms of the left internal carotid artery. The patient was treated with calcium channel blockers and the two aneurysms were successfully treated endovascularly. On day 16 the patient developed new focal neurological symptoms (severe paraparesis) and was successfully treated with intraarterial nimodipine and angioplasty in multiple sessions.

Clinical and radiological features of posterior communicating artery aneurysms.

SUMMARY: Treatment of unruptured intracranial aneurysms based on critical size and predictive risk factors is generally accepted, but several factors contribute to the clinical outcome in a patient with subarachnoid hemorrhage (SAH) secondary to a ruptured aneurysm. We decided to evaluate other parameters that might contribute to the clinical outcome of patients with a ruptured posterior communicating artery aneurysm. A retrospective review of the medical records of patients diagnosed and/or treated of cerebral aneurysms at our institution was carried out. We selected patients with Pcom aneurysms that presented with SAH and reviewed conventional and tridimensional angiographic images to determine its anatomical orientation and correlated the data with amount of SAH and clinical presentation and outcome. A total of 112 Pcom aneurysms presented with SAH and were included in this study. 92 patients were women and 20 were men, with a mean age of 57 years (range 25-81). According to anatomical orientation, 43 were inferolateral, 30 lateral, 13 superolateral, three inferomedial, two in medial location, two superomedial, 11 inferoposterior, five posterior and three superoposterior. Aneurysms in superolateral location are to be watched carefully, it is likely that this location joins several conditions for these aneurysms to grow faster or have a higher hemodynamic stress which makes them more at risk of rupture and contribute to a worse clinical outcome.

Successful embolization of a giant perimedullary arteriovenous fistula of the cervical spine in a 6-year-old child.

CASE: We report a case of a 6-year-old boy with a giant perimedullary arteriovenous fistula of the cervical spine who presented with progressive tetraparesis. METHOD: Transarterial glue embolization was performed and complete occlusion of the fistula was achieved. RESULT: The patient's symptoms resolved completely during the next year.