Utility of transcranial color-coded duplex sonography in diagnosis and monitoring of PICA aneurysm in subarachnoid hemorrhage.

This case describes the successful use of transcranial color-coded duplex sonography (TCCD) to diagnose a posterior circulation aneurysm in a patient with subarachnoid hemorrhage. A 33-year-old, was admitted to the ICU after a brain CT scan showed peritroncal subarachnoid hemorrhage. TCCD revealed a rounded image with color Doppler near the P1 portion of the right posterior cerebral artery, which was later confirmed to be a 4 mm aneurysm at the right posterior inferior cerebellar artery (PICA). The aneurysm was treated with coil exclusion and TCCD confirmed its disappearance post-treatment. While TCCD has limitations, including its inability to detect small aneurysms, it is a noninvasive diagnostic tool that provides real-time visualization of the brain and allows for follow-up evaluations. This case demonstrates the potential usefulness of TCCD in diagnosing cerebral aneurysms in patients with subarachnoid hemorrhage and for follow-up evaluations post-treatment.

Effect of prone position on right ventricular dysfunction due to pulmonary embolism assessed by speckle tracking echocardiography.

Prone position has shown beneficial hemodynamic effects in patients with right ventricular dysfunction associated with acute respiratory distress syndrome decreasing the right ventricle afterload. We describe the case of a 57-year-old man with right ventricular dysfunction associated with pulmonary thromboembolism with severe hypoxemia that required mechanical ventilation in prone position. With this maneuver, we verified an improvement not only in his oxygenation, but also in his right ventricular function assessed with speckle tracking echocardiography. Our case shows the potential beneficial effect of the prone position maneuver in severely hypoxemic patients with right ventricular dysfunction associated with pulmonary thromboembolism.