Artery of Percheron as a Rare Feeder of Hemorrhagic Thalamic Arteriovenous Malformation: A Case Report and Literature Review

Arteriovenous malformation (AVM) fed by the artery of Percheron (AOP) is extremely rare, with only one case described in the literature to date. We herein present a case of a 43-year-old female with hemorrhagic thalamic AVM mainly supplied by the AOP, who subsequently underwent conservative management and recovered well except for mild right hemiparesis. This case highlights that the AOP is a rarely recognized but clinically significant entity and should be identified when dealing with AOP-associated neurovascular disorder as described.

Cortical blindness as a rare presentation of hemorrhagic cerebral hyperperfusion syndrome following vertebral angioplasty

Cerebral hyperperfusion syndrome (CHS) is a well-documented complication after carotid endarterectomy or stenting. In contrast, CHS following vertebral revascularization is extremely rare. Here we present a case of a 77-year-old man with high-grade vertebral stenosis who subsequently underwent balloon angioplasty, complicated by hemorrhagic CHS manifesting as cortical blindness, although strict postoperative blood pressure control was administered. To our knowledge, cortical blindness as a presentation of hemorrhagic CHS has not previously been reported. This study highlights the fact that identifying high-risk patients, as well as making an individual therapeutic plan, is important prior to revascularization. Further studies are needed to elucidate the exact mechanism of this condition and thereby prevent it.

Surgical Resection of a Progressive Giant Arteriovenous Malformation After 13-year Follow-Up

Giant arteriovenous malformation (AVM) is a complex and relatively rare congenital lesion with high morbidity and mortality. Its optimal treatment, however, remains controversial. Normal perfusion pressure breakthrough (NPPB) is a potentially devastating complication following surgical resection. Generally, strict blood pressure control is particularly recommended for preventing this phenomenon. Here we present a case of a 21-year-old patient with a progressive giant AVM who developed frequent seizures and subsequently underwent microsurgical total resection after 13-year follow-up, complicated by NPPB. Hypertensive hypervolemic treatment rather than strict blood pressure control was administrated postoperatively; however thalamic infarction occurred. During the 1 year of follow-up, the patient remained seizure-free with only mild right-sided hemiparesis.This case highlights that, in view of potential growth of the lesion, early intervention is necessary when possible. Microsurgical resection is challenging but remains to be an effective option for eliminating such giant AVM, and it is vital to keep risks associated with surgery in mind, such as NPPB. Moreover, whether blood pressure control is needed or not should be individualized.

Growing dissecting aneurysm of basilar trunk treated with stent-assisted coiling

Growing basilar dissecting aneurysm is a scarce but increasingly recognized entity, accounting for a significant risk of death and disability. Controversy exists regarding the optimal management. A 61-year-old man presented with dysarthria and left hemiparesis attributable to a basilar trunk dissecting aneurysm. Antiplatelet therapy was instituted, and the patient's clinical condition markedly improved. However, he developed severe headache, dysarthria, and left hemiparesis 35 days later. Angiography revealed significant enlargement of the aneurysm, and stent-assisted coiling was then uneventfully performed. The patient remained clinically stable with only mild left-sided hemiparesis at the 2-year clinical follow-up.

Early cerebral infarction following aneurysmal subarachnoid hemorrhage: frequency, risk factors, patterns, and prognosis

Early cerebral infarction (ECI) following aneurysmal subarachnoid hemorrhage (aSAH) remains poorly understood. This study aims to determine the frequency and risk factors of this special episode, as well as to assess the relationship between its patterns and outcome. We retrospectively enrolled 243 patients who underwent aneurysm treatment within 60 hours of SAH. ECI was defined as one or more new hypodense abnormalities on computed tomography within 3 days after SAH, rather than lesions attributable to edema, retraction effect, and ventricular drain placement. Risk factors were tested by multivariate analysis. The infarct was classified by an established grading system (single or multiple, cortical or deep or combined). Poor outcome was defined as the Glasgow Outcome Score of severe disability or worse. Sixty-five patients (26.7%) had early infarction. Acute hydrocephalus (odds ratio [OR] 6.67; 95% confidence interval [CI] 1.59-27.95), admission plasma glucose level (OR 1.42 per mmol/L; 95% CI 1.16-1.73), and treatment modality (OR 16.27; 95% CI 4.05-65.28) were independent predictors of ECI. The pattern was single cortical in 19 patients (29.2%), single deep in 9 (13.8%), multiple cortical in 8 (12.3%), multiple deep in 14 (21.5%), and multiple combined in 15 (23.1%). ECI was associated with delayed cerebral infarction (DCI) (P = 0.002) and poor outcome (P < 0.001). Multiple combined infarction was related to poor outcome (P = 0.001). In summary, the occurrence of ECI, which is associated with surgical treatment, acute hydrocephalus and high admission plasma glucose, may potentially predict DCI and unfavorable outcome. Further studies are warranted to reveal the underlying mechanisms of this event and thereby minimize it.