Repeat Catheter Angiography in Patients with Aneurysmal-Pattern Angiographically Negative Subarachnoid Hemorrhage

Emergency management of intracerebral hemorrhage

Acute intracerebral hemorrhage is a medical emergency with high mortality and morbidity. Neuroimaging has a fundamental role in the etiological diagnosis, patients monitoring and in the risk stratification of hematoma expansion and poor outcome. The cornerstones of medical treatment in the acute phase are blood pressure lowering and coagulopathy reversal. Prevention of hematoma expansion is the main goal of these therapies and their efficacy is strongly time-dependent with a narrow time window. This review provides an update on the etiological diagnostic workup, acute treatment and prognosis of intracerebral hemorrhage.

Current status of perimesencephalic non-aneurysmal subarachnoid hemorrhage

Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is a distinctive disease, representing SAH centered in perimesencephalic cisterns, with negative angiography findings. In recent years, the number of patients with PNSAH has increased significantly; however, the knowledge of PNSAH is insufficient. Therefore, we performed a review of the literature from a PubMed search and recounted our understanding of PNSAH. In this review, we summarized that current high-resolution computed tomography angiography is an acceptable replacement for digital subtraction angiography to rule out aneurysms in PNSAH with strict criteria. The current hypothesis about the etiology of PNSAH is that there is deep vein rupture from aberrant venous anatomy and increased intracranial venous pressure. PNSAH is associated with mild symptoms and lower rates of hydrocephalus and symptomatic vasospasm. For PNSAH, conservative treatment has been the mainstream treatment. PNSAH has a benign clinical course and an excellent prognosis; in long-term follow-up, re-bleeding and death were uncommon.

Efficacy of Magnetic Resonance Contrast-Enhanced Vessel Wall Imaging as an Ancillary Examination for Subarachnoid Hemorrhage With Bleeding Points Difficult to Determine on Conventional Vascular Imaging: A Report of Three Cases

Here, we have demonstrated the efficacy of magnetic resonance contrast-enhanced vessel wall imaging (CE-VWI) as an ancillary examination for subarachnoid hemorrhage with bleeding points difficult to confirm by conventional vascular imaging. Case 1 had a ruptured small aneurysm with a size of 1.8 × 1.1 mm at the origin of left anterior choroidal artery. CE-VWI showed enhancement of the apex of the aneurysm. Surgical clipping was performed by a mini-clip. In Case 2, a ruptured small aneurysm, 2.1 × 1.9 mm, was detected at right middle cerebral artery bifurcation. CE-VWI showed enhancement of the aneurysmal wall. Endovascular coil embolization was performed. In Case 3, irregular dilatation of left internal carotid artery (ICA) was detected. CE-VWI demonstrated enhancement of the dilatation wall. The lesion was deemed to be a dissection of the ICA or a blood blister-like aneurysm. Endovascular treatment using intracranial stent placement was performed, and the patient has had no rebleeding events for one and a half years. In all cases, conventional vascular imaging detected scanty morphological changes, and CE-VWI information provided reliable confirmation of the lesions as bleeding points.