An Unusual Posttraumatic Pseudoaneurysm of Intracranial Segment (V4) of the Vertebral Artery

Case Series of Neurotrauma Managed by General Surgeon at Ladakh - The Highest Plateau State of India

Trauma including neurotrauma is one of the major killers in the world. The health infrastructure in developing countries has a huge disparity, with super specialist care confined to big cities only. Adding to this problem is factors like poverty, poor road condition and no organised emergency evacuation system. The utopian scenario where specialist and infrastructure are made available in every village is a distant dream. So at present, the most feasible and cost-effective way to prevent death due to neurotrauma in rural and remote setting is putting the general surgeon working in remote area at the forefront. Our study is an effort in this direction and is reporting operative management of patients with neurotrauma in remote high-altitude Ladakh. So today, the need of hour is continuing skill enhancement training for capacity building of rural surgeon, where they are trained to do burr hole and craniotomy for reducing mortality and morbidity from neurotrauma.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12262-021-03002-x.

Characteristics and Predictors of Outcome of Pseudoaneurysms Associated With Vertebral Artery Dissections: A 310-Patient Case Series

BACKGROUND

Vertebral artery dissections (VADs) are a common cause of stroke in young patients and can result in various secondary effects, including pseudoaneurysm formation.

OBJECTIVE

To identify differences in predisposing factors and outcomes for VADs with and without concomitant pseudoaneurysms.

METHODS

We retrospective chart reviewed patients who presented to our institution at the time of VAD with at least a 3-mo clinical follow-up. Demographics, VAD characteristics, treatment, and outcomes represented as modified Rankin scale (mRS) scores were collected.

RESULTS

Of 310 patients with a VAD included in this study, 301 patients had an identified pseudoaneurysm status, with 54 pseudoaneurysm-associated VADs and 247 VADs not associated with pseudoaneurysm. VAD patients with associated pseudoaneurysms were more likely to be female (P < .004), have bilateral VADs (P < .001), and have fewer vertebral artery segments affected (P = .018), and less likely to have stroke (P < .008) or occlusion of the vertebral artery (P < .001). There was no difference in the proportion of patients treated with antiplatelet agents (P = .12) or anticoagulants (P = .27) between the groups. VAD patients with associated pseudoaneurysms were more likely to have a higher mRS at 3-mo follow-up (P = .044) but not discharge (P = .18) or last follow-up (P = .05). VAD patients with pseudoaneurysms were equally likely to have resolution of occlusion (P = .40) and stenosis (P = .19).

CONCLUSION

Demographics and clinical and radiological characteristics of VADs associated with pseudoaneurysms are different from those without associated pseudoaneurysms. Vertebral artery dissections with concomitant pseudoaneurysms are neither associated with worse functional nor radiographic outcomes.