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Heredia-Gutiérrez A, Carbarín-Carbarín ME. Cerebral aneurysms in pediatrics: a case report and review of the literature. Bol Med Hosp Infant Mex 2021; 78:636-641. [PMID: 34934213 DOI: 10.24875/bmhim.20000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cerebral aneurysms in pediatrics represent < 4% of the total of this condition, and their rupture represents 10-23% mortality. Aneurysms have been associated with infections, head injuries, sickle cell anemia, cardiovascular diseases, autoimmune diseases, immunodeficiencies, and connective tissue diseases. Their clinical presentation includes severe headache, seizures, motor-sensory deficits, and death due to subarachnoid and intraparenchymal hemorrhage. CASE REPORT We describe the case of a 12-year-old female patient who presented with a sudden intense headache; after 72 hours, generalized tonic-clonic seizures were observed. At the hospital, she was stabilized with antiepileptic drugs and analgesics. A simple head computed tomography scan showed intraparenchymal hemorrhage in the right frontal lobe and subarachnoid hemorrhage. The study was complemented with a cerebral angiotomography, which revealed an aneurysm of the anterior communicating artery. The pediatric neurosurgeon evaluated the case, and management in the pediatric intensive care unit was decided. Two weeks after the stroke, the aneurysm was clipped and excluded. The patient developed adequate clinical evolution and resolution of initial symptoms, resuming her daily activities. CONCLUSIONS Pediatric cerebral aneurysms differ from their adult counterparts, mainly in their etiology and evolution. In addition, pediatric patients have a longer life expectancy. Aneurysm clipping and neurological endovascular therapy have shown similar results.
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Affiliation(s)
| | - María E Carbarín-Carbarín
- Unidad de Terapia Intensiva Pediátrica. Hospital para el Niño Poblano, San Andrés Cholula, Puebla, Mexico
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Nicolás-Cruz CF, Mondragón-Soto MG, Calderón JRA, Melo-Guzmán G. Manejo bimodal de aneurismas asociados a malformaciones arteriovenosas cerebrales. Reporte de caso y breve revisión de la literatura. CIR CIR 2020; 88:79-83. [PMID: 33284274 DOI: 10.24875/ciru.20000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La patogénesis de los aneurismas intracraneales asociados a malformaciones arteriovenosas cerebrales no es bien entendida y es aún objeto de discusión. Las decisiones sobre cuándo y cómo tratar los aneurismas intracraneales de estas características siempre han sido un reto terapéutico tanto para neurocirujanos vasculares como para terapistas endovasculares neurológicos. Reportamos el caso de una paciente de 51 años con aneurismas múltiples asociados a una malformación arteriovenosa, así como su manejo neuroquirúrgico, con un análisis comparativo con lo publicado en la literatura médica y científica en los últimos 10 años. The pathogenesis of intracranial aneurysms associated with arteriovenous malformations is not well understood and is still under discussion; the decisions about when and how to treat intracranial aneurysms of these characteristics have always been a therapeutic challenge for both, vascular neurosurgeons and endovascular neurological therapists. We report the case of a 51-year-old patient with multiple aneurysms associated with arteriovenous malformation, as well as her neurosurgical management, with a comparative analysis what has been published in the medical and scientific literature in the last 10 years.
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Affiliation(s)
- Carlos F Nicolás-Cruz
- Servicio de Cirugía General, Instituto Mexicano del Seguro Social (IMSS). Ciudad de México, México
| | - Michel G Mondragón-Soto
- Servicio de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez. Ciudad de México, México
| | - José R Aguilar Calderón
- Servicio de Neurocirugía, Hospital Central Sur de Alta Especialidad, Petróleos Mexicanos (PEMEX). Ciudad de México, México
| | - Gustavo Melo-Guzmán
- Unidad de Terapia Endovascular Neurológica, Servicio de Neurocirugía, Hospital Juárez de México, Secretaría de Salud. Ciudad de México, México
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3
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Alvarez-Fernandez D, Rodriguez-Balsera C, Shehadeh-Mahmalat S, Señaris-Gonzalez A, Alvarez-Coronado M. Junctional scotoma. A case report. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:445-448. [PMID: 31253509 DOI: 10.1016/j.oftal.2019.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/17/2019] [Accepted: 03/23/2019] [Indexed: 06/09/2023]
Abstract
The case concerns a 55 year-old female patient with progressive visual decrease in her right eye that showed a junctional scotoma in the visual field study. A magnetic resonance scan was performed, which showed a right middle cerebral artery aneurysm with ipsolateral chiasmatic involvement.
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Affiliation(s)
- D Alvarez-Fernandez
- Unidad de Gestión Clínica de Oftalmología, Hospital Vital Álvarez-Buylla, Santuyano (Mieres, Principado de Asturias), España.
| | - C Rodriguez-Balsera
- Unidad de Gestión Clínica de Oftalmología, Hospital Vital Álvarez-Buylla, Santuyano (Mieres, Principado de Asturias), España
| | - S Shehadeh-Mahmalat
- Servicio de Radiología, Hospital Vital Álvarez-Buylla, Santuyano (Mieres, Principado de Asturias), España
| | - A Señaris-Gonzalez
- Unidad de Gestión Clínica de Oftalmología, Hospital Vital Álvarez-Buylla, Santuyano (Mieres, Principado de Asturias), España
| | - M Alvarez-Coronado
- Servicio de Oftalmología, Hospital Universitario de Cabueñes, Gijón (Principado de Asturias), España
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Thenier-Villa JL, Riveiro Rodríguez A, Martínez-Rolán RM, Gelabert-González M, González-Vargas PM, Calero-Félix L, Galarraga Campoverde RA, De La Lama Zaragoza AR, Pou J, Alonso CC. A1 asynchrony, a potential risk factor for the rupture of anterior communicating artery aneurysms: A computational fluid dynamics study. Neurocirugia (Astur) 2019; 30:207-14. [PMID: 31155281 DOI: 10.1016/j.neucir.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/15/2019] [Accepted: 04/07/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The anterior communicating complex is one the most common locations for aneurysm development. It receives blood from both carotid circulations and the effect of synchrony on the arrival of blood flow has not been previously studied. The objective of this study was to compare the asynchrony conditions of the A1 pulse and its effects on the haemodynamic conditions of anterior communicating artery (ACoA) aneurysms. MATERIALS AND METHODS From 2008 to 2017, 54 anterior communicating artery aneurysms treated at our centre were included in the study. Computational fluid dynamics (CFD) techniques were employed and simulations consisted of complete conditions of synchrony and introducing a delay of 0.2s in the non-dominant A1 artery. Time-averaged wall shear stress (TAWSS), low shear area (LSA), A1 diameter and ACoA angles were measured. RESULTS The difference in the LSA in conditions of synchrony and asynchrony resulted in a broad range of positive and negative values. The symmetry index (p=0.04) and A1/A2 angle on the dominant artery (p=0.04) were associated with changes in LSA. CONCLUSIONS In asynchrony, LSA increased in the absence of A1 asymmetry and low A1/A2 angles, potentially increasing the risk of aneurysm rupture in this location.
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Delgado-López PD, López-Martínez JL, Gero-Escapa M, Martín-Alonso J, Castaño-Blazquez M, Ossa-Echeverri S, Martín-Velasco V, Castilla-Díez JM. [Aneurysmal subarachnoid haemorrhage: Results after introducing endovascular therapy in a medium-low volume centre]. Neurocirugia (Astur) 2016; 27:207-19. [PMID: 26975879 DOI: 10.1016/j.neucir.2016.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the impact of introducing endovascular therapy for patients with aneurysmal subarachnoid haemorrhage (aSAH) in a medium-low volume centre. MATERIAL AND METHODS A retrospective observational study was conducted by comparing the clinical outcome of patients with aSAH before and after introducing endovascular therapy in our centre. The main variables analysed were: type of treatment, hospital and late mortality, intra-procedural morbidity, rate of re-bleeding and vasospasm, and clinical outcome according to the Glasgow Outcome Score (GOS). RESULTS Seventy-one patients were treated in two periods: 2010-2011 (32 patients; 19 clipped, 6 coiled, 7 untreated), and 2012-2013 (39 patients, 3 clipped, 34 coiled, 2 untreated). No significant differences were found in age, sex, clinical grade at admission, type and location of aneurysm, Fisher score, or in hospital mortality (28.1% vs 25.6%, P=.35), GOS (except for GOS 5: 43.37% vs 53.8%, P=.045), rate of hydrocephalus and rate of vasospasm. The second cohort obtained better results for aggregated GOS 1+2+3 (36.3% vs 43.75%, P=.034) and for GOS 4+5 (61.5% vs 56.25%, P=.078). The percentage of patients left untreated was significantly lower in the second period (5.1% vs 21.8%, P<.01), as well as the rate of re-bleeding (0% vs 9.4%, P<.01). Patients were treated earlier (2.51 vs 3.95 days), and hospital and total stay were lower (15.2 and 24.6 vs 10.3 and 18 days) in the second period, these differences not reaching statistical significance. CONCLUSIONS Endovascular therapy allowed treating more patients with aSAH, and with a lower re-bleeding rate. This led to a modest reduction in morbidity and mortality.
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Affiliation(s)
| | - José Luis López-Martínez
- Servicio de Radiología, Sección de Neurorradiología Intervencionista, Hospital Universitario de Burgos, Burgos, España
| | - María Gero-Escapa
- Servicio de Cuidados Intensivos, Hospital Universitario de Burgos, Burgos, España
| | | | - Miguel Castaño-Blazquez
- Servicio de Radiología, Sección de Neurorradiología Intervencionista, Hospital Universitario de Burgos, Burgos, España
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Sánchez-Vicente JL, Frau-Aguilera L, Sánchez-Vicente P, Herrador-Montiel A, Rueda-Rueda T, Castilla-Lázpita A, Romera-Piñero A, Medina-Tapia A. [Macular atrophy in Terson's syndrome]. ACTA ACUST UNITED AC 2014; 90:26-9. [PMID: 25443182 DOI: 10.1016/j.oftal.2014.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/31/2014] [Accepted: 02/09/2014] [Indexed: 10/24/2022]
Abstract
CASE REPORT The case is presented on a 63-year-old patient with Terson's syndrome who complained of loss of visual acuity. The optical coherence tomography showed macular atrophy. DISCUSSION The patient developed macular atrophy probably secondary to macular hemorrhage caused by the rupture of a cerebral aneurysm.
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Affiliation(s)
- J L Sánchez-Vicente
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - L Frau-Aguilera
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | | | - A Herrador-Montiel
- Servicio de Oftalmología, Hospital Universitario Reina Sofía, Córdoba, España
| | - T Rueda-Rueda
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - A Romera-Piñero
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Medina-Tapia
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
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Delgado F, Saiz A, Hilario A, Murias E, San Román Manzanera L, Lagares Gomez-Abascal A, Gabarrós A, González García A. [Neuroimaging follow-up of cerebral aneurysms treated with endovascular techniques]. Radiologia 2013; 56:118-28. [PMID: 24144295 DOI: 10.1016/j.rx.2013.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/25/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022]
Abstract
There are no specific recommendations in clinical guidelines about the best time, imaging tests, or intervals for following up patients with intracranial aneurysms treated with endovascular techniques. We reviewed the literature, using the following keywords to search in the main medical databases: cerebral aneurysm, coils, endovascular procedure, and follow-up. Within the Cerebrovascular Disease Group of the Spanish Society of Neuroradiology, we aimed to propose recommendations and an orientative protocol based on the scientific evidence for using neuroimaging to monitor intracranial aneurysms that have been treated with endovascular techniques. We aimed to specify the most appropriate neuroimaging techniques, the interval, the time of follow-up, and the best approach to defining the imaging findings, with the ultimate goal of improving clinical outcomes while optimizing and rationalizing the use of available resources.
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Affiliation(s)
- F Delgado
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Reina Sofia, Córdoba, España
| | - A Saiz
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, España
| | - A Hilario
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital 12 de Octubre, Madrid, España
| | - E Murias
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, España
| | - L San Román Manzanera
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Clinic, Barcelona, España
| | | | - A Gabarrós
- Servicio Neurocirugía, Hospital de Bellvitge, Barcelona, España
| | - A González García
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España.
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Almeida-Pérez R, Espinosa-García H, Alcalá-Cerra G, de la Rosa-Manjarréz G, Orozco-Gómez F. [Endovascular coiling of a «true» posterior communicating artery aneurysm]. Neurocirugia (Astur) 2013; 25:90-3. [PMID: 23831341 DOI: 10.1016/j.neucir.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/19/2013] [Indexed: 10/26/2022]
Abstract
True posterior communicating artery aneurysms originate exclusively from the wall of this artery and should be differentiated from aneurysms of the posterior communicating segment of the distal carotid artery. As these lesions are rare, their anatomical relationships have been poorly described; likewise, reports concerning their endovascular treatment are extremely rare and the technical aspects poorly detailed. A case of a patient with a true aneurysm of the left posterior communicating artery treated by endovascular coiling is presented. A literature review was also conducted to illustrate the anatomical and technical details relevant to achieving its successful treatment.
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Affiliation(s)
- Rafael Almeida-Pérez
- Sección de Neurocirugía, Universidad de Cartagena, Cartagena de Indias, Colombia; Servicio de Neurocirugía Endovascular y Neurorradiología Intervencionista, Neurodinamia S.A., Cartagena de Indias, Colombia
| | - Héctor Espinosa-García
- Servicio de Neurocirugía Endovascular y Neurorradiología Intervencionista, Neurodinamia S.A., Cartagena de Indias, Colombia
| | - Gabriel Alcalá-Cerra
- Sección de Neurocirugía, Universidad de Cartagena, Cartagena de Indias, Colombia; Grupo de Investigación en Ciencias de la Salud y Neurociencias (CISNEURO), Cartagena de Indias, Colombia.
| | - Ginna de la Rosa-Manjarréz
- Servicio de Neurocirugía Endovascular y Neurorradiología Intervencionista, Neurodinamia S.A., Cartagena de Indias, Colombia
| | - Fernando Orozco-Gómez
- Servicio de Neurocirugía Endovascular y Neurorradiología Intervencionista, Neurodinamia S.A., Cartagena de Indias, Colombia
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Vivancos J, Gilo F, Frutos R, Maestre J, García-Pastor A, Quintana F, Roda JM, Ximénez-Carrillo A, Díez Tejedor E, Fuentes B, Alonso de Leciñana M, Alvarez-Sabin J, Arenillas J, Calleja S, Casado I, Castellanos M, Castillo J, Dávalos A, Díaz-Otero F, Egido JA, Fernández JC, Freijo M, Gállego J, Gil-Núñez A, Irimia P, Lago A, Masjuan J, Martí-Fábregas J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Morales A, Nombela F, Purroy F, Ribó M, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J. Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment. Neurologia 2012; 29:353-70. [PMID: 23044408 DOI: 10.1016/j.nrl.2012.07.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 07/11/2012] [Accepted: 07/13/2012] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment. MATERIAL AND METHODS A review and analysis of the existing literature. Recommendations are given based on the level of evidence for each study reviewed. RESULTS The most common cause of spontaneous subarachnoid haemorrhage (SAH) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm. CONCLUSIONS SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes.
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