Peter Keston

The endovascular management of pericallosal artery aneurysms

AIM to describe our experience with a series of 18 patients with pericallosal artery aneurysms, in whom endovascular coil insertion was attempted. METHOD the CT and angiographic appearances, coiling techniques and patient outcomes are discussed. RESULTS we encountered a higher than expected level of technical difficulty and procedure related complication than when coiling aneurysms in more common locations. In particular the distal position of the aneurysms lead to poorer control over the microcatheter position. Procedure related rupture occurred in three cases. Coiling was not possible in one case only. An association between an angulated bifurcation of the anterior cerebral artery and a sidewall aneurysm configuration was noted. CONCLUSION despite the technical difficulties and high procedure related rupture rate, coiling of pericallosal aneurysms is feasible and has good outcome.

Vascular plug for ICA occlusion in cavernous carotid aneurysms: technical note

IntroductionLarge, symptomatic aneurysms of the cavernous internal carotid artery (ICA) can be successfully treated by a combination of aneurysm coiling and occlusion of the parent vessel.Case presentationWe describe the use of an Amplatzer (AGA medical corporation, Plymouth, MA, USA) detachable nitinol vascular plug to occlude the ICA in four patients with symptomatic cavernous ICA aneurysms.

Spontaneous subdural haematoma in a healthy young male

The authors present an unusual case of a healthy young male who developed a spontaneous subdural haematoma. Headache was followed by blurring of vision and left upper limb symptoms. The diagnosis was made from a CT scan. Symptoms resolved with surgical decompression. The authors explore the risk factors and pathophysiology implicated in this condition. The authors demonstrate that apparently ‘healthy’ pursuits can have significant consequences, but the physician must also exclude serious underlying risk factors for bleeding, which the authors discuss.

Initial experience with a new soft stretch-resistant coil

The UltiPaq very soft, stretch-resistant coil is a useful new addition to the coil range available to neurointerventionists. Its highly compliant character makes it very suitable for small, ruptured aneurysms, which can easily rerupture during coiling, and for packing the necks of larger aneurysms. It has the advantage of a rapid detachment and does not leave any tail in the parent vessel. The high density of packing achieved in these cases should result in good long-term results, but further follow up is awaited.

A traumatic pseudoaneurysm of the vertebral artery

Although uncommon, vertebral artery pseudoaneurysms harbour significant risk of embolic stroke and their presence should be considered in cases of blunt cervical trauma. We illustrate a case of a traumatically ruptured vertebral artery pseudoaneurysm treated with coil embolisation.

Bacterial meningitis associated with a complex ischiorectal abscess

We describe a case of bacterial meningitis in a 37 year old man resulting from the direct extension of an spontaneously occurring ischiorectal abscess into the intradural space. The patient presented with back pain and urinary retention and this was followed by the development of headache, photophobia and a left VIth nerve palsy. The patient was not diabetic or immunocompromised. He was treated with broad spectrum antibiotics and with drainage of the ischiorectal abscess; no organism was grown from blood, abscess contents or cerebrospinal fluid. He went on to make a full recovery.

Unusual case of intracranial dural AV fistula presenting with acute myelopathy

We present a case of intracranial arteriovenous fistula with perimedullary venous drainage presenting with acute myelopathy, which is an unusual presentation of this uncommon condition. Subsequent catheter angiogram defined the arterial feeders from the meningohypophyseal trunk and petrosal branch of the middle meningeal artery. The patient was successfully embolised, resulting in complete obliteration of the fistula, and significant resolution of brainstem and cervical cord changes along with clinical improvement.

Diagnostic Spinal Angiography

Spinal angiography encompasses both transarterial catheter digital subtraction angiography and, increasingly, magnetic resonance- and computed tomography-based techniques for noninvasive imaging of spinal blood vessels.

Unlocking the ‘locked-in syndrome’

We present a case of a 48-year-old man who was initially thought to have had a brainstem stroke and was clinically ‘locked-in’. Upon investigation, a petrous apex dural atriovenous fistula was identified causing profound brainstem venous hypertension. Surgical clipping lead to complete neurological recovery.

K. A. Miles, J. D. Eastwood, M. Konig: Multidetector computed tomography in cerebrovascular disease: CT perfusion imaging

This book is a collection of individually authored, referenced chapters logically arranged to discuss various aspects of perfusion CT (PCT). It begins with a full explanation of the mathematical models that can be used to measure regional perfusion parameters in vivo using a contrast bolus tracking technique. Next there is discussion of the technical performance and optimisation of image acquisition strategies. Stroke imaging has been the driving force behind CTP development and the chapters dealing with this clinical application of CTP are authoritative. There is little discussion of the role of CTP in tumour permeability imaging and only short chapters covering imaging of vasospasm and comparing CTP with other methods of cerebral perfusion imaging. This aside, the book ‘does what it says on the tin’ and I would recommend it as a comprehensive reference text for radiologists providing a PCT service, stroke physicians and for those with a research interest in cerebral perfusion imaging. Acta Neurochir (Wien) (2008) 150:1115 DOI 10.1007/s00701-008-0035-1