Yoshihiko Fu

Aneurysmal rupture during angiography.

The aim of the present study was to analyze the clinical data on rebleeding in cerebral aneurysms during angiography and to evaluate the importance of the time interval between the latest rupture and angiography. Fourteen personal cases and 202 patients reported in the literature are reviewed. Rebleeding during angiography occurred most often (78%) on Day O; 89% bled when angiography was performed within 6 hours of the latest rupture. The prognosis in such ruptures was poor, with a mortality of 79%. Intentional delay in angiography of at least 6 hours from the latest rupture is recommended if the associated hematoma is not large.

Simultaneous bleeding from multiple lenticulostriate arteries in hypertensive intracerebral haemorrhage

Angiography within 1 h of the onset of an intracerebral haematoma in a hypertension man showed active bleeding from at least two lenticulostriate arteries. We discuss the pathophysiological significance of this finding.

Spontaneous Spinal Subarachnoid Hematoma of Unknown Pathogenesis: Case Reports

OBJECTIVE AND IMPORTANCE The occurrence of spontaneous spinal subarachnoid hematoma of unknown pathogenesis is extremely rare. In the cases reported to date, the hematoma, located dorsal to the spinal cord (dorsal type), has caused paraplegia and has required emergency surgical intervention. CLINICAL PRESENTATION We examined two patients who sustained spontaneous spinal subarachnoid hematoma. Both experienced sudden back pain, but there were no symptoms of spinal cord compression. Magnetic resonance imaging revealed spinal subarachnoid hematoma located ventral to the spinal cord (ventral type). INTERVENTION Both patients were treated conservatively, and follow-up examinations have revealed that they have remained neurologically normal for 7 years and 6 months, respectively. CONCLUSION We postulate that there are two types of spontaneous spinal subarachnoid hematoma of unknown pathogenesis (ventral and dorsal types), each of which presents a distinct clinical picture and prognosis. Ventral type hematoma may be one of the causes of acute back pain, and because of its benign prognosis, surgical treatment may not be necessary.

Traumatic carotid-cavernous sinus fistula associated with an intradural pseudoaneurysm: a case report.

A case of traumatic carotid-cavernous sinus fistula (CCF) associated with an intradural pseudoaneurysm is reported. A 42-year-old man developed traumatic CCF after severe head trauma. Cerebral angiography demonstrated a direct CCF associated with an intradural pseudoaneurysm at the C2 portion. Transarterial balloon embolization of the CCF caused severe subarachnoid hemorrhage. A CCF with an intradural pseudoaneurysm is life-threatening and requires emergency treatment. However, balloon occlusion in such cases is contraindicated because of possible rupture of a pseudoaneurysm. Trapping or a direct surgical approach is the treatment of choice.

Indirect carotid-cavernous sinus fistula: Transvenous embolization from the external jugular vein using a superior ophthalmic vein approach. A case report

A case of indirect carotid-cavernous sinus fistula treated by combined transarterial and transvenous embolization is described. A 49-year-old woman with a right indirect carotid-cavernous sinus fistula draining solely to the right superior ophthalmic vein was treated first by transarterial embolization with polyvinyl alcohol particles. Then, by approaching through the superior ophthalmic vein from the right external jugular vein, the cavernous sinus was embolized with platinum wire using a tracker microcatheter, which resulted in marked clinical improvement. Transvenous embolization by approaching from the external jugular vein through the superior ophthalmic vein represents a promising alternative when shunted blood drains anteriorly to the superior ophthalmic vein.

MR imaging of dural AV fistulas at the cavernous sinus.

The magnetic resonance appearance of dural arteriovenous fistulas (AVFs) at the cavernous sinus (CS) was studied in six angiographically verified cases. Magnetic resonance clearly demonstrated shunted blood as an area of signal void both in the CS and in the superior ophthalmic vein. The relationship between shunted blood, internal carotid artery, and extraocular nerves, as well as proptosis, enlargement of the extraocular muscles, and bulging of the lateral wall of the CS were also depicted in the images. Normal venous flow in the involved CS was shown as a low signal area that enhanced after gadolinium administration. Magnetic resonance is useful for screening and follow-up examinations of dural AVFs at the CS. It is essentially a noninvasive procedure that may be repeated and obviates the need for follow-up angiography. However, it should be noted that a signal void in the CS sometimes represents normal venous flow. A definite diagnosis should rely on angiography, which is essential for therapeutic planning.

Angiographic extravasation of contrast medium in acute “spontaneous” subdural hematoma

Acute spontaneous subdural hematoma is very rare. We have encountered four such cases and verified the arterial origin of the bleeding at operation. None of the patients had a history of head trauma, and each had developed sudden onset of headache and other neurologic deficits, which simulate other cerebrovascular diseases. CT directly revealed subdural hematoma but gave no indication as to the source of the bleeding. Cerebral angiography was performed in all cases, with three of them showing localized extravasation of the contrast material into the subdural space. The extravasation was noted usually in the late arterial phase. This is a useful finding for diagnosing this disease and localizing the bleeding point. It is expected that with more routine use of cerebral angiography in cases of acute spontaneous subdural hematoma, extravasation of the contrast medium will be seen more frequently.

Direct surgery for posttraumatic carotid-cavernous fistula as a result of an intradural pseudoaneurysm : case report

OBJECTIVE AND IMPORTANCE Traumatic carotid-cavernous fistula (CCF) is currently treated with interventional neuroradiological embolization procedures. A rare case of posttraumatic CCF that resulted from an intradural pseudoaneurysm is presented. The patient was treated by direct surgery because an embolization procedure was not suitable. CLINICAL PRESENTATION A 16-year-old boy developed chemosis in the right eye 17 days after a traffic accident. Angiography revealed a pseudoaneurysm that arose from the site of origin of the posterior communicating artery, drained directly into the cavernous sinus, and formed a high-flow CCF. INTERVENTION Direct surgery was performed to repair the arterial laceration at the junction of the internal carotid artery and the posterior communicating artery. A clip was applied along the internal carotid artery. The posterior stump of the damaged posterior communicating artery was also included in the clip. Postoperatively, the CCF and pseudoaneurysm were completely obliterated, and the symptoms were cured. CONCLUSION Awareness of an unusual intradural origin of a CCF and the possibility of a direct surgical treatment should be kept in mind.

Chronic subdural hematoma associated with middle meningeal arteriovenous fistula treated by a combination of embolization and burr hole drainage

A rare case of chronic subdural hematoma associated with a middle meningeal arteriovenous fistula was treated by a combination of embolization and burr hole drainage. This clinical situation might be missed in this era of computed tomography, when cerebral angiography is seldom indicated for the diagnosis of neuro-traumatic diseases. We should bear in mind the possibility of this clinical situation of a chronic subdural hematoma associated with a linear skull fracture crossing the middle meningeal groove in order to avoid possible hemorrhagic complications during surgery for chronic subdural hematoma.

Mechanism of acute deterioration of the neurological status following rapid and massive intraluminal thrombosis in case of a giant intracavernous carotid artery aneurysm: Demonstration by mr imaging

A case is reported of a thrombosed giant aneurysm of the intracavernous carotid artery. Transient neurological deterioration was attributable to the acute swelling of the aneurysmal mass after rapid and massive intraluminal thrombosis. Characteristics on the magnetic resonance imaging of this case are reported and discussed.