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Spontaneous middle meningeal arteriovenous fistula without cortical venous reflux presenting with acute subdural hematoma: illustrative case

Masahiro Yabuki, Yosuke Akamatsu, Hiroshi Kashimura, Yoshitaka Kubo, and Kuniaki Ogasawara

–14 We demonstrate a rare case of spontaneous acute subdural hematoma (SDH) caused by an MMAVF without CVR and discuss the mechanism of hemorrhagic presentation based on the findings during transarterial Onyx embolization. Illustrative Case A 17-year-old previously healthy male presented to our emergency department with the acute onset of headache. The patient had no history of head trauma. Computed tomography (CT) revealed a left acute SDH without significant mass effect ( Fig. 1A ). T2-weighted magnetic resonance imaging (MRI) performed on admission showed no

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Subarachnoid hemorrhage due to intradural cerebral aneurysm and simultaneous spinal subdural hematoma: illustrative case

Francisco Hernández-Fernández, Noemí Cámara-González, María José Pedrosa-Jiménez, and Cristian Alcahut-Rodríguez

. Spinal subdural hematoma. A review . Surg Neurol . 1983 ; 20 ( 2 ): 133 – 137 . 10.1016/0090-3019(83)90464-0 3 Gillilan LA . Veins of the spinal cord. Anatomic details; suggested clinical applications . Neurology . 1970 ; 20 ( 9 ): 860 – 868 . 10.1212/WNL.20.9.860 4 Boop WC Jr , Chou SN , French LA . Ruptured intracranial aneurysm complicated by subdural hematoma . J Neurosurg . 1961 ; 18 : 834 – 836 . 10.3171/jns.1961.18.6.0834 5 Koerbel A , Ernemann U , Freudenstein D . Acute subdural haematoma without

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Middle meningeal artery embolization for chronic subdural hematoma in a young patient with refractory thrombocytopenia secondary to leukemia: more evidence for a paradigm shift? Illustrative case

Emalee J. Burrows, Seng Chye Lee, Omar K. Bangash, Timothy J. Phillips, and Sharon Lee

subdural hematoma: meta-analysis and systematic review . World Neurosurg . 2019 ; 122 : 613 – 619 . 30481628 5 Feghali J , Yang W , Huang J . Updates in chronic subdural hematoma: Epidemiology, etiology, pathogenesis, treatment, and outcome . World Neurosurg . 2020 ; 141 : 339 – 345 . 32593768 6 Edlmann E , Giorgi-Coll S , Whitfield PC , Carpenter KLH , Hutchinson PJ . Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy . J Neuroinflammation . 2017 ; 14 ( 1 ): 108

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Traumatic aneurysm at the superior cerebellar artery: illustrative case

Mun-Chun Yeap, Meng-Wu Chung, and Chun-Ting Chen

convexity and tentorium. Surgery was not indicated then because of no neurological deficit. However, he had persistent left-sided headache. Ten days later, sudden unbearable headache, nausea, vomiting, and gradual decrease level of consciousness were noted. His Glasgow Coma Scale (GCS) score was E2V3M5. CT revealed an increased amount of hyperdense subdural hematoma. He received emergency craniotomy for hematoma evacuation. Postoperatively, he regained clear consciousness but still complained of frequent headache. Repeat CT on postoperative day 2 showed residual subdural

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Transarterial embolization through the infraorbital artery of the ethmoidal dural arteriovenous fistula causing recurrent epistaxis: illustrative case

Min-Yong Kwon, Sae Min Kwon, Chang-Hyun Kim, and Chang-Young Lee

cortical veins Type IV Transarterial embolization (rt IOA) Complete (no recurrence) SDH = subdural hematoma. Başkaya et al. 10 found an intranasal hyperintense signal on T1-weighted MRI in an ethmoidal DAVF with epistaxis but did not mention what was the likely source. van Dijk et al. 11 noted that the bleeding was associated with the fistulous network extending downward into the nasal cavity. Tripathi et al. 12 found that the cause of epistaxis was likely the enlarged friable vessels originating from the ophthalmic artery (OA) with a beaded

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Ruptured aneurysms at the distal superior cerebellar artery successfully treated by combining occipital artery–superior cerebellar artery anastomosis and endovascular therapy: illustrative case

Takenori Ogura, Taketo Hatano, Masaomi Koyanagi, Taisuke Kitamura, and Daisuke Yamada

-stage treatment in a hybrid operating room was chosen. A major concern associated with combined treatment is hemorrhagic complications caused by heparinization. The potential for incidence of intracranial hemorrhage, such as subdural hematoma, is a concern associated with two-stage treatments performed soon after bypass surgery. In this regard, single-stage treatment is considered beneficial because adequate hemostasis can be confirmed before wound closure after endovascular treatment. Although our combined treatment strategy provided new insights, it had several limitations

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Coccidioidal meningitis with multiple aneurysms presenting with pseudo–subarachnoid hemorrhage: illustrative case

Rohin Singh, Visish M. Srinivasan, Joshua S. Catapano, Joseph D. DiDomenico, Jacob F. Baranoski, and Michael T. Lawton

from the EVD, prompting concern for aneurysmal rupture. CT of the head demonstrated diffuse hyperdensities in the basal cisterns, obscuring visualization of possible aneurysmal SAH ( Fig. 1E ). However, CT scans also showed a clear right acute subdural hematoma with a midline shift ( Fig. 2A ). The patient was taken for emergent craniotomy. A right pterional craniotomy was performed, and the subdural hematoma was evacuated. Upon inspection, all aneurysms were intact, and the blood was determined to be of subdural origin, likely caused by the patient’s CM ( Fig. 2B

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Spontaneous intracranial hemorrhage presenting in a patient with vitamin K deficiency and COVID-19: illustrative case

Nathaniel R. Ellens and Howard J. Silberstein

lethargic with a bulging but compressible fontanelle and a fixed right gaze deviation with reports of seizure activity en route to the hospital. Intravenous Keppra was administered at a dose of 60 mg/kg. Noncontrast computed tomography (CT) scans of the head demonstrated extensive subdural hematomas, most prominently over the tentorium bilaterally, along the falx, and extending inferiorly toward the foramen magnum. There was also moderate intraventricular hemorrhage within the bilateral lateral ventricles and the 3rd and 4th ventricles, with prominent hydrocephalus ( Fig

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High-flow bypass for giant dolichoectatic vertebrobasilar aneurysms: illustrative cases

Richard Shaw, Alistair Kenneth Jukes, and Rodney Stewart Allan

embolism; PICA = posterior inferior cerebellar artery; pst = posterior; SDH = subdural hematoma; TL/TC = translabyrinthine/transcochlear; VPS = ventriculoperitoneal shunt. High-Flow Bypass Technique Both patients had insufficient posterior communicating artery collateral supply. Consequently, we elected to perform an ECA-to-PCA (P2) high-flow bypass to initially establish an alternative posterior circulation before proximal Hunterian ligation. Although a detailed description of this surgical technique has been published previously, 12 we herein describe

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Atlantoaxial wiring hardware failure resulting in intracranial hemorrhage and hydrocephalus: illustrative case

Anass Benomar, Harrison J. Westwick, Sami Obaid, André Nzokou, Sung-Joo Yuh, and Daniel Shedid

tomography (CT) of the head demonstrated subarachnoid and intraventricular hemorrhage with moderate hydrocephalus and signs of intracranial hypertension. Imaging also revealed a high cervical and posterior fossa subdural hematoma ( Fig. 1 ). She was transferred to our institution with a high-grade subarachnoid hemorrhage and hydrocephalus. FIG. 1. Axial noncontrast CT of the head showing upper cervical subdural hemorrhage ( A ), posterior fossa subarachnoid hemorrhage ( B ), intraventricular hemorrhage in the fourth ventricle ( B ), and hydrocephalus ( C ). She