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Ruptured aneurysm–induced pituitary apoplexy: illustrative case

Michiharu Yoshida, Takeshi Hiu, Shiro Baba, Minoru Morikawa, Nobutaka Horie, Kenta Ujifuku, Koichi Yoshida, Yuki Matsunaga, Daisuke Niino, Ang Xie, Tsuyoshi Izumo, Takeo Anda, and Takayuki Matsuo

Pituitary apoplexy is a clinical syndrome caused by acute hemorrhage or ischemic infarction of the pituitary gland. Pituitary apoplexy associated with a ruptured aneurysm is extremely rare. 1 We report the first case of pituitary apoplexy caused by rupture of an A1 segment anterior cerebral artery aneurysm that was embedded within a giant nonfunctioning pituitary adenoma, and we review the pathophysiology and relevant literature. Illustrative Case A 78-year-old right-handed man experienced sudden headache and nausea with bitemporal hemianopia and

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Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture

Thanh N. Nguyen, Jean Raymond, François Guilbert, Daniel Roy, Maxime D. Bérubé, Mostafa Mahmoud, and Alain Weill

P rocedure-related rupture, one of the most feared complications of endovascular therapy for ruptured aneurysms, is associated with high rates of neurological disability (5–63%) 2 , 7 and mortality (20–63%). 4 , 12 , 13 , 16 In a large meta-analysis, ruptured aneurysm was confirmed as a risk factor for procedure-related rupture. 2 Small size has also been reported as a risk factor, 14 , 18 but this was recently challenged. 15 Confirmation of size as a risk factor for procedure-related rupture is important for better estimates of patient risk

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A rapid noninvasive method to visualize ruptured aneurysms in the emergency room: three-dimensional power Doppler imaging

Fabienne Perren, Peter Horn, Rolf Kern, Eva Bueltmann, Michael Hennerici, and Stephen Meairs

confirmed the diagnosis of intracranial aneurysm in all cases, with identical location and size. On follow-up review none of the patients had died and all of them recovered well. We describe two cases to illustrate our results in more detail. TABLE 1 Summary of findings in patients with SAH in whom 3D power Doppler imaging was performed * Case No. Age (yrs), Sex Initial GCS Score Hunt & Hess Grade Diagnosis Treatment Outcome 1 45, F 6 IV ruptured aneurysm, lt MCA clip occl, good  EVD, & VP

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Ruptured aneurysms of the middle cerebral artery

Richard G. Robinson

N orman Dott in 1930 seems to have been the first surgeon to have deliberately operated on a ruptured aneurysm of the middle cerebral artery. 2 The lesion was located by clinical acumen, the sac wrapped with muscle hammered onto gauze, and the patient survived another 12 years to die of a myocardial infarction. Yet surgery of cerebral aneurysms did not get underway until after World War II by which time carotid arteriography had become available. There are many reports on the surgical management of ruptured intracranial aneurysms, and most interest has

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Ruptured aneurysm at the anterior cerebral artery fenestration

Case report

Tohru Yamada, Tetsuji Inagawa, and Tetsuji Takeda

F enestration of the anterior cerebral artery (ACA) is rare. We present the case of a patient who presented with a ruptured aneurysm arising from the proximal end of a fenestration of the ACA. The lesion was demonstrated by angiography and confirmed at surgery. Case Report This 43-year-old man suddenly developed severe headache on February 26, 1980, followed by gradual development of stupor. Examination . On admission on February 27, the significant findings were hemorrhage in the right ocular fundus and stiffness of the neck. Computerized tomography

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Results of early operations for ruptured aneurysms

Bengt Ljunggren, Lennart Brandt, Erik Kågström, and Göran Sundbärg

T he choice of timing of surgical intervention for ruptured intracranial aneurysms has caused controversy for many years. In 1953, Norlén and Olivecrona 29 concluded that intracranial operations for ruptured aneurysms were extremely dangerous during the acute phase, and advised that surgery should be delayed until after the 3rd week of the acute illness. On the other hand, Pool 31 pointed out in 1961 that the mortality rate need not be forbiddingly high in young patients in good condition. The first observation that angiographic spasm does not develop

Open access

Endovascular treatment of a ruptured aneurysm arising from the proximal end of a partial vertebrobasilar duplication with a contralateral prominent persistent primitive hypoglossal artery: illustrative case

Nobuyuki Genkai, Kouichirou Okamoto, Toshiharu Nomura, and Hiroshi Abe

Persistent carotid-basilar connections have a low prevalence, and a persistent primitive hypoglossal artery (PPHA) is extremely rare. 1 Most carotid-basilar connections are incidental findings. However, a high incidence of PPHAs has been associated with cerebral aneurysms. 1 , 2 Hypoplasia or aplasia of the vertebral artery (VA) is a common finding in patients with a PPHA, 1 requiring precise analysis of the vascular anatomy and hemodynamics when treating a ruptured aneurysm in these patients. The primitive lateral basilovertebral anastomosis (PLBA) is

Free access

Saccular aneurysms in the post–Barrow Ruptured Aneurysm Trial era

Joshua S. Catapano, Mohamed A. Labib, Visish M. Srinivasan, Candice L. Nguyen, Kavelin Rumalla, Redi Rahmani, Tyler S. Cole, Jacob F. Baranoski, Caleb Rutledge, Kristina M. Chapple, Andrew F. Ducruet, Felipe C. Albuquerque, Joseph M. Zabramski, and Michael T. Lawton

T he Barrow Ruptured Aneurysm Trial (BRAT) was a single-center trial comparing endovascular embolization (coiling) to microsurgical clipping for treatment of patients experiencing aneurysmal subarachnoid hemorrhage (aSAH). 1 – 5 At long-term follow-up, the neurological outcome did not differ for patients with saccular aneurysms treated endovascularly and those treated microsurgically, but rates of retreatment were significantly higher in patients with endovascular treatment. 1 , 2 However, results from the BRAT have been heavily criticized because of a

Free access

An evaluation of the SAFIRE grading scale as a predictor of long-term outcomes for patients in the Barrow Ruptured Aneurysm Trial

Joshua S. Catapano, Mohamed A. Labib, Fabio A. Frisoli, Megan S. Cadigan, Jacob F. Baranoski, Tyler S. Cole, James J. Zhou, Candice L. Nguyen, Alexander C. Whiting, Andrew F. Ducruet, Felipe C. Albuquerque, and Michael T. Lawton

study that investigated outcomes in patients with aSAH who underwent either endovascular coiling or surgical clipping. 10 The present study attempts to assess the long-term predictive capability of the SAFIRE grading scale using the Barrow Ruptured Aneurysm Trial (BRAT) patient population by comparing patient outcomes at the 1- and 6-year follow-ups with retrospectively calculated SAFIRE grades. The BRAT contains longitudinal patient outcome data, making it an excellent population in which to analyze the viability of the SAFIRE scale in predicting long-term outcomes

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The Barrow Ruptured Aneurysm Trial: 6-year results

Robert F. Spetzler, Cameron G. McDougall, Joseph M. Zabramski, Felipe C. Albuquerque, Nancy K. Hills, Jonathan J. Russin, Shahram Partovi, Peter Nakaji, and Robert C. Wallace

E ndovascular coil embolization and surgical clip occlusion are the currently accepted treatment options for patients with ruptured intracranial aneurysms. Since the publication of results from the International Subarachnoid Aneurysm Trial (ISAT) in 2002, endovascular treatment has become the mainstay in many centers, especially in Europe. 6 The 1-year results of ISAT showed that for the treatment of ruptured aneurysms, coil embolization was superior to clip occlusion, but most of the trial patients had small aneurysms in the anterior circulation and were