Intracranial arterial aneurysm due to birth trauma

Case report

Full access

✓ The authors present what is believed to be the first description of an intracranial arterial aneurysm attributable to birth trauma. A male neonate, the product of a precipitious, instrumented, footling breech delivery, exhibited seizures at the age of 18 hours. A computerized tomography scan of the head showed hemorrhage along the tentorium with a globular component at the incisura. Transfontanel Doppler ultrasound examination detected pulsatile arterial flow within the globular mass. Cerebral angiography demonstrated a 1.5-cm saccular aneurysm arising from a small distal branch of the superior cerebellar artery. The pathogenesis of aneurysms in children is obscure and controversial. Birth trauma may be responsible for some pediatric aneurysms that are currently classified as idiopathic or congenital, particularly aneurysms in the region of the tentorial incisura.

Abstract

✓ The authors present what is believed to be the first description of an intracranial arterial aneurysm attributable to birth trauma. A male neonate, the product of a precipitious, instrumented, footling breech delivery, exhibited seizures at the age of 18 hours. A computerized tomography scan of the head showed hemorrhage along the tentorium with a globular component at the incisura. Transfontanel Doppler ultrasound examination detected pulsatile arterial flow within the globular mass. Cerebral angiography demonstrated a 1.5-cm saccular aneurysm arising from a small distal branch of the superior cerebellar artery. The pathogenesis of aneurysms in children is obscure and controversial. Birth trauma may be responsible for some pediatric aneurysms that are currently classified as idiopathic or congenital, particularly aneurysms in the region of the tentorial incisura.

Infants and children are subject to the development of infectious and traumatic intracranial aneurysms just like adults, and, similar to adults, they occasionally exhibit aneurysms with an apparently hemodynamic pathogenesis in association with conditions such as arteriovenous malformations and moyamoya syndrome. Nevertheless, most pediatric intracranial arterial aneurysms are unexplained, and the etiology of these lesions remains controversial. Despite speculation that certain pediatric aneurysms may be attributable to birth trauma,27,36,41 a review of the literature discloses no previous examples of this phenomenon.

Case Report

This infant was born to a 36-year-old woman after an unremarkable full-term pregnancy. Presentation was by footling breech, the delivery was precipitous, and the after-coming head was delivered with forceps. The Apgar scores were 8 and 9 at 1 and 10 minutes, respectively. The infant was well until the age of 18 hours when opisthotonic posturing was observed, followed shortly by two tonic-clonic seizures. A computerized tomography (CT) scan of the head demonstrated hemorrhage layered over the surface of the tentorium with a discrete globular hematoma at the edge of the incisura in the ambient cistern on the left (Fig. 1).

Fig. 1.
Fig. 1.

Computerized tomography scan of the head without intravenous contrast enhancement showing fresh hemorrhage layered over the surface of the tentorium. At the edge of the tentorial incisura on the left is a discrete globular hematoma with central low density (arrow).

At the time of transfer, the patient appeared well. The head circumference was 37 cm and the fontanel was slack. The lambdoid sutures were overriding. Transfontanel Doppler ultrasound examination of the head demonstrated pulsatile arterial flow at the center of the globular incisural mass (Fig. 2); there was no hydrocephalus. At the age of 5 days, a cerebral angiogram was performed. The left vertebral artery injection demonstrated a 1.5-cm saccular aneurysm arising from a small branch of the left superior cerebellar artery (Fig. 3). Conservative management was recommended, and the patient was discharged home at the age of 6 days.

Fig. 2.
Fig. 2.

Left: Transfontanel ultrasound study in a coronal plane demonstrating an echogenic mass (arrow) with a hypoechoic center at the level of the tentorial incisura. Right: The Doppler ultrasound cursor has been positioned overlying the hypoechoic center of the incisural mass. A pulsatile blood velocity signal is recorded below.

Fig. 3.
Fig. 3.

Left vertebral angiograms, lateral projection. A: An early image demonstrating a 1.5-cm aneurysm arising from a distal vermian branch of the left superior cerebellar artery. A jet of contrast material is seen entering the aneurysm (arrow). B: Later image showing a blood contrast level (arrows). C: This follow-up angiogram obtained 5 weeks later was normal.

Repeat angiography at 40 days of age was normal. The aneurysm was not visualized. Repeat transfontanel Doppler ultrasound examination was also normal. Pulsatile arterial flow was no longer detected at the site of the hematoma, and there was no hydrocephalus. The patient remained well at 6 months of age.

Discussion
Intracranial Hemorrhage in the Neonate

Intracranial hemorrhage has long been recognized as a major source of morbidity and mortality in the neonate. In the modern era the most common form of neonatal intracranial hemorrhage is the germinal matrix hemorrhage of extreme prematurity; however, in the first part of this century birth trauma was the predominant etiology, and the mechanisms and gross pathology of traumatic neonatal intracranial hemorrhage received intensive examination.5,6,8,11,14,15,17,28 Births with vertex or breech presentation subject the head to compressive fronto-occipital foreshortening during passage through the birth canal. Actual flexion of the skull base about a transverse axis through the spheno-occipital synchondrosis has been demonstrated.28 Because the contents of the cranial cavity are noncompressible, the volume of the cranial cavity must remain constant and, as the distance from the nasion to the inion diminishes, the distance from the skull base to the vertex must increase.15,17,28 The tentorium and the posterior portion of the falx resist this deformation and are placed under tension. Abrupt fronto-occipital compression in the course of a precipitous delivery may cause laceration of the falx or the free edge of the tentorium. Rupture of the great vein of Galen and its tributaries has been observed in this setting.5,6,8,11,15,17

Neonatal hemorrhage in the region of the tentorial incisura has generally been considered to be venous in origin.5,6,8,15,17,45 We have found only two examples of intracranial arterial hemorrhage related to birth trauma, and neither of these cases involved the incisura.22,35 Nevertheless, there are at least two plausible mechanisms for arterial hemorrhage at this location during the birth process: 1) the deformation to which the region of the incisura is subject during the birth process might lead to forcible apposition of the posterior cerebral artery against the sharp, hard free edge of the tentorium; 2) as the superior cerebellar and posterior cerebral arteries both give off small branches that pass through the perimesencephalic cistern to irrigate the free edge of the tentorium,30 severe deformation of the tentorium might rupture or avulse one of these branches.

Aneurysms in Infancy and Childhood

Compelling circumstantial evidence suggests that the aneurysm in the case reported here was of traumatic etiology. Breech presentation, precipitous delivery, and the use of forceps are all risk factors for neonatal intracranial hemorrhage that suggest that sudden fronto-occipital compression of the head occurred during the birth process in this case. The CT appearance of the hematoma was consistent with hemorrhage during delivery or at some time during the first 18 hours after birth. The location of the aneurysm, although not characteristic of traumatic aneurysms in older age groups, was at a site critically affected by the deformations of intracranial structures associated with fronto-occipital compression. We believe that fronto-occipital compression of the head in the course of a precipitous delivery caused stretching of the tentorium with injury of a small distal branch of the superior cerebellar artery. Whether the aneurysm that developed was a true or a false aneurysm could not be determined because thrombosis and healing of the lesion occurred in the interval between angiograms and no operation was performed. Other explanations seem very improbable. The situation of the aneurysm at the end of a small vessel distal to the circle of Willis argues against a degenerative, hemodynamic pathogenesis. The clinical setting and the patient's complete recovery without specific treatment allow dismissal of an infectious etiology. Although birth trauma as a cause for intracranial arterial aneurysm has not been described before, there is no other plausible explanation for the observations in this case.

Intracranial arterial aneurysms in the neonatal period are rare occurrences. Defining the neonatal period as the first 4 weeks after birth, we have identified only 13 other cases in the literature.4,10,19,20,23,24,29,34,39,43,44,47 The aneurysms were located on the middle cerebral artery in six cases, on the internal carotid artery in two cases, on the posterior cerebral artery in two cases, on the posterior inferior cerebellar artery in one case, and at the basilar bifurcation in one case; in one case the precise location was not described. In none of these reports was the lesion suspected to be mycotic, and no patient had a systemic disease associated with the development of intracranial arterial aneurysms. Bremer4 described a basilar bifurcation aneurysm in a 42-mm fetus, and Wierdis, et al.,47 described a middle cerebral artery aneurysm in a stillborn infant. These cases aside, our patient had the earliest reported presentation of aneurysm. No other patient had a history of difficult delivery, and in no case was the possibility of a traumatic etiology entertained. Thus, in every other case the development of the aneurysm was believed to be prenatal, and only in the case of Wierdis, et al., did there appear to be rupture of a pre-existing lesion during delivery.

The peak incidence of aneurysmal subarachnoid hemorrhage (SAH) is in the fifth and sixth decades of life, and the diagnosis of intracranial arterial aneurysm in childhood is uncommon.25 In the Cooperative Study only 0.2% of patients with aneurysmal SAH presented in the first decade of life.25 Infection, trauma, hemodynamic disturbances such as arteriovenous malformation and moyamoya disease, postirradiation vasculopathy, intracranial neoplasms, and a variety of systemic diseases such as arterial hypertension, polycystic kidney disease, fibromuscular hyperplasia, coarctation of the aorta, disorders of collagen metabolism, and tuberous sclerosis have all been identified as settings for pediatric intracranial arterial aneurysms,1–3,9,12,13,31,46,48 but no more than one-third of cases have evident etiologies.12,18,32,42,48

If the large fraction of pediatric aneurysms that cannot be attributed to identifiable vascular diseases cannot alternatively be attributed to the mechanisms that generate aneurysms in adults, the etiology of aneurysms in childhood is obscure indeed. That most aneurysms found in adults are acquired during adult life is manifest by the virtual nonexistence of incidental aneurysms in pediatric cerebral angiography and in pediatric autopsy material.16,26,37,42 The great majority of aneurysms in adulthood are now attributed to degeneration of the internal elastic lamina at sites of hemodynamic stress.38,40 Stehbens,41 the major proponent of the acquired degenerative theory of arterial aneurysm formation, has presented a critical review of reports of congenital arterial aneurysms and has argued that typical berry aneurysms of adulthood do not occur in early childhood. The possibility that birth trauma may be responsible for pediatric aneurysms has been entertained,27,36,41 but we have been unable to find previous documentation of this phenomenon. Our observations suggest that some pediatric aneurysms that have been categorized in the past as idiopathic or congenital, particularly aneurysms in the region of the tentorial incisura, are due to birth trauma.

Interestingly, several reviews of intracranial arterial aneurysms in infancy and early childhood have reported a higher prevalence of posterior circulation aneurysms among infants as compared to adults.7,44 The higher prevalence is especially pronounced for posterior cerebral artery lesions, which account for 11% of aneurysms among infants and young children as compared to no more than 2% among adults.7,33,44 Childhood posterior cerebral artery aneurysms tend to develop distal to the circle of Willis;21 the proximity of this artery to the free edge of the tentorium and the deformation to which the region of the incisura is subjected during the birth process suggest that birth trauma may account for the excess of lesions at this location.

Conclusions

Our experience suggests that noninvasive imaging modalities, such as transfontanel Doppler ultrasonography or magnetic resonance angiography,36 may be indicated in neonates with intracranial hemorrhage, particularly hemorrhage in the region of the tentorial incisura, and may lead to more frequent detection of intracranial arterial aneurysms attributable to birth trauma.

References

  • 1.

    Benson PJSung JH: Cerebral aneurysms following radiotherapy for medulloblastoma. J Neurosurg 70:5455501989J Neurosurg 70:

  • 2.

    Blumenkopf BHuggins MJ: Tuberous sclerosis and multiple intracranial aneurysms: case report. Neurosurgery 17:7978001985Neurosurgery 17:

  • 3.

    Bolander HHassler OLiliequist Bet al: Cerebral aneurysm in an infant with fibromuscular hyperplasia of the renal arteries. Case report. J Neurosurg 49:7567591978J Neurosurg 49:

  • 4.

    Bremer JL: Congenital aneurysms of the cerebral arteries. An embryologic study. Arch Pathol 35:8198311943Bremer JL: Congenital aneurysms of the cerebral arteries. An embryologic study. Arch Pathol 35:

  • 5.

    Capon NB: Intracranial traumata in the new born. J Obstet Gynaecol Br Emp 29:5725901922Capon NB: Intracranial traumata in the new born. J Obstet Gynaecol Br Emp 29:

  • 6.

    Craig WS: Intracranial haemorrhage in new-born: study of diagnosis and differential diagnosis based upon pathological and clinical findings in 126 cases. Arch Dis Child 13:891241938Craig WS: Intracranial haemorrhage in new-born: study of diagnosis and differential diagnosis based upon pathological and clinical findings in 126 cases. Arch Dis Child 13:

  • 7.

    Ferrante LFortuna ACelli Pet al: Intracranial arterial aneurysms in early childhood. Surg Neurol 29:39561988Surg Neurol 29:

  • 8.

    Fleming GBMorton ED: Meningeal haemorrhage in new-born. Arch Dis Child 5:3613681930Arch Dis Child 5:

  • 9.

    Forster FMAlpers BJ: Aneurysms of circle of Willis associated with congential polycystic disease of the kidneys. Arch Neurol Psychiatry 50:6696761978Arch Neurol Psychiatry 50:

  • 10.

    Grode MISaunders MCarton CA: Subarachnoid hemorrhage secondary to ruptured aneurysms in infants. Report of two cases. J Neurosurg 49:8989021978J Neurosurg 49:

  • 11.

    Gröntoft O: Intracranial haemorrhage and blood-brain barrier problems in the new-born. A pathologico-anatomical and experimental investigation. Acta Pathol Microbiol Scand (Suppl 100):11021954Gröntoft O: Intracranial haemorrhage and blood-brain barrier problems in the new-born. A pathologico-anatomical and experimental investigation. Acta Pathol Microbiol Scand (Suppl 100):

  • 12.

    Gutierrez FABailes JMcLone DG: Intracranial aneurysm and pseudo-aneurysm occurring during infancy and childhood: diagnosis and surgical resultsMarlin AE (ed): Concepts in Pediatric Neurosurgery 7. Basal: Karger1987153168Concepts in Pediatric Neurosurgery 7.

  • 13.

    Hacker RJ: Intracranial aneurysms of childhood: a statistical analysis of 500 cases from the world literature. Neurosurgery 10:7751982 (Abstract)Hacker RJ: Intracranial aneurysms of childhood: a statistical analysis of 500 cases from the world literature. Neurosurgery 10:

  • 14.

    Hemsath FA: Birth injury of the occipital bone with a report of thirty-two cases. Am J Obstet Gynecol 27:1942031934Hemsath FA: Birth injury of the occipital bone with a report of thirty-two cases. Am J Obstet Gynecol 27:

  • 15.

    Holland E: Cranial stress in the foetus during labour and on the effects of excessive stress on the intracranial contents; with an analysis of eighty-one cases of torn tentorium cerebelli and subdural cerebral haemorrhage. J Obstet Gynaecol Br Emp 29:5495711922Holland E: Cranial stress in the foetus during labour and on the effects of excessive stress on the intracranial contents; with an analysis of eighty-one cases of torn tentorium cerebelli and subdural cerebral haemorrhage. J Obstet Gynaecol Br Emp 29:

  • 16.

    Housepian EMPool JL: A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian Hospital, 1914 to 1956. J Neuropathol Exp Neurol 17:4094231958J Neuropathol Exp Neurol 17:

  • 17.

    Hughes EC: Intracranial birth injuries. Am J Obstet Gynecol 24:27401932Hughes EC: Intracranial birth injuries. Am J Obstet Gynecol 24:

  • 18.

    Humphreys RP: Intracranial arterial aneurysmsEdwards MSBHoffman HJ (eds): Cerebral Vascular Disease in Children and Adolescents. Baltimore: Williams & Wilkins1989247254Cerebral Vascular Disease in Children and Adolescents.

  • 19.

    Hungerford GDMarzluff JMKempe LGet al: Cerebral arterial aneurysm in a neonate. Neuroradiology 21:1071101981Neuroradiology 21:

  • 20.

    Jones RKShearburn EW: Intracranial aneurysm in a four-week-old infant. Diagnosis by angiography and successful operation. J Neurosurg 18:1221241961J Neurosurg 18:

  • 21.

    Kaplan PAHahn FJ: Aneurysms of the posterior cerebral artery in children. AJNR 5:7717741984AJNR 5:

  • 22.

    Krauland W: Riss der a. Basilaris als Geburtsverletzung. Beitr Gerichtl Med 19:82851952Krauland W: Riss der a. Basilaris als Geburtsverletzung. Beitr Gerichtl Med 19:

  • 23.

    Lee YJKandall SRGhali VS: Intracerebral arterial aneurysm in a newborn. Arch Neurol 35:1711721978Arch Neurol 35:

  • 24.

    Lipper SMorgan DKrigman MRet al: Congenital saccular aneurysm in a 19-day-old neonate. Case report and review of the literature. Surg Neurol 10:1611651978Surg Neurol 10:

  • 25.

    Locksley HB: Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section V, Part I. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the Cooperative Study. J Neurosurg 25:2192391966J Neurosurg 25:

  • 26.

    Matson DD: Intracranial arterial aneurysms in childhood. J Neurosurg 23:5785831965Matson DD: Intracranial arterial aneurysms in childhood. J Neurosurg 23:

  • 27.

    Meyer FBSundt TM JrFode NCet al: Cerebral aneurysms in childhood and adolescence. J Neurosurg 70:4204251989J Neurosurg 70:

  • 28.

    Moloy HC: Studies on head molding during labor. Am J Obstet Gynecol 44:7627821942Moloy HC: Studies on head molding during labor. Am J Obstet Gynecol 44:

  • 29.

    Newcomb ALMunns GF: Rupture of aneurysm of the circle of Willis in the newborn. Pediatrics 3:7697721949Pediatrics 3:

  • 30.

    Ono MOno MRhoton AL Jret al: Microsurgical anatomy of the region of the tentorial incisura. J Neurosurg 60:3653991984J Neurosurg 60:

  • 31.

    Østergaard JRVoldby B: Intracranial arterial aneurysms in children and adolescents. J Neurosurg 35:8328371983J Neurosurg 35:

  • 32.

    Patel ANRichardson AE: Ruptured intracranial aneurysms in the first two decades of life. A study of 58 patients. J Neurosurg 35:5715761971J Neurosurg 35:

  • 33.

    Pia HWFontana H: Aneurysms of the posterior cerebral artery. Locations and clinical pictures. Acta Neurochir 38:13351977Acta Neurochir 38:

  • 34.

    Pickering LKHogan GRGilbert EF: Aneurysm of the posterior inferior cerebellar artery. Rupture in a newborn. Am J Dis Child 119:1551581970Am J Dis Child 119:

  • 35.

    Potter ELCraig JM III: Pathology of the Fetus and the Infant. Chicago: Year Book Medical1975103120Pathology of the Fetus and the Infant.

  • 36.

    Putty TKLuerssen TGCampbell RLet al: Magnetic resonance imaging diagnosis of a cerebral aneurysm in an infant. Case report and review of the literature. Pediatr Neurosurg 16:48511990Pediatr Neurosurg 16:

  • 37.

    Riggs HERupp C: Miliary aneurysms: relation of anomalies of the circle of Willis to formation of aneurysms. Arch Neurol Psychiatry 49:6156161943Arch Neurol Psychiatry 49:

  • 38.

    Sekhar LNHeros RC: Origin, growth, and rupture of saccular aneurysms: a review. Neurosurgery 8:2482601981Neurosurgery 8:

  • 39.

    Shimauchi MYamakawa YMaruoka Net al: Ruptured intracranial aneurysm in a 19-day-old infant. Case report. Neurol Med Chir 29:104710501989Neurol Med Chir 29:

  • 40.

    Stehbens WE: Etiology of intracranial berry aneurysms. J Neurosurg 70:8238311989Stehbens WE: Etiology of intracranial berry aneurysms. J Neurosurg 70:

  • 41.

    Stehbens WE: Intracranial berry aneurysms in infancy. Surg Neurol 18:58601982Stehbens WE: Intracranial berry aneurysms in infancy. Surg Neurol 18:

  • 42.

    Thompson JRHarwood-Nash DCFitz CR: Cerebral aneurysms in children. AJR 118:1631751973AJR 118:

  • 43.

    Thompson RAPribram HFW: Infantile cerebral aneurysm associated with ophthalmoplegia and quadriparesis. Neurology 19:7857891969Neurology 19:

  • 44.

    Thrush ALMarano GD: Infantile intracranial aneurysm: report of a case and review of the literature. AJNR 9:9039061988AJNR 9:

  • 45.

    Towbin A: Central nervous system damage in the human fetus and newborn infant. Mechanical and hypoxic injury incurred in the fetal-neonatal period. Am J Dis Child 119:5295421970Towbin A: Central nervous system damage in the human fetus and newborn infant. Mechanical and hypoxic injury incurred in the fetal-neonatal period. Am J Dis Child 119:

  • 46.

    Waga STochio H: Intracranial aneurysm associated with moyamoya disease in childhood. Surg Neurol 23:2372431985Surg Neurol 23:

  • 47.

    Wierdis TGiannini YIaia E: Foetal and neonatal cerebrovascular disease. Early results of post-mortem carotid angiography. Panminerva Med 7:3253381965Panminerva Med 7:

  • 48.

    Zee CSSegall HDMcComb JGet al: Intracranial arterial aneurysms in childhood: more recent considerations. J Child Neurol 1:991141986J Child Neurol 1:

Article Information

Address reprint requests to: Joseph H. Piatt, Jr., M.D., Division of Neurosurgery (L472), Oregon Health Sciences University, Portland, Oregon 97201–3098.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Computerized tomography scan of the head without intravenous contrast enhancement showing fresh hemorrhage layered over the surface of the tentorium. At the edge of the tentorial incisura on the left is a discrete globular hematoma with central low density (arrow).

  • View in gallery

    Left: Transfontanel ultrasound study in a coronal plane demonstrating an echogenic mass (arrow) with a hypoechoic center at the level of the tentorial incisura. Right: The Doppler ultrasound cursor has been positioned overlying the hypoechoic center of the incisural mass. A pulsatile blood velocity signal is recorded below.

  • View in gallery

    Left vertebral angiograms, lateral projection. A: An early image demonstrating a 1.5-cm aneurysm arising from a distal vermian branch of the left superior cerebellar artery. A jet of contrast material is seen entering the aneurysm (arrow). B: Later image showing a blood contrast level (arrows). C: This follow-up angiogram obtained 5 weeks later was normal.

References

1.

Benson PJSung JH: Cerebral aneurysms following radiotherapy for medulloblastoma. J Neurosurg 70:5455501989J Neurosurg 70:

2.

Blumenkopf BHuggins MJ: Tuberous sclerosis and multiple intracranial aneurysms: case report. Neurosurgery 17:7978001985Neurosurgery 17:

3.

Bolander HHassler OLiliequist Bet al: Cerebral aneurysm in an infant with fibromuscular hyperplasia of the renal arteries. Case report. J Neurosurg 49:7567591978J Neurosurg 49:

4.

Bremer JL: Congenital aneurysms of the cerebral arteries. An embryologic study. Arch Pathol 35:8198311943Bremer JL: Congenital aneurysms of the cerebral arteries. An embryologic study. Arch Pathol 35:

5.

Capon NB: Intracranial traumata in the new born. J Obstet Gynaecol Br Emp 29:5725901922Capon NB: Intracranial traumata in the new born. J Obstet Gynaecol Br Emp 29:

6.

Craig WS: Intracranial haemorrhage in new-born: study of diagnosis and differential diagnosis based upon pathological and clinical findings in 126 cases. Arch Dis Child 13:891241938Craig WS: Intracranial haemorrhage in new-born: study of diagnosis and differential diagnosis based upon pathological and clinical findings in 126 cases. Arch Dis Child 13:

7.

Ferrante LFortuna ACelli Pet al: Intracranial arterial aneurysms in early childhood. Surg Neurol 29:39561988Surg Neurol 29:

8.

Fleming GBMorton ED: Meningeal haemorrhage in new-born. Arch Dis Child 5:3613681930Arch Dis Child 5:

9.

Forster FMAlpers BJ: Aneurysms of circle of Willis associated with congential polycystic disease of the kidneys. Arch Neurol Psychiatry 50:6696761978Arch Neurol Psychiatry 50:

10.

Grode MISaunders MCarton CA: Subarachnoid hemorrhage secondary to ruptured aneurysms in infants. Report of two cases. J Neurosurg 49:8989021978J Neurosurg 49:

11.

Gröntoft O: Intracranial haemorrhage and blood-brain barrier problems in the new-born. A pathologico-anatomical and experimental investigation. Acta Pathol Microbiol Scand (Suppl 100):11021954Gröntoft O: Intracranial haemorrhage and blood-brain barrier problems in the new-born. A pathologico-anatomical and experimental investigation. Acta Pathol Microbiol Scand (Suppl 100):

12.

Gutierrez FABailes JMcLone DG: Intracranial aneurysm and pseudo-aneurysm occurring during infancy and childhood: diagnosis and surgical resultsMarlin AE (ed): Concepts in Pediatric Neurosurgery 7. Basal: Karger1987153168Concepts in Pediatric Neurosurgery 7.

13.

Hacker RJ: Intracranial aneurysms of childhood: a statistical analysis of 500 cases from the world literature. Neurosurgery 10:7751982 (Abstract)Hacker RJ: Intracranial aneurysms of childhood: a statistical analysis of 500 cases from the world literature. Neurosurgery 10:

14.

Hemsath FA: Birth injury of the occipital bone with a report of thirty-two cases. Am J Obstet Gynecol 27:1942031934Hemsath FA: Birth injury of the occipital bone with a report of thirty-two cases. Am J Obstet Gynecol 27:

15.

Holland E: Cranial stress in the foetus during labour and on the effects of excessive stress on the intracranial contents; with an analysis of eighty-one cases of torn tentorium cerebelli and subdural cerebral haemorrhage. J Obstet Gynaecol Br Emp 29:5495711922Holland E: Cranial stress in the foetus during labour and on the effects of excessive stress on the intracranial contents; with an analysis of eighty-one cases of torn tentorium cerebelli and subdural cerebral haemorrhage. J Obstet Gynaecol Br Emp 29:

16.

Housepian EMPool JL: A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian Hospital, 1914 to 1956. J Neuropathol Exp Neurol 17:4094231958J Neuropathol Exp Neurol 17:

17.

Hughes EC: Intracranial birth injuries. Am J Obstet Gynecol 24:27401932Hughes EC: Intracranial birth injuries. Am J Obstet Gynecol 24:

18.

Humphreys RP: Intracranial arterial aneurysmsEdwards MSBHoffman HJ (eds): Cerebral Vascular Disease in Children and Adolescents. Baltimore: Williams & Wilkins1989247254Cerebral Vascular Disease in Children and Adolescents.

19.

Hungerford GDMarzluff JMKempe LGet al: Cerebral arterial aneurysm in a neonate. Neuroradiology 21:1071101981Neuroradiology 21:

20.

Jones RKShearburn EW: Intracranial aneurysm in a four-week-old infant. Diagnosis by angiography and successful operation. J Neurosurg 18:1221241961J Neurosurg 18:

21.

Kaplan PAHahn FJ: Aneurysms of the posterior cerebral artery in children. AJNR 5:7717741984AJNR 5:

22.

Krauland W: Riss der a. Basilaris als Geburtsverletzung. Beitr Gerichtl Med 19:82851952Krauland W: Riss der a. Basilaris als Geburtsverletzung. Beitr Gerichtl Med 19:

23.

Lee YJKandall SRGhali VS: Intracerebral arterial aneurysm in a newborn. Arch Neurol 35:1711721978Arch Neurol 35:

24.

Lipper SMorgan DKrigman MRet al: Congenital saccular aneurysm in a 19-day-old neonate. Case report and review of the literature. Surg Neurol 10:1611651978Surg Neurol 10:

25.

Locksley HB: Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section V, Part I. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the Cooperative Study. J Neurosurg 25:2192391966J Neurosurg 25:

26.

Matson DD: Intracranial arterial aneurysms in childhood. J Neurosurg 23:5785831965Matson DD: Intracranial arterial aneurysms in childhood. J Neurosurg 23:

27.

Meyer FBSundt TM JrFode NCet al: Cerebral aneurysms in childhood and adolescence. J Neurosurg 70:4204251989J Neurosurg 70:

28.

Moloy HC: Studies on head molding during labor. Am J Obstet Gynecol 44:7627821942Moloy HC: Studies on head molding during labor. Am J Obstet Gynecol 44:

29.

Newcomb ALMunns GF: Rupture of aneurysm of the circle of Willis in the newborn. Pediatrics 3:7697721949Pediatrics 3:

30.

Ono MOno MRhoton AL Jret al: Microsurgical anatomy of the region of the tentorial incisura. J Neurosurg 60:3653991984J Neurosurg 60:

31.

Østergaard JRVoldby B: Intracranial arterial aneurysms in children and adolescents. J Neurosurg 35:8328371983J Neurosurg 35:

32.

Patel ANRichardson AE: Ruptured intracranial aneurysms in the first two decades of life. A study of 58 patients. J Neurosurg 35:5715761971J Neurosurg 35:

33.

Pia HWFontana H: Aneurysms of the posterior cerebral artery. Locations and clinical pictures. Acta Neurochir 38:13351977Acta Neurochir 38:

34.

Pickering LKHogan GRGilbert EF: Aneurysm of the posterior inferior cerebellar artery. Rupture in a newborn. Am J Dis Child 119:1551581970Am J Dis Child 119:

35.

Potter ELCraig JM III: Pathology of the Fetus and the Infant. Chicago: Year Book Medical1975103120Pathology of the Fetus and the Infant.

36.

Putty TKLuerssen TGCampbell RLet al: Magnetic resonance imaging diagnosis of a cerebral aneurysm in an infant. Case report and review of the literature. Pediatr Neurosurg 16:48511990Pediatr Neurosurg 16:

37.

Riggs HERupp C: Miliary aneurysms: relation of anomalies of the circle of Willis to formation of aneurysms. Arch Neurol Psychiatry 49:6156161943Arch Neurol Psychiatry 49:

38.

Sekhar LNHeros RC: Origin, growth, and rupture of saccular aneurysms: a review. Neurosurgery 8:2482601981Neurosurgery 8:

39.

Shimauchi MYamakawa YMaruoka Net al: Ruptured intracranial aneurysm in a 19-day-old infant. Case report. Neurol Med Chir 29:104710501989Neurol Med Chir 29:

40.

Stehbens WE: Etiology of intracranial berry aneurysms. J Neurosurg 70:8238311989Stehbens WE: Etiology of intracranial berry aneurysms. J Neurosurg 70:

41.

Stehbens WE: Intracranial berry aneurysms in infancy. Surg Neurol 18:58601982Stehbens WE: Intracranial berry aneurysms in infancy. Surg Neurol 18:

42.

Thompson JRHarwood-Nash DCFitz CR: Cerebral aneurysms in children. AJR 118:1631751973AJR 118:

43.

Thompson RAPribram HFW: Infantile cerebral aneurysm associated with ophthalmoplegia and quadriparesis. Neurology 19:7857891969Neurology 19:

44.

Thrush ALMarano GD: Infantile intracranial aneurysm: report of a case and review of the literature. AJNR 9:9039061988AJNR 9:

45.

Towbin A: Central nervous system damage in the human fetus and newborn infant. Mechanical and hypoxic injury incurred in the fetal-neonatal period. Am J Dis Child 119:5295421970Towbin A: Central nervous system damage in the human fetus and newborn infant. Mechanical and hypoxic injury incurred in the fetal-neonatal period. Am J Dis Child 119:

46.

Waga STochio H: Intracranial aneurysm associated with moyamoya disease in childhood. Surg Neurol 23:2372431985Surg Neurol 23:

47.

Wierdis TGiannini YIaia E: Foetal and neonatal cerebrovascular disease. Early results of post-mortem carotid angiography. Panminerva Med 7:3253381965Panminerva Med 7:

48.

Zee CSSegall HDMcComb JGet al: Intracranial arterial aneurysms in childhood: more recent considerations. J Child Neurol 1:991141986J Child Neurol 1:

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 34 34 27
PDF Downloads 16 16 7
EPUB Downloads 0 0 0

PubMed

Google Scholar