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Neurol Med Chir (Tokyo). 2002 Apr;42(4):158-61.
Successful clipping of a distal posterior inferior cerebellar artery aneurysm located on the anterior surface of the medulla oblongata--case report.
Todaka T, Hamada J, Yano S, Kai Y, Morioka M, Ushio Y.
Department of Neurosurgery, Kumamoto University School of Medicine, Kumamoto. ossac.kuh.kumamoto-u.ac.jp
A 55-year-old male presented with a ruptured distal posterior inferior cerebellar artery (PICA) aneurysm manifesting as subarachnoid hemorrhage. Angiography demonstrated a saccular aneurysm arising from the lateral medullary segment of the left PICA and located on the medial side of the left vertebral artery (VA) and the anterior surface of the medulla oblongata. A transcondylar fossa approach was used to ensure a sufficient operating field and to obtain adequate visualization of the aneurysm, the parent artery, and the perforating arteries to the medulla oblongata. The aneurysm dome protruded medially at the hairpin curve, and was located on the medial side of the left VA and on the anterior surface of the medulla oblongata. There was no vessel branches in the vicinity of the aneurysm. The aneurysm was successfully clipped with minimum retraction of the cerebellar hemisphere and medulla oblongata. Distal PICA aneurysms can be located at various sites in the posterior fossa. The exact location of the aneurysm must be established to select the best surgical approach.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12013667&dopt=Abstract hemorrhage
Neurol Med Chir (Tokyo). 2002 Apr;42(4):166-9.
Brain surface ependymoma with repeated episodes of intratumoral hemorrhage--case report.
Takeshima H, Kawahara T, Uchida H, Hirano H, Nakazato Y, Kuratsu J.
Department of Neurosurgery, Faculty of Medicine, Kagoshima University, Kagoshima. m20403.kufm.kagoshima-u.ac.jp
A 70-year-old woman presented with a rare brain surface ependymoma with repeated intratumoral hemorrhage. She was admitted with progressive dementia. Two years earlier, a diagnosis of subcortical hematoma in the right frontal lobe had been made following a fall. On admission, magnetic resonance imaging showed a huge right frontal mass lesion with multiple hemorrhagic cysts. She underwent gross total resection. The tumor was located on the surface of the frontal lobe, and was sharply demarcated from the surrounding brain tissue with no attachment to the ventricular wall. The histological features were consistent with an ependymoma forming perivascular pseudorosettes. Immunohistochemistry showed positive staining for glial fibrillary acidic protein. Electron microscopy showed microvilli and zonula adherens. This case demonstrates the natural course of malignant progression of ectopic ependymomas. Ependymoma should be included in the differential diagnosis of tumors associated with repeated subcortical hematomas, even if located on the brain surface and distant from ventricles.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12013669&dopt=Abstract hemorrhage
Neurol Med Chir (Tokyo). 2002 Apr;42(4):181-3.
Migration of ventriculoperitoneal shunt into the heart--case report.
Imamura H, Nomura M.
Department of Neurosurgery, Keiwakai Ebetsu Hospital, Ebetsu, Hokkaido.
A 76-year-old man underwent ventriculoperitoneal shunting for hydrocephalus after subarachnoid hemorrhage. Eighteen days after the shunt operation, fluoroscopy revealed the peritoneal catheter in the heart. Three-dimensional computed tomography demonstrated penetration of the catheter into the internal jugular vein. Under local anesthesia, part of the peritoneal catheter was pulled out through the cervical incision and cut off. The ends of the peritoneal catheter were connected so that the distal end was settled in the right atrium of the heart under fluoroscopic visualization. The migration of the peritoneal catheter into the heart presumably occurred because the subcutaneous wire guide of the shunt catheter perforated the internal jugular vein and the catheter was drawn into the heart through the internal jugular vein by the negative pressure of the vein and thoracic cavity.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12013672&dopt=Abstract hemorrhage
Arch Esp Urol. 2002 Mar;55(2):197-9.
[Spontaneous bleeding from renal cyst as a cause of acute anemia]
[Article in Spanish]
Mederos Curbelo ON, Barrera ON, Barrera Ortega JC, Romero Diaz C, Cantero Ronquillo A, Pereiro Costa R.
Hospital Universitario Manuel Fajodo, Citudad de la Habana, Cuba.
OBJECTIVE: To report a case of a simple left renal cyst in a patient who presented with spontaneous pain and acute anemia due to intracystic hemorrhage. METHODS: Diagnostic imaging techniques such as assessment of the urinary tract with contract medium, ultrasound CT and MRI were utilized for correct preoperative diagnosis and surgical management. RESULTS: The patient was able to return to normal active work. CONCLUSIONS: Rarely as in the case described renal cysts can collect blood at the expense of the renal parenchayma. Ultrasound and CT are very useful diagnostic imaging techniques in renal pathologies.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12014053&dopt=Abstract hemorrhage
Ned Tijdschr Geneeskd. 2002 Apr 27;146(17):804-8.
[Subarachnoid hemorrhage without aneurysm on the angiogram: the value of repeat angiography]
[Article in Dutch]
Houben MP, van Rooij WJ, Sluzewski M, Tijssen CC.
Afd. Neurologie, St. Elisabeth Ziekenhuis, Postbus 90.151, 5000 LC Tilburg.
OBJECTIVE: To determine the yield of repeated angiography in patients with a non-perimesencephalic subarachnoid haemorrhage (SAH) and a negative first cerebral angiogram. DESIGN: Retrospective. METHOD: All diagnostic data of patients with a spontaneous SAH admitted to the Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands, in the period 1 January 1992-30 June 2000 were analysed. Patients with a perimesencephalic haemorrhage on a CT-scan were excluded and follow-up was completed. A negative angiogram was considered false-negative, if an aneurysm was shown on a repeat angiogram or after a rebleed. These angiograms were reviewed. RESULTS: A total of 333 patients with a spontaneous SAH were registered. Of these, 249 patients had one or more angiograms made, which resulted in 59 first angiograms being negative (24%). A total of 36 patients had a non-perimesencephalic SAH (26 women and 10 men; mean age: 54 years (range: 25-77)). In 25 of these 36 patients, angiography was repeated revealing 9 aneurysms. Four patients suffered from a rebleed after a previous negative angiogram. Altogether, in 13 of these 36 patients the first negative angiogram was false-negative (36%). In 5 of the 9 patients with a positive repeat angiogram, the first angiogram had been incorrectly assessed as negative. CONCLUSION: Of the 36 patients with a non-perimesencephalic subarachnoid haemorrhage and a negative angiogram, 13 were revealed to have an aneurysm. Nine of these 13 aneurysms were demonstrated on a repeat angiogram. Technical and interpretation factors appeared to play an important role in missing an aneurysm on a cerebral angiogram.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12014239&dopt=Abstract hemorrhage
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