 69 y/o female with a 3 day history of posterior cervical pain and posterior headache.  On 8/13/15 at 2:30 PM she presented with sudden severe worsening.

Slides:

Advertisements

Similar presentations

Radiology Slideshow CT & MRI Ian Anderson, 2007.

Advertisements

William Beaumont Hospital Royal Oak, Michigan

Aneurysmal Subarachnoid Hemorrhage

Neuroradiology DR. Sharifa AL-Duraibi.

Advances in Interventional Neuroradiology Dr James F Peerless March 2014.

Author(s):Ross, Ian B. MD; Fratkin, Jonathan D. MD Issue:Volume 63(2), August 2007, pp E47-E50 Publication Type:[Case Report] Publisher:© 2007 Lippincott.

Seeing a Stroke Developed by: K. Banasky, RN, BSN Educator GCH Emergency Services.

Head CT: The Basics Stephen Magill Radiology Rotation August, 2012.

Neuroendovascular Surgeon consulted by ER physician for a patient who presented with severe headaches and left eye drooping: Procede to evaluate the patien.

Left facial numbness Ann Schmidt Oct Patient Presentation 54 yo female 54 yo female Left facial swelling, left leg swelling and left arm weakness.

Consultant Neuroradiologist

Scan Coverage: Floor of sella to thoracic inlet (to scan for nodes) Standard axial scanning at 0 degrees is depicted on the lined scout image in this.

Management of Subarachnoid Hemorrhage Gregory W Balturshot, M.D. Central Ohio Neurological Surgeons May 24, 2013.

Dr. _______, Mr. Jones is awaiting your arrival in the CT room where you will perform a CT scan to confirm the diagnosis of SAH stroke. Be sure to follow.

“It’s all in your head” Kyle McLaughlin Sept. 1, 2005 Diagnostic Imaging Rounds Kyle McLaughlin Sept. 1, 2005 Diagnostic Imaging Rounds.

BASILAR ANEURYSM DOES THIS CASE NEED FURTHER MANAGEMENT ? IF SO, WHAT IS BETTER; OPEN SURGERY &CLIPPING OR AGAIN ENDOVASCULAR COILING ?

Neurotrauma Radiology. What is this? Extradural haematoma Any patients Usually high impact Usually associated fracture Arterial bleed – peels dura off.

Joseph Gastala, MD and Bruno Policeni, MD University of Iowa Hospitals and Clinics DISTRIBUTION OF SUBARACHNOID HEMORRHAGE WITH RESPECT TO THE FORAMEN.

Jjlkjkjlkjk jkj Run Ct Scan References Protocol Doctor Notes 1.Run Ct Scan 2.Determine primary diagnosis 3.Order secondary diagnosis Description/Actions:

H.Ghanaati; M.D. Associate Professor of Radiology Tehran University Of Medical Sciences Outcomes of intracranial aneurysms treated with coils: A six-month.

Cigarette Smoking Increases the Risk Of Formation and Rupture of Intracranial Aneurysms Shelebra Bartley Master’s Project Dr. Grimes.

Resident and Fellow Section

Advances in Treatment for Acute Stroke

Neuroradiology of Stroke and Headaches

Clipping in Awake Surgery as End-Stage in a Complex Internal Carotid Artery Aneurysm After Failure of Multimodal Endovascular and Extracranial-Intracranial.

Volume 98, Pages 879.e1-879.e4 (February 2017)

FIGURE 1. Illustration of the retractable, self-expandable Enterprise stent (Cordis, Miami Lakes, FL). From: PRELIMINARY EXPERIENCE WITH THE ENTERPRISE.

Volume 92, Pages (August 2016) Posterior Cerebral Artery Aneurysms: Treatment and Outcome Analysis in 121 Patients Felix Goehre, Behnam Rezai.

Subarachnoid Haemorrhage

A 50 year-old female with right hemiplegia and encephalopathy

Volume 1, Issue 1, Pages 8-10 (March 2014)

George Hadjigeorgiou Department of Neurosurgery Red Cross Hospital

A 22 year old male with acute seizures and hemiparesis

Fig. 1. Digital subtraction angiography (DSA) images of a 39-year-old woman presented with subarachnoid hemorrhage (SAH). The anterior-posterior (AP) and.

Endovascular treatment of renal artery aneurysms and renal arteriovenous fistulas Zhongming Zhang, MD, Min Yang, MD, Li Song, MD, Xiaoqiang Tong, MD,

A 9-year old girl with multi-compartmental intracranial hemorrhage

Cerebral Venous Sinus (Sinovenous) Thrombosis in Children

Rupture and spontaneous resolution of a P1 perforator pseudoaneurysm

Endovascular management of juxtarenal aneurysms with fenestrated endovascular grafting Roy K Greenberg, MD, Stephan Haulon, MD, Sean P Lyden, MD, Sunita.

Volume 78, Pages (January 2018)

A Case of Cryptogenic Recurrent Cerebral Fusiform Aneurysms involving the Distal Anterior Circulation Arthur K Omuro, DO Department of Neurology, Desert.

High-complexity example of Pipeline embolisation device (PED) treatment of a giant 25 mm right-sided petrocavernous internal carotid artery (ICA) cerebral.

Brain Vasculature.

A 48-year-old man who presented with severe sudden headache.

Case 1, a 45-year-old female (same patient shown in Figure 1 images) with recurrent infarctions in the right middle cerebral artery. (A) Axial fluid attenuation.

VW-MR imaging to differentiate among causes of intracranial arterial stenosis when angiography findings are inconclusive. VW-MR imaging to differentiate.

Case 1, a 45-year-old female with recurrent small strokes in the right middle cerebral artery. (A) Axial computed tomography angiography (CTA) images on.

Direct sonographic-guided superior gluteal artery access for treatment of a previously treated expanding internal iliac artery aneurysm Michael M. Herskowitz,

Have You Seen SAM? EJVES Short Reports

A 46-year-old female with a giant left internal carotid artery carotid–ophthalmic aneurysm symptomatic with headaches and left eye vision impairment. A.

Endovascular Treatment of Intracranial Aneurysms

Seyed Ameli-Renani, MBBS, FRCR, Vyzantios Pavlidis, MD, Robert A

Plain CT scan of head (a) and prethrombectomy (b) and post-thrombectomy (c) digital subtraction angiograms in a 49-year-old woman with sudden onset left.

Endovascular treatment of ruptured axillary and large internal mammary artery aneurysms in a patient with Marfan syndrome Jessica F. Rose, DO, Layla.

Plain CT scan of head (a) and prethrombectomy (b) and post-thrombectomy (c) CT angiograms in a 49-year-old woman with sudden onset left hemiparesis and.

Endovascular treatment of renal artery aneurysms and renal arteriovenous fistulas Zhongming Zhang, MD, Min Yang, MD, Li Song, MD, Xiaoqiang Tong, MD,

Erik P. Hess, MD, Eric T. Boie, MD, Roger D. White, MD

Patient 16 is a 39-year-old woman status post bowel resection and appendectomy for Crohn disease being maintained on antibiotics and steroids with baseline.

A: Axial noncontrast computed tomography (CT) demonstrates a sizable volume of subarachnoid hemorrhage centered in the suprasellar cistern with extension.

Plain CT scan of head (a) and prethrombectomy (b) and post-thrombectomy (c) digital subtraction angiograms in a 49-year-old woman with sudden onset left.

A 29-year-old man with sudden neck pain followed by right-sided muscle weakness and difficulty in swallowing. A 29-year-old man with sudden neck pain followed.

Pipeline embolisation device (PED) treatment of two right-sided intracranial carotid artery (ICA) aneurysms, 4 mm anterior choroidal aneurysm and a 5 mm.

Non-contrast head CT (A) showing diffuse subarachnoid hemorrhage and hydrocephalus. Non-contrast head CT (A) showing diffuse subarachnoid hemorrhage and.

62-year-old woman with incidentally discovered bilateral cavernous sinus aneurysms. 62-year-old woman with incidentally discovered bilateral cavernous.

A 63-year-old female with a giant left internal carotid artery, cavernous segment aneurysm undergoing treatment with PED. Angiography from a catheter positioned.

A 51-year-old man with a long history of headaches with associated nausea and vomiting. A 51-year-old man with a long history of headaches with associated.

(A) Pre-embolization right external carotid lateral view angiograms demonstrating a large blush consistent with a hypervascular glomus jugulare tumor.

A, 3D volume-rendered reformat of a left ICA rotational angiogram shows a giant distal supraclinoid ICA aneurysm. A, 3D volume-rendered reformat of a left.

Procedural and follow-up angiograms of a 28-year-old female patient with a history of subarachnoid hemorrhage due to rupture of a contralateral MCA bifurcation.

A 71-year-old female with multiple large intracranial aneurysms.

Presentation transcript:

 69 y/o female with a 3 day history of posterior cervical pain and posterior headache.  On 8/13/15 at 2:30 PM she presented with sudden severe worsening of her pain, reported as 10/10 with some photophobia and dizziness  EMS contacted  Patient brought to the Umass ED  She was alert, somnolient but arousable with no gross motor or sensitive deficit

Axial CT image of the head demonstrated a bulbous appearance of the anterior communicating artery Coronal CT reconstructed image of the neck which partially included the head demonstrated again the bulbous appearance of the anterior communicating artery. This was consistent with a small blister-like aneurysm.

Axial CT image of the head demonstrating diffuse subarachnoid hemorrhage in the basal and Sylvian cisterns (yellow arrows). Also, mild hydrocephalus (yellow arrowheads) Coronal CT reconstructed image of the head demonstrating the SAH

A 4 mm anterior communicating artery aneurysm pointing superiorly, anteriorly and right laterally, likely the source of the intracranial bleed (yellow arrows). When compared to the prior CT of the head from 3 years ago, there has been significant interval growth of this aneurysm

 Acute rupture of an anterior communicating artery aneurysm with secondary subarachnoid hemorrhage, Hunt & Hess 2  Plan for treatment:  Neurosurgery to place an extraventricular drainage catheter for treatment of hydrocephalus and intracranial pressure monitoring.  NeuroInterventional Radiology consulted. Plan is to characterize the aneurysm and outline treatment accordingly

Digital subtraction angiographic magnified oblique view of the anterior communicating artery aneurysm (white arrow).

3-Dimensional C-arm rotational Angiogram performed on the NeuroInterventional Suite further characterizes the ruptured aneurysm (red arrow) and the vascular anatomy to plan treatment. Note the low dome to neck ratio and wide neck. An adjunctive device, likely a balloon, will be required when coiling.

Frontal oblique view shows the inflated balloon (red arrow) which assists in the placement of platinum coils (yellow arrow) into the aneurysm pouch.

Final angiogram demonstrates lack of filling of the aneurysm Three small platinum coils (white arrow) have occluded the aneurysmal pouch. Patency of both the right and left anterior cerebral arteries is preserved.

 On post treatment day # 1 the patient reports significant improvement of her headache.  She has no neurological deficits  She will continue her recovery in the NeuroICU during the next several days.

 As shown in this case, this patient had significant interval growth of her anterior communicating artery aneurysm from 2012 until her current admission.  At the New England Center for Stroke Research ( Dr. Matthew Gounis and his team are conducting NIH funded investigations into the causes for aneurysm growth and aneurysm rupture.  Dr. Gounis and his team are also working on advanced imaging techniques which would help further characterize this aneurysm inflammation and growth.