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Teaching NeuroImages Neurology Resident and Fellow Section

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Presentation on theme: "Teaching NeuroImages Neurology Resident and Fellow Section"— Presentation transcript:

1 Teaching NeuroImages Neurology Resident and Fellow Section
64-year-old female with paraclinoid aneurysm found after screening by Enrico Giordan, Waleed Brinjikji, Giuseppe Lanzino Teaching NeuroImages Neurology Resident and Fellow Section Giordan et al. © 2013 American Academy of Neurology

2 Vignette 64-year-old female
Paraclinoid aneurysm found during screening for strong family history Endovascular treatment with flow diversion After 2 months she presented with headache and intermittent word finding difficulty Brain MRI demonstrated multiple areas of nodular enhancement ipsilateral to the treated aneurysm After a 6-week course of oral steroids the radiological findings and her symptoms resolved Giordan et al. © 2013 American Academy of Neurology

3 Imaging Giordan et al. A B C D E
Figure 1. Left ICA aneurysm on cerebral angiogram and rationale behind pipeline placement. A. Cerebral angiogram shows a 6-mm periophtalmic left ICA aneurysm. Drawing of flow diversion for intracranial aneurysms. B. Blood flow through an untreated aneurysm. C. Flow diverter placed in the parent vessel redirects blood causing intraaneurysmal stasis. D. Progressive intraaneurysmal thrombosis leads to E. aneurysm occlusion. Giordan et al. © 2013 American Academy of Neurology

4 Imaging Figure 2. Brain MRI shows presentation, progression and resolution of foreign body reaction. A. T1-contrast-enhanced MRI two months after treatment shows nodular enhancement in the left frontal and parietal lobes (arrowheads). B. T2-enhanced/FLAIR MRI shows marked edema/T2-changes in the region of nodular enhancement (arrow). C. Four months later MRI shows marked reduction in enhancement and D. improvement in edema/T2 changes (arrowheads). Giordan et al. © 2013 American Academy of Neurology

5 Intracranial foreign body reaction after endovascular procedures
The clinical course and imaging findings are consistent with a foreign body reaction It can occasionally occur after endovascular treatment The phenomenon is related to a foreign body reaction to microparticles sheared from catheters/devices during endovascular procedures.1, 2 References 1. Cruz JP, Marotta T, O'Kelly C, et al. Enhancing brain lesions after endovascular treatment of aneurysms. AJNR Am J Neuroradiol 2014;35: 2. Lorentzen AO, Nome T, Bakke SJ, Scheie D, Stenset V, Aamodt AH. Cerebral foreign body reaction after carotid aneurysm stenting. Interv Neuroradiol 2016;22:53-57. Giordan et al. © 2013 American Academy of Neurology

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