• Journal of Korean Neurosurgical Society
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• v.56 no.5
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• pp.419-422
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• 2014

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset headache with focal neurologic deficit and prolonged but reversible multifocal narrowing of the distal cerebral arteries. Stroke, either hemorrhagic or ischemic, is a relatively frequent presentation in RCVS, but progressive manifestations of subarachnoid hemorrhage, intracerebral hemorrhage, cerebral infarction in a patient is seldom described. We report a rare case of a 56-year-old woman with reversible cerebral vasoconstriction syndrome consecutively presenting as cortical subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarction. When she complained of severe headache with subtle cortical subarachnoid hemorrhage, her angiography was non-specific. But, computed tomographic angiography showed typical angiographic features of this syndrome after four days. Day 12, she suffered mental deterioration and hemiplegia due to contralateral intracerebral hematoma, and she was surgically treated. For recurrent attacks of headache, medical management with calcium channel blockers has been instituted. Normalized angiographic features were documented after 8 weeks. Reversible cerebral vasoconstriction syndrome should be considered as differential diagnosis of non-aneurysmal subarachnoid hemorrhage, and repeated angiography is recommended for the diagnosis of this under-recognized syndrome.

• Journal of Korean Neurosurgical Society
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• v.62 no.5
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• pp.526-535
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• 2019

Objective : While the risk of aneurysmal rebleeding induced by catheter cerebral angiography is a serious concern and can delay angiography for a few hours after a subarachnoid hemorrhage (SAH), current angiographic technology and techniques have been much improved. Therefore, this study investigated the risk of aneurysmal rebleeding when using a recent angiographic technique immediately after SAH. Methods : Patients with acute SAH underwent immediate catheter angiography on admission. A four-vessel examination was conducted using a biplane digital subtraction angiography (DSA) system that applied a low injection rate and small volume of a diluted contrast, along with appropriate control of hypertension. Intra-angiographic aneurysmal rebleeding was diagnosed in cases of extravasation of the contrast medium during angiography or increased intracranial bleeding evident in flat-panel detector computed tomography scans. Results : In-hospital recurrent hemorrhages before definitive treatment to obliterate the ruptured aneurysm occurred in 11 of 266 patients (4.1%). Following a univariate analysis, a multivariate analysis using a logistic regression analysis revealed that modified Fisher grade 4 was a statistically significant risk factor for an in-hospital recurrent hemorrhage (p=0.032). Cerebral angiography after SAH was performed on 88 patients ${\leq}3$ hours, 74 patients between 3-6 hours, and 104 patients >6 hours. None of the time intervals showed any cases of intra-angiographic rebleeding. Moreover, even though the DSA ${\leq}3$ hours group included more patients with a poor clinical grade and modified Fisher grade 4, no case of aneurysmal rebleeding occurred during erebral angiography. Conclusion : Despite the high risk of aneurysmal rebleeding within a few hours after SAH, emergency cerebral angiography after SAH can be acceptable without increasing the risk of intra-angiographic rebleeding when using current angiographic techniques and equipment.

• Journal of Korean Neurosurgical Society
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• v.41 no.2
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• pp.134-136
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• 2007

A woman who had a spontaneous subarachnoid hemorrhage [SAH] and temporal intracerebral hemorrhge [ICH] without any causative lesions on computed tomography [CT] and digital angiography at the day of the stroke. She was considered to have an angiographically negative SAH and scheduled for a repeated angiography. While she was waiting for the next study, she developed a second hemorrhage. CT angiography showed an aneurysmal shadow in the course of the posterior cerebral artery. After the operation, the aneurysm proved to be a pseudoaneurysm.

• Journal of Korean Neurosurgical Society
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• v.41 no.2
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• pp.123-126
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• 2007

A 58-year-old woman was admitted to our department due to headache. Brain computed tomography [CT] indicated subarachnoid hemorrhage [SAH], and emergency angiography showed dissecting aneurysm involving the left A1 segment We performed trapping of dissecting A1 aneurysm and the postoperative course was uneventful. We present a case of dissecting aneurysm in the anterior cerebral artery with spontaneous SAH which was treated by early surgery and resulted in clinically good prognosis.

• Journal of radiological science and technology
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• v.42 no.5
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• pp.357-363
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• 2019

To the basic information of patients with subarachnoid hemorrhage due to rupture of cerebral aneurysm treated with coil embolization, and to identify the general trend of treatment through classification according to hospitalization route, residence distribution, location and size of cerebral aneurysm, and procedure. A total of 164 patients with ruptured cerebral aneurysms treated with coil embolization were 54(32.9%) males and 110(67.1%) females. The sex and frequency of occurrence by age group were the most in 50s(31.3%), and among them, females were the most. The hospitalization route was the most common in 122(74.4%) people who were admitted to the emergency room through 119 evacuation, 79(48.2%) patients lived in where hospitals belong to the hospital. The season had 23(14%) in December, 18(11%) in January, 15(9.1%) in February, and the anterior circulation was 153(93%). The largest size was 5-7 mm found in 63(38.4%) patients. Patients underwent initial coil embolization for subarachnoid hemorrhage due to cerebral aneurysm rupture treated more patients than the incidence of the population. As a result of cerebral aneurysm rupture was seasonally affected, and winter occurs more frequently, female than male, age 50 is most common, and ruptured cerebral aneurysm is 5-7 mm in size.

• Journal of Korean Neurosurgical Society
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• v.66 no.2
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• pp.205-210
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• 2023

Delayed cerebral ischemia (DCI) remains a devastating complication in subarachnoid hemorrhage (SAH), however, there were no present reports that is associated with a ruptured spinal arteriovenous fistula (sAVF). We would like to present a rare case of DCI following embolization of a ruptured perimedullary sAVF. Initially, the patient clinical symptoms mimic a SAH caused by a ruptured intracranial aneurysm. Further evaluation revealed that the SAH was caused by a ruptured perimedullary sAVF and the patient's condition improved following the embolization procedure. Three days later, the patient developed an acute left-sided facial and motor weakness, which persisted until the patient was discharged on the day-15 onset. A magnetic resonance imaging and angiography is performed 1.5 years after discharge and revealed no signs of cerebral infarction and hemorrhage. In this paper, we reported DCI after embolization in a ruptured sAVF with SAH, supported by evidence from the current literature. We would like to also stress the importance of complete spinal and cerebral vessel imaging to reveal the underlying abnormalities and determine the most appropriate intervention.

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.172-178
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• 2012

Objective : The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes. Methods : We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms. Results : For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vasospasm and the change in diameter (p=0.022). Conclusion : IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our findings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.345-352
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• 2000

Objective : The purpose of this study was to compare computed tomographic angiography(CTA) with conventional cerebral angiography(CCA) and to assess usefulness of CTA in detection and anatomic definition of intracranial aneurysms of the circle of Willis in subarachnoid hemorrhage. Patients and Methods : Fifty consecutive patients with known or suspected intracranial saccular aneurysms underwent CTA with preoperative CCA from 1997 to 1999. Using surface shaded display post-processing technique, CTA was interpreted for the presence, location of aneurysms and anatomic features. The image obtained with CTA was then compared with CCA image. Results : In 47 patients, CCA revealed 57 cerebral aneurysms and CTA revealed 54 aneurysms. Two of the 57 cerebral aneurysms were located outside of the imaging volume of CTA and one case was misdiagnosed. The sensitivity of CTA was 94.7% and the specificity was 100%. The results obtained with CTA were, compared with the results obtained with CCA, equal in determining dome shape, direction and lobularity. However, CTA provided a 3-dimensional representation of aneurysmal lesion very useful for surgical planning. Moreover, CTA was useful for rapid and relatively noninvasive detection of aneurysms in the circle of Willis. Conclusion : CTA can be a diagnostic tool for the patients with acute subarachnoid hemorrhage due to a ruptured aneurysm of the circle of Willis and provides adequate anatomic detail for surgical planning, especially to complex cerebral aneurysms. However, we think CCA is necessary because of CTA limitations including its difficulty in detecting unusually located aneurysms(including those in cavernous sinus or distal artery) and combined vascular lesion (including arteriovenous malformation) and acquiring dynamic flow information.

• Journal of Korean Neurosurgical Society
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• v.39 no.2
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• pp.125-129
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• 2006

Objective : The purpose of this study is to identify any differential point in computerized tomographic[CT] findings between aneurysmal subarachnoid hemorrhage[ASAH] and traumatic subarachnoid hemorrhage[TSAH], which sometimes make us not confident in differentiation. Methods : CT of 142 ASAH and 82 TSAH patients over the last 2 years were retrospectively reviewed. We evaluated the thickness of SAH, the laterality of sylvian cisternal hemorrhage, the location, the number of involved cisterns, and the associated other lesions between two types of SAH. Results : Suprasellar cisterns and sylvian cisterns were most prominently and frequently involved cisterns in ASAH but cortical sulci and sylvian cisterns were most frequently involved in TSAH. Intraventricular and intracerebral hemorrhage were frequently seen in ASAH. Thickness of SAH over 1mm, bilateral sylvian SAH, multiple cisternal SAH were in favor of ASAH. The number of involved cisterns were more frequently seen in ASAH than in TSAH. In ASAH, bilateral sylvian hemorrhages were more frequently seen than in TSAH. Skull fracture, subdural hematoma, subgaleal hematoma, and hemorrhagic contusion were frequently associated with TSAH. Conclusion : As a result of our study, the authors conclude that when IVH, hydrocephalus, thick SAH > 1mm bilateral sylvian SAH, and multiple cisternal SAH are seen in CT, immediate angiography should be performed to rule out cerebral aneurysms whether associated with other traumatic lesions or not.

• Journal of Korean Neurosurgical Society
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• v.49 no.3
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• pp.157-162
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• 2011

Objective : Vasospasm of cerebral vessels remains a major source of morbidity and mortality after an aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to evaluate the safety and efficacy of transluminal balloon angioplasty (TBA) for SAH-induced vasospasm. Methods : Eleven patients with an angiographically confirmed significant vasospasm (>50% vessel narrowing and clinical deterioration) were studied. A total of 54 vessel segments with significant vasospasm were treated by TBA. Digital subtraction angiography was used to confirm the presence of vasospasm, and TBA was performed to dilate vasospastic arteries. Medical and angiographic reports were reviewed to determine technical efficacy and for procedural complications. Results : TBA using Hyper-Glide or Hyper-Form balloons (MicroTherapeutics, Irvine, CA) was successfully accomplished in 88.9% vasospastic segments (48 of 54), namely, in the distal internal carotid artery (100%, n=7), the middle cerebral artery (100%), including the M1 (n=10), M2 (n=10), and M3 segments (n=4), in the vertebral artery (100%, n=2), basilar artery (100%, n=1), and in the anterior cerebral artery (ACA), including the A1 (66%), A2 (66%), and A3 segments (100%). Vessel diameters significantly increased after TBA. There were no cases of vessel rupture or thromboembolic complications. GCS at one day after TBA showed an improvement in all patients except one. Conclusion : This study suggests that TBA using Hyper-Glide or Hyper-Form balloons is a safe and effective treatment for subarachnoid hemorrhage-induced cerebral vasospasm.