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Cerebral Aneurysm

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5341. Determination of Wall Tension in Cerebral Artery Aneurysms by Numerical Simulation. Full Text available with Trip Pro

Determination of Wall Tension in Cerebral Artery Aneurysms by Numerical Simulation. Cerebral artery aneurysms rupture when wall tension exceeds the strength of the wall tissue. At present, risk-assessment of unruptured aneurysms does not include evaluation of the lesions shape, yet clinical experience suggests that this is of importance. We aimed to develop a computational model for simulation of fluid-structure interaction in cerebral aneurysms based on patient specific lesion geometry (...) , with special emphasis on wall tension.An advanced isogeometric fluid-structure analysis model incorporating flexible aneurysm wall based on patient specific computed tomography angiogram images was developed. Variables used in the simulation model were retrieved from a literature review.The simulation results exposed areas of high wall tension and wall displacement located where aneurysms usually rupture.We suggest that analyzing wall tension and wall displacement in cerebral aneurysms by numeric

2008 Stroke

5342. An unusual case of ruptured distal anterior cerebral artery aneurysm associated with brucellosis. (Abstract)

An unusual case of ruptured distal anterior cerebral artery aneurysm associated with brucellosis. Reports have noted aneurysmal dilatation of arteries in association with brucellosis, but involvement of intracranial vessels has not been documented to date. Sixty-one year old female patient who had been diagnosed with brucellosis 14 months earlier presented with symptoms of subarachnoid hemorrhage (SAH). Due to deterioration of the patient's clinical condition in spite of a two-drug antibiotic

2005 Journal of Infection

5343. Cerebral aneurysmal arteriopathy associated with HIV infection in an adult. Full Text available with Trip Pro

Cerebral aneurysmal arteriopathy associated with HIV infection in an adult. Human immunodeficiency virus (HIV)-associated cerebral aneurysmal arteriopathy is described in the pediatric medical literature and features diffuse fusiform aneurysms of the arteries of the circle of Willis. We present the first report (to our knowledge) of this disease entity in an adult, a 29-year-old woman with acquired immunodeficiency syndrome who presented with subarachnoid hemorrhage.

2006 Clinical Infectious Diseases

5344. Endothelial nitric oxide synthase gene polymorphisms predict susceptibility to aneurysmal subarachnoid hemorrhage and cerebral vasospasm. Full Text available with Trip Pro

Endothelial nitric oxide synthase gene polymorphisms predict susceptibility to aneurysmal subarachnoid hemorrhage and cerebral vasospasm. Rupture of an intracranial aneurysm (subarachnoid hemorrhage) is a potentially devastating condition frequently complicated by delayed cerebral ischemia from sustained contraction of intracranial arteries (cerebral vasospasm). There is mounting evidence linking the formation of intracranial aneurysms and the pathogenesis of post-subarachnoid hemorrhage (...) number tandem repeat polymorphism (eNOS 27 VNTR) predicts susceptibility to intracranial aneurysm rupture, while the eNOS gene promoter T-786C single nucleotide polymorphism (eNOS T-786C SNP) predicts susceptibility to post-subarachnoid hemorrhage vasospasm. We believe that genetic information such as this, which can be obtained expeditiously at the time of diagnosis, may be used as a helpful adjunct to other clinical information aimed at predicting and favorably modifying the clinical course

2004 Journal of Cerebral Blood Flow and Metabolism

5345. Angiography postclipping and coiling of cerebral aneurysms. (Abstract)

Angiography postclipping and coiling of cerebral aneurysms. Postclipping cerebral angiography is generally not practised in the UK. The International Subarachnoid Trial (ISAT) data show that coiling compared favourably with clipping in the early posttreatment phase. We present a 4-year, single unit experience comparing cerebral angiography at 6 months postclipping and postcoiling, defining the proportion of aneurysms in either group, which were incompletely excluded from the cerebral (...) circulation after treatment. There were 4 'dog-ear' remnants (4.6%) in the clipping group of 86 aneurysms, one of which required further surgery. Thirty-one out of 82 (37.8%) coiled aneurysms that underwent check angiography were inadequately excluded from the cerebral circulation at 6 months. Of these, to date, four patients have undergone re-coiling. Although the immediate complications of coiling may be less than those of clipping (ISAT), it seems that the degree and permanence of exclusion

2005 British Journal of Neurosurgery

5346. Polymorphism of the heme oxygenase-1 gene and cerebral aneurysms. (Abstract)

Polymorphism of the heme oxygenase-1 gene and cerebral aneurysms. Inflammation is thought to play an important role in intracranial aneurysm formation. Heme-oxygenase-1(HO-1) is a novel anti-inflammatory factor. A length polymorphic variant of the HO-1 gene promoter region, comprising (GT)n dinucleotide repeats, is associated with altered levels of gene transcription: long (= 36 GT) repeats are associated with decreased HO-1. We hypothesized that patients with aneurysmal subarachnoid (...) haemorrhage were more likely to have long repeats than controls. Sixty-nine patients with aneurysms and 230 age-matched controls were genotyped, and allelic repeats were classed as <36 (short and medium repeats) and >36 (long repeats). Patients were more likely to have =36 repeats than controls (8 v. 4%, p = 0.037. Control patients without aneurysms were more likely to have short alleles. Thus, facilitated up-regulation of HO-1 may be a protective anti-inflammatory factor against the development

2005 British Journal of Neurosurgery

5347. Cerebral aneurysm associated with an intracranial tumour: staged endovascular and surgical treatment in two cases. (Abstract)

Cerebral aneurysm associated with an intracranial tumour: staged endovascular and surgical treatment in two cases. Two cases are reported in which an anterior communicating artery aneurysm was associated with an intracranial tumour. The tumour was a suprasellar meningioma in one case and an optic chiasm/hypothalamic astrocytoma in the other. In both cases, the aneurysm was successfully embolized using Guglielmi detachable coils. Subsequently craniotomy was performed with complete excision (...) of the meningioma and subtotal removal of the astrocytoma. Endovascular techniques can be employed to make the surgical excision of an intracranial tumour co-existing with an incidental aneurysm safer.

2004 British Journal of Neurosurgery

5348. The interleukin-6 gene -174G>C and -572G>C promoter polymorphisms are related to cerebral aneurysms. Full Text available with Trip Pro

The interleukin-6 gene -174G>C and -572G>C promoter polymorphisms are related to cerebral aneurysms. An important part is played by inflammation in intracranial aneurysm formation. The hypothesis that there is an association of the proinflammatory cytokine interleukin-6 (IL-6) genotypes (-572G>C and -174G>C) with intracranial aneurysms was tested.IL-6 genotypes were determined in 91 Caucasian patients with aneurysms and compared with 2720 healthy UK controls.For both polymorphisms (...) , the distribution of the genotypes and estimated allele frequency were different between the control group and the aneurysm group. For -572G>C, a higher frequency of the C allele (p = 0.001) and more people homozygous for the C allele were found among those with aneurysms than among the controls (4.4% v 0.3%, p = 0.001). For -174G>C, more people homozygous for the C allele were found among the controls than among those with aneurysm (18% v 7%, p = 0.007). The 572C/174G haplotype was associated with an increased

2006 Neurosurgery and Psychiatry

5349. Early circulating levels of endothelial cell activation markers in aneurysmal subarachnoid haemorrhage: associations with cerebral ischaemic events and outcome. Full Text available with Trip Pro

Early circulating levels of endothelial cell activation markers in aneurysmal subarachnoid haemorrhage: associations with cerebral ischaemic events and outcome. To investigate the relation of endothelial cell activation with delayed cerebral ischaemia (DCI) and outcome after subarachnoid haemorrhage (SAH).Concentrations of soluble (s) intercellular adhesion molecule-1, sE-selectin, sP-selectin, ED1-fibronectin, von Willebrand Factor (vWf), and vWf propeptide were measured within three days (...) of SAH onset. The associations with poor outcome were investigated at three months in 106 patients. In 90 patients in whom the occurrence of cerebral ischaemia could be dated accurately, two analyses were undertaken: one for all ischaemic events (n = 32), including those related to treatment, and another for spontaneous DCI (n = 11). Concentrations of markers were dichotomised at their medians. The associations of endothelial cell activation markers with outcome were expressed as odds ratios

2006 Neurosurgery and Psychiatry

5350. Does the method of treatment of acutely ruptured intracranial aneurysms influence the incidence and duration of cerebral vasospasm and clinical outcome? Full Text available with Trip Pro

Does the method of treatment of acutely ruptured intracranial aneurysms influence the incidence and duration of cerebral vasospasm and clinical outcome? Cerebral vasospasm remains the leading cause of death and permanent disability after subarachnoid haemorrhage. This study determined whether the method of aneurysm treatment plays an important role in determining the incidence of cerebral vasospasm and its clinical consequences.Admission data, cranial computed tomography (CT), treatment details (...) , transcranial Doppler (TCD) results, and clinical outcomes of patients who had surgical or endovascular management of their ruptured aneurysm were recorded and subject to multivariate analysis.Between January 1995 and December 1999, 292 eligible patients (206 female, 86 male) had definitive aneurysm treatment at our unit. 212 patients were clipped, 80 coiled. There was no significant difference in patient age, pre-treatment neurological grade, Fisher grade, or timing of treatment in the two groups. 48.3

2004 Neurosurgery and Psychiatry

5351. Intracranial aneurysm and arachnoid cyst: a rare association between two cerebral malformations. (Abstract)

Intracranial aneurysm and arachnoid cyst: a rare association between two cerebral malformations. Intracranial aneurysms and arachnoid cysts are cerebral disorders of a high prevalence. However, association between both malformations is a rare finding. The aim was to analyse this association with regard to the different clinical presentations according to the haemorrhage types, as well as the pathogenesis of this association. We searched the English language literature in MEDLINE database (...) middle cerebral artery in three cases, internal carotid artery bifurcation in two cases, posterior communicating segment of carotid artery in two cases, anterior communicating artery in one case and azygos pericallosal artery in one case. Clinical presentation was related to aneurysmal rupture in six cases (subarachnoid haemorrhage in four, subdural haematoma in one and intracystic haematoma in two) and related to arachnoid cysts in three cases, where the most common symptoms were seizures

2007 British Journal of Neurosurgery

5352. Wrapping and coating of cerebral aneurysms: history, evolution and surgical management after a re-bleed. (Abstract)

Wrapping and coating of cerebral aneurysms: history, evolution and surgical management after a re-bleed. Wrapping or coating of ruptured cerebral aneurysms was an acceptable method of surgical treatment until the 1980s. Occasionally, patients still present with a re-bleed. Management of these patients can be challenging. The author describes his experience of surgically treating ruptured aneurysms that have been previously wrapped. Technical issues in the surgical treatment are discussed (...) with three illustrative cases of aneurysms at different locations encountered from 1999 to 2003. Despite operative difficulties satisfactory surgical results can be accomplished in the majority of these cases.

2004 British Journal of Neurosurgery

5353. A failure to communicate: patients with cerebral aneurysms and vascular neurosurgeons. Full Text available with Trip Pro

A failure to communicate: patients with cerebral aneurysms and vascular neurosurgeons. To assess communication between vascular neurosurgeons and their patients with unruptured cerebral aneurysms about treatment options and expected outcomes.Vascular neurosurgeons and their patients with cerebral aneurysms were surveyed immediately following outpatient appointments in a neurosurgery clinic. Data collected included how well the patient understood their aneurysm treatment options, the risks (...) = 0.040; and nopatient 63% v neurosurgeon 25%, p<0.001).Following consultation with a vascular neurosurgeon, many patients with cerebral aneurysms have an inaccurate understanding of their aneurysm treatment plan and an exaggerated sense of the risks of aneurysmal disease and treatment.

2005 Neurosurgery and Psychiatry

5354. Treatment Options for Unruptured Cerebral Aneurysm. (Abstract)

Treatment Options for Unruptured Cerebral Aneurysm. The management of unruptured cerebral aneurysm is controversial. Because the natural history of unruptured cerebral aneurysm is not well defined, the best management strategy is unclear. The current consensus on the management of unruptured cerebral aneurysm includes observation, microsurgical clipping, and endovascular treatment. The methodologies used to follow up a known unruptured aneurysm are controversial and may be dependent (...) on the preferences of the treating physician. Most aneurysms are managed by the neurosurgeons and interventional neuroradiologists, but neurologists often are the first to discover the unruptured aneurysms when screening the patients for other neurologic disorders. Therefore, the knowledge on when to screen patients for and how to best manage an unruptured aneurysm will have a direct impact on their daily practices. Unruptured aneurysms often cause other neurologic symptoms including ischemic events, seizures

2004 Current Treatment Options in Neurology Controlled trial quality: uncertain

5355. A comparison of bispectral index and entropy monitoring, in patients undergoing embolization of cerebral artery aneurysms after subarachnoid haemorrhage. Full Text available with Trip Pro

A comparison of bispectral index and entropy monitoring, in patients undergoing embolization of cerebral artery aneurysms after subarachnoid haemorrhage. Processed EEG monitoring of anaesthetic depth could be useful in patients receiving general anaesthesia following subarachnoid haemorrhage. We conducted an observational study comparing performance characteristics of bispectral index (BIS) and entropy monitoring systems in these patients.Thirty-one patients of the World Federation (...) of Neurosurgeons grades 1 and 2, undergoing embolization of cerebral artery aneurysms following acute subarachnoid haemorrhage, were recruited to have both BIS and entropy monitoring during general anaesthesia. BIS and entropy indices were matched to clinical indicators of anaesthetic depth. Anaesthetists were blinded to the anaesthetic depth monitoring indices. Analysis of data from monitoring devices allowed calculation of prediction probability (P(K)) constants, and receiver operating characteristic (ROC

2006 British Journal of Anaesthesia

5356. Development of torsade de pointes caused by exacerbation of QT prolongation during clipping of cerebral artery aneurysm in a patient with subarachnoid haemorrhage. Full Text available with Trip Pro

Development of torsade de pointes caused by exacerbation of QT prolongation during clipping of cerebral artery aneurysm in a patient with subarachnoid haemorrhage. We report the case of a 79-yr-old woman with subarachnoid haemorrhage (SAH) in whom torsade de pointes (TdP) caused by worsening the QT prolongation occurred during clipping of cerebral artery aneurysm. This patient shows a potential risk of occurrence of life-threatening tachyarrhythmia, TdP by prolonging the QT interval during

2006 British Journal of Anaesthesia

5357. Moderate hypothermia for 359 operations to clip cerebral aneurysms. Full Text available with Trip Pro

Moderate hypothermia for 359 operations to clip cerebral aneurysms. Experimental data have suggested that hypothermia (32-34 degrees C) may improve outcome after cerebral ischaemia, but its efficacy has not yet been established conclusively in humans. In this study we examined the feasibility and safety of deliberate moderate perioperative hypothermia during operations for subarachnoid aneurysms.A total of 359 operations for intracranial cerebral aneurysms were included in this prospective (...) correlation between the occurrence of complications and the severity of the underlying neurological disease as assessed by the Hunt and Hess score.Moderate hypothermia accomplished within 1 h of induction of anaesthesia and maintained during surgery for subarachnoid aneurysms appears to be a safe method as far as the risks of peri/postoperative complications such as circulatory instability, coagulation abnormalities and infections are concerned.

2004 British Journal of Anaesthesia

5358. A Case of Multiple Intracranial Aneurysms with Unruptured Associated Aneurysms and Newly Developed Ruptured Aneurysm Full Text available with Trip Pro

A Case of Multiple Intracranial Aneurysms with Unruptured Associated Aneurysms and Newly Developed Ruptured Aneurysm We report a case of mirror aneurysms at the middle cerebral artery bifurcation with rupture on the left side. After six years, the patient had subarachnoid haemorrhage from a de novo aneurysm which developed separate from but adjacent to the already present aneurysm on the right side. The mechanism of development of multiple aneurysms, especially of the mirror-image type cannot (...) be explained based only on haemodynamic factors and congenital segmental arterial vulnerability which is generalised than focal is highly likely. The sequence of development of aneurysms in this patient along with existing knowledge regarding rupture of aneurysms in conditions like polycystic kidney disease raise questions about the current trend of treating all patients with coincidental, unruptured aneurysms as they may never bleed from such aneurysms but could still be at risk of SAH from newly

2001 Interventional Neuroradiology

5359. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. (Abstract)

dysfunction was reported in 7% of the patients, with 15% of that figure deemed to be of life-threatening severity. There was an association (p = .001) with antibiotic therapy.Potentially preventable medical complications after ruptured cerebral aneurysm add to the total mortality rate of patients, and may increase length of hospital stay in the critical care setting. The proportion of deaths after subarachnoid hemorrhage from medical complications equals those deaths from either direct effects, rebleeding (...) Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subarachnoid

1995 Critical care medicine Controlled trial quality: uncertain

5360. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. Full Text available with Trip Pro

Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. To determine the efficacy of oral nimodipine in reducing cerebral infarction and poor outcomes (death and severe disability) after subarachnoid haemorrhage.Double blind, placebo controlled, randomised trial with three months of follow up and intention to treat analysis. To have an 80% chance with a significance level of 0.05 of detecting a 50% reduction in an incidence (...) of cerebral infarction of 15% a minimum of 540 patients was required.Four regional neurosurgical units in the United Kingdom.In all 554 patients were recruited between June 1985 and September 1987 out of a population of 1115 patients admitted with subarachnoid haemorrhage proved by the results of lumbar puncture or computed tomography, or both. The main exclusion criterion was admission to the neurosurgical units more than 96 hours after subarachnoid haemorrhage. There were four breaks of code

1989 BMJ Controlled trial quality: predicted high

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