Introduction:
Endovascular therapy (EVT) for intracranial arterial aneurysms is depicted
with several complications. Very recently, delayed non-ischemic cerebral enhanced (NICE) lesions
have been identified as a rare complication associated with EVT. This complication always
stands a higher chance of being missed in asymptomatic patients. We report a case of multiple
NICE lesions in a known chronic hepatitis B infection and chronic gastritis patient with left internal
carotid aneurysm (ICA) treated with detachable coils.
Case Presentation:
A 52 years old female with left ICA was treated with detachable coils via the
endovascular route. Three weeks after the operation, she presented with numbness of her right
limbs which was persistent and waked her up from sleep each night. She admitted skin allergies after
wearing metals except for gold and silver since childhood. MRI revealed multiple abnormal lesions
in the left temporal lobe, hippocampus, insula, and parietal lobe and some perifocal edema
which were consistent with the diagnosis of delayed NICE lesions.
Conclusion:
It is very important to report the occurrences of these lesions in literature because of
their allergic origin. We advocate that allergy to metals especially those used in coating endovascular
equipment should be evaluated before every EVT for intracranial aneurysms.
Introduction:
Pseudoaneurysms or false aneurysms originating from superficial temporal artery (STA) are rare and often seen as facial swellings. These forms of aneurysms often involve the intimal and media layers of the arterial wall. So far only single cases have been reported at various locations across the world since 1644. We report another unique case of traumatic STA pseudoaneurysms.
Case Presentation:
We present a 51-year-old man with a 1-year history of a pulsatile mass on the left forehead. He suffered a blunt trauma at the temporal region of the left forehead a year prior. Computed tomography angiography confirmed left STA pseudoaneurysms. The lesion was total resected via surgery. We reconstructed parent artery after resecting the pseudoaneurysm. The patient recovered well with an overall good cosmetic look.
Conclusions:
It is very necessary to report the occurrences of STA pseudoaneurysms because the swelling could be mistaken for other lesions leading to inappropriate treatment especially in facilities with no modern radiologic modalities.
Rationale: The hybrid surgical concept for the treatment of brain arteriovenous malformations (AVMs) with associated intracranial aneurysms (IAs) is still not widely practiced. Concomitant occurrence of AVMs with IAs is common. Subarachnoid hemorrhage (SAH) as a result of AVM or IA rupture is often associated with these dual pathological phenomena. We present a case of concomitant occurrence of AVMs and IAs that was successfully treated using the hybrid operation concept.Patient concerns: A 62-year-old man presented with sudden onset of severe headache, dizziness, nausea, and vomiting for 4 hours.Diagnosis: Computed tomography revealed SAH and a hematoma in the right frontal lobe. A computed tomographic angiogram also revealed a right frontal AVM with 3 IAs.Interventions: We used a hybrid operating room to successfully treat both AVMs and IAs.Outcomes: Two years of follow-up showed that the patients were well and performed their daily duties.Lessons: The hybrid operating room is an innovative, safe, and effective method for the treatment of AVMs with associated IAs, particularly high-grade AVMs and IAs with hemorrhage or SAH. Patients with concomitant AVMs and IAs have the highest chance of hemorrhage compared with those with AVM or IAs alone.
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