Vessel Wall Imaging After Subarachnoid Hemorrhage in Patients with Multiple Intracranial Aneurysms: A Cautionary Case

Zolnourian, Ardalan; Borg, Nicholas; Akhigbe, Taiwo; Macdonald, Jason; Bulters, Diederik

doi:10.1016/j.wneu.2019.04.130

Cited by 8 publications

(3 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In one reported case, a patient with acute SAH was found to have 2 lesions: a 3.5-mm MCA aneurysm and a 1.5-mm PCoA aneurysm. 73 On VWI, the MCA aneurysm demonstrated circumferential enhancement, whereas the PCoA aneurysm did not enhance. Intraoperatively, the PCoA aneurysm was found to be acutely ruptured, in contradiction to the VWI result.…”

Section: Cerebral Aneurysmsmentioning

confidence: 95%

See 1 more Smart Citation

Magnetic resonance vessel wall imaging in cerebrovascular diseases

Young

Bonow

Barros

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

Cerebrovascular diseases manifest as abnormalities of and disruption to the intracranial vasculature and its capacity to carry blood to the brain. However, the pathogenesis of many cerebrovascular diseases begins in the vessel wall. Traditional luminal and perfusion imaging techniques do not provide adequate information regarding the differentiation, onset, or progression of disease. Intracranial high-resolution MR vessel wall imaging (VWI) has emerged as an invaluable technique for understanding and evaluating cerebrovascular diseases. The location and pattern of contrast enhancement in intracranial VWI provides new insight into the inflammatory etiology of cerebrovascular diseases and has potential to permit earlier diagnosis and treatment. In this report, technical considerations of VWI are discussed and current applications of VWI in vascular malformations, blunt cerebrovascular injury/dissection, and steno-occlusive cerebrovascular vasculopathies are reviewed.

show abstract

Section: Cerebral Aneurysmsmentioning

confidence: 95%

“…These results suggest that VWI has a high sensitivity and negative predictive value for identifying acute ruptured aneurysms. 51, 64,73 Stability of Cerebral Aneurysms. Unstable aneurysms are at higher risk of rupture and warrant treatment.…”

Section: Cerebral Aneurysmsmentioning

confidence: 99%

Magnetic resonance vessel wall imaging in cerebrovascular diseases

Young

Bonow

Barros

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…Recently, computational flow dynamics (CFD) may be helpful in the determination of the ruptured one. [4][5][6][7] Treatment options include surgical, endovascular, or combined securing depending on the clinical situation, imaging findings, and center experiences. Securing of all aneurysms in one session whenever feasible protects the patient from rebleeding and treating only the unruptured ones.…”

Section: Introductionmentioning

confidence: 99%

Multiple Intracranial Aneurysms Presented with Subarachnoid Hemorrhage; Which to Secure and How?

Metwaly

Sultan

Rayan

2021

Pan Arab Journal of Neurosurgery

View full text Add to dashboard Cite

BACKGROUND: Dealing with multiple intracranial aneurysms (MIA) presenting with subarachnoid hemorrhage (SAH) is challenging.OBJECT: To make a proposal for the decision-making regarding which aneurysm to secure and how, as the most challenging part in the management of MIA. METHODS: This descriptive study included 25 patients presenting with SAH and having multiple intracranial aneurysms. All patients had a brain computed tomography (CT) scan, CT angiography (CTA), and digital subtraction angiography (DSA). Patients were treated in our institution using microsurgical clipping and/or endovascular embolization according to the clinical and radiological situation. Functional outcome was assessed by modified Rankin scale. RESULTS: Fifteen females and 10 males with average age of 48 years were included. All patients (100%) presented with hemorrhage. Ten patients (40%) were hunt and Hess (H&H) grade I, seven patients (28%) grade II, 3 patients (12%) grade III, 3 patients (12%) grade V and 2 patients (8%) grade IV. Fisher scale was grade II in 11 patients (44%), grade IV in 9 patients (36%) and 5 patients (20%) were grade III. Criteria for the suspected ruptured aneurysm were aneurysm wall irregularity in 24 patients (96%) and the largest size in 23 cases (92%). The epicenter of hemorrhage was a satisfactory localizing sign on CT in only 10 cases (40%). Fifty-six aneurysms were encountered in the 25 patients; 19 patients (76%) had 2 aneurysms and 6 patients (24%) had 3 aneurysms. Clipping was done for 40 aneurysms (71%), wrapping for 2 aneurysms (3%), 4 aneurysms (7%) were followed up, 8 aneurysms (14%) were coiled, and 2 aneurysms (3%) were treated by flow diverters. Twenty patients (80%) had a good outcome on the modified Rankin scale, 4 patients (16%) had mental changes and one patient (4%) had residual neurological deficit. CONCLUSION: The ruptured one in multiple intracranial aneurysms can be suspected by its size and wall irregularity especially in the absence of localizing sign in the CT scan. High-resolution CTA and/or 3D DSA are highly helpful. These cases should be managed in specialized centers where the surgical and endovascular treatment modalities are available.

show abstract