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Sreenivasan S, Agarwal N, Roychowdhury S, Nanda A, Gupta G. Super-selective cerebral angiography mimicking subarachnoid hemorrhage: Revisited by an old demon with a different mask! Interv Neuroradiol 2022:15910199221135701. [PMID: 36325714 DOI: 10.1177/15910199221135701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Affiliation(s)
- Sanjeev Sreenivasan
- Department of Neurosurgery, RUTGERS- Robert Wood Johnson Medical School & University Hospital, New Brunswick, New Jersey, USA
| | - Neha Agarwal
- Fetal Centre, Department of Obstetrics & Gynecology, University of Texas health, McGovern Medical School, Houston, Texas, USA
| | - Sudipta Roychowdhury
- Department of Neurosurgery, RUTGERS- Robert Wood Johnson Medical School & University Hospital, New Brunswick, New Jersey, USA
| | - Anil Nanda
- Department of Neurosurgery, RUTGERS- Robert Wood Johnson Medical School & University Hospital, New Brunswick, New Jersey, USA
| | - Gaurav Gupta
- Department of Neurosurgery, RUTGERS- Robert Wood Johnson Medical School & University Hospital, New Brunswick, New Jersey, USA
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Yokoya S, Oka H, Shiomi N, Hino A, Fujimoto M. Aneurysm of Distal Medial Lenticulostriate Artery: Report of 2 Cases. World Neurosurg 2020; 143:219-222. [PMID: 32750519 DOI: 10.1016/j.wneu.2020.07.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Aneurysms originating from the distal portion of the lenticulostriate artery (LSA) are uncommon. Distal medial LSA (MLSA) aneurysms are particularly uncommon when compared with distal lateral LSA aneurysms, and their clinical features are unclear. Here, we present 2 patients with aneurysms of the distal MLSA who exhibited hemorrhages of the caudate nucleus and intraventricular region (intraventricular hemorrhage [IVH]). CASE DESCRIPTION Patient 1 is a 50-year-old woman who was admitted to our hospital because of a hemorrhage in the left caudate nucleus and ventricles. She underwent external ventricular drainage (EVD). Cerebral angiography (CAG) performed on hospital day 24 showed an aneurysm located in the distal portion of the MLSA; however, CAG performed on admission revealed no abnormal vessels. We excised the aneurysm using a transcallosal-transventricular approach. Patient 2 is an 88-year-old woman who was admitted to our hospital with a right caudate nucleus hematoma and a dense IVH. She underwent emergent EVD. CAG demonstrated a 2.5-mm aneurysm in the distal MLSA, and a 6-mm aneurysm which originated from the right horizontal portion of the anterior cerebral artery (A1)-MLSA bifurcation aneurysm. We performed direct clipping of the A1-MLSA bifurcation aneurysm with proximal ligation of the distal MLSA aneurysm. CONCLUSIONS We should consider the possibility of a ruptured distal MLSA aneurysm when diagnosing a patient with IVH-with or without a caudate nucleus hematoma. Repeated imaging evaluations may be necessary to find the lesion.
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Affiliation(s)
- Shigeomi Yokoya
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan.
| | - Hideki Oka
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Naoto Shiomi
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Akihiko Hino
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Masahito Fujimoto
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
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Chaohui L, Chuan H, Hongqi Z. Embolization of Ruptured Distal Lenticulostriate Artery Aneurysms. World Neurosurg 2018; 118:e147-e154. [DOI: 10.1016/j.wneu.2018.06.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/15/2018] [Accepted: 06/16/2018] [Indexed: 12/01/2022]
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Nomura M, Baba E, Shirokane K, Tsuchiya A. Aneurysm of lenticulostriate artery in a patient presenting with hemorrhage in the caudate nucleus and lateral ventricle-delayed appearance and spontaneous resolution. Surg Neurol Int 2018; 9:192. [PMID: 30294496 PMCID: PMC6169348 DOI: 10.4103/sni.sni_126_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/02/2018] [Indexed: 12/03/2022] Open
Abstract
Background: An aneurysm of distal lenticulostriate artery is very rare. The natural course and management of this rare aneurysm are not clear. Case Description: An 81-year-old woman developed consciousness disturbance. Computed tomography revealed hemorrhage in the right caudate nucleus and lateral ventricles. Three-dimensional computed tomographic angiography demonstrated only an aneurysm at the basilar artery. On angiography, on the sixth day, an aneurysm at the right lenticulostriate artery was demonstrated. Then, the aneurysm disappeared on three-dimensional computed tomographic angiography on the 15th day. Subsequent radiological examinations revealed no vascular anomaly in the right lenticulostriate artery. Conclusion: An aneurysm at this location can show dynamic changes based on radiological findings. Close radiological observation is necessary.
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Affiliation(s)
- Motohiro Nomura
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Eiichi Baba
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan
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Choo YS, Kim YB, Shin YS, Joo JY. Deep Intracerebral Hemorrhage Caused by Rupture of Distal Lenticulostriate Artery Aneurysm : A Report of Two Cases and a Literature Review. J Korean Neurosurg Soc 2015; 58:471-5. [PMID: 26713149 PMCID: PMC4688318 DOI: 10.3340/jkns.2015.58.5.471] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 08/08/2014] [Accepted: 08/31/2014] [Indexed: 11/27/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is common among various types of storkes; however, it is rare in young patients and patients who do not have any risk factors. In such cases, ICH is generally caused by vascular malformations, tumors, vasculitis, or drug abuse. Basal ganglia ICH is rarely related with distal lenticulostriate artery (LSA) aneurysm. Since the 1960s, a total of 29 distal LSA aneurysm cases causing ICH have been reported in the English literature. Despite of the small number of cases, various treatment methods have been attempted : surgical clipping, endovascular treatment, conservative treatment, superficial temporal artery-middle cerebral artery anastomosis, and gamma-knife radiosurgery. Here, we report two additional cases and review the literature. Thereupon, we discerned that young patients with deep ICH are in need of conventional cerebral angiography. Moreover, initial conservative treatment with follow-up cerebral angiography might be a good treatment option except for cases with a large amount of hematoma that necessitates emergency evacuation. If the LSA aneurysm still persists or enlarges on follow-up angiography, it should be treated surgically or endovascularly.
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Affiliation(s)
- Yeon Soo Choo
- Department of Neurosurgery, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Yang Joo
- Department of Neurosurgery, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea
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Vargas J, Walsh K, Turner R, Chaudry I, Turk A, Spiotta A. Lenticulostriate aneurysms: a case series and review of the literature. J Neurointerv Surg 2014; 7:194-201. [DOI: 10.1136/neurintsurg-2013-010969] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Heck O, Anxionnat R, Lacour JC, Derelle AL, Ducrocq X, Richard S, Bracard S. Rupture of lenticulostriate artery aneurysms. J Neurosurg 2014; 120:426-33. [DOI: 10.3171/2013.8.jns13608] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report on 3 rare cases of ruptured lenticulostriate artery (LSA) aneurysms that were heralded by deep cerebral hematomas. The hematomas were unilateral in 2 cases and bilateral in 1; in the bilateral case, only a single LSA aneurysm could be identified on the right side of the brain. Because of their small size (≤ 2 mm), fusiform aspect, and deep location within the brain, all of the aneurysms were treated conservatively. There was no hemorrhage recurrence, and follow-up angiography demonstrated spontaneous thrombosis in 2 of the 3 cases. The clinical course was favorable in 2 of the 3 patients. The course in the patient with the bilateral hematoma was marked by an ischemic event after the initial episode, resulting in an aggravation of deficits. The cause of this second event was uncertain.
Because our knowledge about the natural history of LSA aneurysms is incomplete, there is no consensus concerning a therapeutic strategy. The authors' experience in 3 reported cases leads them to think that a conservative approach involving close angiographic monitoring may be proposed as first-line treatment. If the monitored aneurysm then persists or grows in size, its occlusion should be considered. Nonetheless, other studies are needed to further strengthen the legitimacy of this strategy.
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Affiliation(s)
- Olivier Heck
- 1Departments of Diagnostic and Interventional Neuroradiology and
| | - René Anxionnat
- 1Departments of Diagnostic and Interventional Neuroradiology and
- 2Institut National de la Santé et de la Recherche Médicale, University of Lorraine, Nancy, France
| | | | | | | | | | - Serge Bracard
- 1Departments of Diagnostic and Interventional Neuroradiology and
- 2Institut National de la Santé et de la Recherche Médicale, University of Lorraine, Nancy, France
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Fusiform aneurysms of the lenticulostriate artery. J Clin Neurosci 2013; 21:373-7. [PMID: 24156904 DOI: 10.1016/j.jocn.2013.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 07/13/2013] [Indexed: 11/21/2022]
Abstract
Lenticulostriate artery aneurysms are rare, can be difficult to diagnoze, and when they rupture they are often associated with deep intraparenchymal hemorrhages. In particular, fusiform, dissecting aneurysms of a distal lenticulostriate artery are extremely rare. Typically, they are usually associated with underlying systemic conditions such as systemic lupus erythematosus, moyamoya disease, and substance abuse. Given their usual small size and location, these aneurysms may be difficult to detect with angiography and can be challenging to treat with either endovascular or microsurgical techniques. We provide background information, review the existing treatment experiences reported in the literature, and present a discussion regarding the optimal management using an illustrative clinical vignette. Parent artery obliteration can be a safe and effective treatment in these rare aneurysms.
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Lama S, Dolati P, Sutherland GR. Controversy in the management of lenticulostriate artery dissecting aneurysm: a case report and review of the literature. World Neurosurg 2012; 81:441.e1-7. [PMID: 23246740 DOI: 10.1016/j.wneu.2012.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 11/23/2012] [Accepted: 12/07/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intracranial arterial dissection is an uncommon but well-recognized entity. Treatment remains variable, ranging from observation to intervention via the use of either surgical or endovascular techniques. Aneurysms along the lenticulostriate artery have been reported in only 41 patients. With the current case study we illustrate the effectiveness of observation in the context of a dissecting lenticulostriate aneurysm and discuss other approaches that have been used in the treatment of this particular entity. CLINICAL SUMMARY An accomplished mountain climber presented, after coitus, with acute headache, mild facial weakness, and forgetfulness. Vascular imaging studies revealed a right putaminal hemorrhage secondary to a 3-mm lenticulostriate artery dissecting aneurysm. Clinically, the patient did well, with marked improvement in presenting symptoms enabling his return to mountain climbing. Follow-up angiography showed spontaneous resolution of the arterial dissecting aneurysm. Among the 41 reported cases, 19 were idiopathic, 5 associated with hypertension, and 17 related to various conditions such as Moyamoya disease, arteriovenous malformation, systemic vasculitis, intraventricular tumor, or substance abuse. Of the 42 cases, including the present case, 28 were surgically or endovascularly managed and 12 observed. Only one of the reported cases, a 33-year-old man with Moyamoya disease, who was managed conservatively, died of rebleeding. CONCLUSION There is no common consensus in the literature on a single treatment strategy for a lenticulostriate artery aneurysm. The present case illustrates that observation and follow-up vascular imaging can be an important treatment strategy, allowing healing of the vessel wall and disappearance of the dissecting aneurysm.
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Affiliation(s)
- Sanju Lama
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Parviz Dolati
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Garnette R Sutherland
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
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