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Ikeuchi Y, Shimasaki T, Nitta N, Yamamoto Y, Ishii T. Ruptured traumatic posterior inferior cerebellar artery pseudoaneurysm: A case report and literature review. Surg Neurol Int 2022; 13:257. [PMID: 35855165 PMCID: PMC9282736 DOI: 10.25259/sni_410_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/02/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Traumatic intracranial aneurysm (TICA) accounts for approximately 1% of cerebral aneurysms. There are few reports of TICA limited to the posterior inferior cerebellar artery (PICA-TICA).
Case Description:
A 69-year-old woman fell into a shallow river, bruising her head and chest, and was admitted to our emergency department with disorientation. Computed tomography (CT) showed subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), left temporal lobe contusion, and fractures of the right temporal bone. A cerebral CT angiogram revealed no vascular abnormalities or aneurysms. The patient was in a semi-comatose state 2 h later, and CT showed worsening SAH. A cerebral angiogram revealed an 11 mm aneurysm of the anterior medullary segment of the right PICA. We attempted intra-aneurysmal embolization intending to preserve the PICA, but the aneurysmal neck was thin, and the microcatheter could not be placed in a stable position. Therefore, n-butyl-2-cyanoacrylate (NBCA) was injected to embolize the aneurysm. When the microcatheter was removed, NBCA was scattered distally in the PICA, and the distal PICA was occluded. The aneurysm could be embolized, but there was an increase in hemorrhagic contusion in the left temporal lobe. Decompression craniectomy was performed, but she died due to hemorrhagic contusion and uncal herniation 6 days after surgery.
Conclusion:
PICA-TICA is often accompanied by IVH and SAH, and there are some reports of cases with a vascular anomaly of the posterior circulation. Since TICA is at risk of rapid growth and rupture, an early and appropriate diagnosis is important.
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Affiliation(s)
- Yusuke Ikeuchi
- Department of Neurosurgery, Graduate School of Medicine, Kobe University, Chuo-ku, Kobe, Japan
| | - Tomoya Shimasaki
- Department of Neurosurgery, Toyooka Hospital, Toyooka, Hyogo, Japan
| | - Naoki Nitta
- Department of Neurosurgery, Toyooka Hospital, Toyooka, Hyogo, Japan
| | - Yusuke Yamamoto
- Department of Neurosurgery, Toyooka Hospital, Toyooka, Hyogo, Japan
| | - Taiji Ishii
- Department of Neurosurgery, Toyooka Hospital, Toyooka, Hyogo, Japan
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Palmieri M, Pesce A, Zancana G, Armocida D, Maiese A, Cirelli C, Santoro A, Frati P, Fineschi V, Frati A. Post-traumatic intracranial pseudo-aneurysms of posterior circulation: a comprehensive review of an under-diagnosed and rare entity. Neurosurg Rev 2021; 45:1019-1029. [PMID: 34608549 PMCID: PMC8976800 DOI: 10.1007/s10143-021-01657-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/08/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022]
Abstract
Traumatic aneurysms are rare and the total number of cases involving the posterior circulation (TIPC) is even smaller. Traumatic brain injury (TBI) may be responsible not only of rupture in brain aneurysm (BrA) pre-existing to trauma, but it has been identified also as a possible pathogenetic cause of TIPC formation in patients not affected by intracranial vascular lesions. A complete literature review was performed of all reported cases regarding rupture of BrA with SAH resulting from TIPC not previously identified at the first radiological screening. A representative case of a left posterior inferior cerebellar artery (PICA) pseudo-aneurysm caused by left vertebral artery’s dissection is reported. We show a unique complete collection of all 34 cases. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate, as high as 40–60%. Of the 22 patients with good neurological status (64.7%), we did not notice a significant correlation with regard to the location of the aneurysm, type of treatment, or clinical onset. Early recognition of a pseudo-aneurysm and adequate treatment seem to be the most important prognostic factor for these patients. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate. A TIPC should be suspected in case of delayed deterioration in head‐injured patient and should be investigated with angiography. Conservative management is worsened by poor prognosis and the goal of treatment is to exclude the aneurysm from circulation with surgical or endovascular methods as soon as possible.
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Affiliation(s)
- Mauro Palmieri
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy.
| | - Alessandro Pesce
- Santa Maria Goretti Hospital, Neurosurgery Division, Latina, Italy
| | - Giuseppa Zancana
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy
| | - Daniele Armocida
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy
| | - Aniello Maiese
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL - "Sapienza" University, Rome, Italy
| | - Carlo Cirelli
- Department of Radiological, Oncological and Anatomopathological Sciences, Unit of Interventional Neuroradiology, "Sapienza" University of Rome, Umberto I University Hospital, Rome, Italy
| | - Antonio Santoro
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL - "Sapienza" University, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL - "Sapienza" University, Rome, Italy
| | - Alessandro Frati
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy.,IRCCS "Neuromed", Pozzilli, IS, Italy
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Miao HL, Zhang DY, Wang T, Jiao XT, Jiao LQ. Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature. Int J Med Sci 2020; 17:3005-3019. [PMID: 33173421 PMCID: PMC7646108 DOI: 10.7150/ijms.49137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022] Open
Abstract
The posterior inferior cerebellar artery (PICA), with its unique anatomical complexity, is of great clinical importance and involved in many diseases including aneurysm, ischemic stroke, neurovascular compression syndrome (NVCS), arteriovenous malformation (AVM), and brain tumor. However, a comprehensive systematic review of the importance of the PICA is currently lacking. In this study, we perform a literature review of PICA by searching all the associated papers in the PUBMED database hoping to provide a better understanding of the artery. The PICA has tortuous and variable course and territory, divided into 5 segments. Various aneurysms involving PICA were not uncommon, of which the treatment is challenging. The PICA infarct typically manifests lateral medullary syndrome (LMS) and is more likely to cause mass effects. The PICA frequently compresses the medulla and the cranial nerves resulting in various neurovascular compression syndromes (NVCS). Arteriovenous malformation (AVM) fed by PICA are associated with aneurysm and dissection which have high risk of rupture and worse outcome. PICA injured by head trauma can cause fatal SAH. VA terminating in PICA probably cause Bow hunter's syndrome (BHS). The PICA supplies many brain tumors and can be used in intracerebellar chemotherapy. The PICA can be exposed and injured during surgeries especially in telovelar approach, and it also plays an important role in bypass surgeries, hinting the surgical importance of PICA. In conclusion, PICA is very important in clinical practice.
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Affiliation(s)
- Hui-Lei Miao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China.,Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Deng-Yan Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China.,School of General Practice and Continuing Education, Capital Medical University, Beijing 100069,China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
| | - Xiao-Tian Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
| | - Li-Qun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
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Sato T, Tsuboi K, Nomura M, Iwata M, Abe S, Tamura A, Tsuchihashi H, Nishio H, Suzuki K. Traumatic basal subarachnoid hemorrhage suspected to have been caused by contrecoup cerebellar contusions: a case report. Leg Med (Tokyo) 2014; 16:92-4. [PMID: 24411402 DOI: 10.1016/j.legalmed.2013.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/20/2013] [Accepted: 12/22/2013] [Indexed: 11/16/2022]
Abstract
Traumatic cerebellar hemorrhagic contusions are infrequent, and the pathogenic mechanism involves a coup injury that is associated with motor vehicle accidents in most cases. Traumatic basal subarachnoid hemorrhage (TBSAH) is commonly reported after blunt trauma to the neck or unrestricted movement of the head, and the source of the hemorrhage is most frequently identified in the vertebrobasilar arteries. A 55-year-old woman who was addicted to alcohol was found dead in her bed. She had a bruise on the left side of her posterior parietal region, and autopsy revealed massive subarachnoid hemorrhage at the base of the brain; the hematoma was strongly attached to the right lower surface of the cerebellar hemisphere. No ruptured cerebral aneurysms, arteriovenous malformations or vertebrobasilar artery leakage were detected. Hemorrhagic cerebellar contusions were regarded as the source of the TBSAH. This is the first report of TBSAH suspected to have been caused by contrecoup cerebellar contusions.
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Affiliation(s)
- Takako Sato
- Department of Legal Medicine, Osaka Medical College, Takatsuki, Japan.
| | - Kento Tsuboi
- Department of Legal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Masakatsu Nomura
- Department of Legal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Misa Iwata
- Department of Legal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Shuntaro Abe
- Department of Legal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Akiyoshi Tamura
- Department of Legal Medicine, Osaka Medical College, Takatsuki, Japan
| | | | - Hajime Nishio
- Department of Legal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Koichi Suzuki
- Department of Legal Medicine, Osaka Medical College, Takatsuki, Japan
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5
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Chen JH, Ishikawa T, Michiue T, Maeda H. Cerebellar contusions as a possible cause of traumatic basal subarachnoid hemorrhage: a case report. Leg Med (Tokyo) 2010; 12:97-9. [PMID: 20122864 DOI: 10.1016/j.legalmed.2009.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 12/29/2009] [Accepted: 12/29/2009] [Indexed: 12/01/2022]
Abstract
Traumatic basal subarachnoid hemorrhage (TBSAH) is infrequent but of forensic neuropathological importance because of its high mortality and complex causal mechanisms. The source of the hemorrhage is most frequently identified in the vertebro-basilar arteries but often cannot be identified in these arteries. We present a case of TBSAH possibly originating from hemorrhagic cerebellar contusions due to fist blows to the neck. A 35-year-old woman, who was punched on the right side of the neck, became unconscious about 20 min later and died. Autopsy demonstrated a massive subarachnoid hemorrhage at the base of the brain, with blood clots attached to the right lower surface of the cerebellum. No tear was detected in the vertebro-basilar vessels, but there were hemorrhagic cerebellar contusions beneath the blood clots as a possible source of TBSAH. The site of impact to the neck suggested the cerebellar contusions to be a coup injury due to hard blows.
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Affiliation(s)
- Jian-Hua Chen
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
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Marchetti D, Filograna L, Colecchi C. Sellar fracture followed by sudden death: an autopsy case. Am J Forensic Med Pathol 2007; 28:223-6. [PMID: 17721171 DOI: 10.1097/paf.0b013e3180619608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors describe a case of sellar fracture followed by sudden death. The victim was involved in a wrangle. The autopsy revealed facial damage and sellar fracture and no evidence of cerebral damage, except for a mild subarachnoid hemorrhage in the left parietotemporal regions and undersurface of both frontal lobes. Sellar fracture is a rare and severe entity, associated with serious complications, which is frequently diagnosed postmortem. In any case, death is rarely a direct consequence of the sellar fracture itself and is usually considered to be the result of associated cerebral trauma. This case prompted us to screen the literature on sellar fracture to gain a better understanding of the mechanism of death.
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Affiliation(s)
- Daniela Marchetti
- Istituto Medicina Legale Università Cattolica del Sacro Cuore, Rome, Italy.
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