Presentation
Clinical presentations vary dependent on which specific nucleii and fibres are involved. [physio-pedia.com]
Face, Head & Neck
- Wide Neck
[…] cranial nerves (CNs), and the variation of location. 3, 4, 9, 21, 24 In addition, these aneurysms may cause mass effects such as lower CN palsy, rupture at a small size, have a greater rate of rebleeding, and a high proportion of fusiform, dissecting, or wide-neck [neurosurgerycns.wordpress.com]
Siddiqui MA, Bhattacharya JJ, Lindsay KW, Jenkins S (2009) Horizontal stent-assisted coil embolization of wide-necked intracranial aneurysms with the Enterprise stent – a case series with early angiographic follow-up. [link.springer.com]
A, 3D right vertebral angiogram shows a wide-necked PICA aneurysm. This aneurysm was treated with coil occlusion, including the parent PICA (internal trapping). [ajnr.org]
Evaluation of Onyx HD-500 embolic system in the treatment of 84 wide-neck intracranial aneurysms. Neurosurgery 2009;64:E865-75. [PUBMED] 17. Tevah J, Senf R, Cruz J, Fava M. [neurologyindia.com]
When facing wide neck aneurysms, SAC would be assisted with a stent by using semi-deploy technique. PAO was performed with coils, Onyx only or both coils and Onyx. [journals.lww.com]
Neurologic
- Long Tract Signs
Basilar artery syndrome (the syndrome of the lone vertebral artery is equivalent) A combination of the various brainstem syndromes plus those arising in the posterior cerebral artery distribution Bilateral long tract signs (sensory and motor; cerebellar [minclinic.ru]
- Fixed Pupils
[…] corticospinal signs Vascular, tuberculoma, tumor Nothnagel Midbrain tectum Unilateral or bilateral III Superior cerebellar peduncles Ocular palsies, paralysis of gaze, cerebellar ataxia Tumor Parinaud Dorsal Midbrain Paralysis of upward gaze and accommodation, fixed [tchain.com]
- Clonus
On admission to the emergency department, the Glasgow Coma Scale score was 10/15 and she presented irregular polypneic breathing, anisocoric reactive pupils, enhanced reflexes, lower limb clonus and bilateral pyramidal signs. [analesdepediatria.org]
- Loss of Gait
facial weakness, limb and facial sensory loss, gait ataxia, and cerebellar dysmetria. [ahajournals.org]
Workup
Workup did not show evidence for cardioembolic or atheroembolic source. The presence of an extradural origin of PICA may be considered a predisposing factor for non-traumatic LMS associated with head and neck movement. [link.springer.com]
Workup All patients presenting with scleritis should be worked up for associated systemic disease. [reviewofophthalmology.com]
Moreover, cardiac workup showed no evidence of intramural thrombus, endocarditis or atrial fibrillation in our patient. [cureus.com]
Other ECG Findings
- Ischemic Changes
Postoperative 3D CTA showed complete clipping of the aneurysm and no ischemic change, and his consciousness was better postoperatively than preoperatively. [surgicalneurologyint.com]
Treatment
Safety and efficacy of this treatment modality are unclear. [neurologyindia.com]
Conclusion The heterogeneity of PICA anatomy renders preoperative characterization of angioarchitecture and locoregional anatomy critical in the treatment of PICA aneurysms. [asianjns.org]
They provided a new treatment option for VA dissecting aneurysms involving the origin of PICA. In this letter, we will discuss alternative treatment options for these complex aneurysms. [ajnrblog.org]
Endovascular treatment of ruptured distal posterior inferior cerebellar artery aneurysms:report of 11 cases Abstract Objective: To investigate the clinical characteristics and endovascular treatment of ruptured distal posterior inferior cerebellar artery [ajol.info]
Prognosis
prognosis. 10 Fig. 7 A Hamasaki/2014[62] 56/M 5 Proximal endovascular occlusion,. [medsci.org]
Older individuals and ones with a higher grade of severity when admitted have a higher chance of a poor prognosis. [brain-surgery.com]
Treatment and prognosis Treatment of posterior inferior cerebellar artery, and posterior circulation strokes in general, depends upon the nature, timing, and severity of symptoms. [radiopaedia.org]
Etiology
Etiology Clinical features Clinical features Structure affected Ipsilateral Dysphagia ↓ Gag reflex Hoarseness, dysphonia Nucleus ambiguus (motor neuron) Ataxia, dysmetria, dysdiadochokinesia Inferior cerebellar peduncle Horner syndrome Uncontrollable [amboss.com]
The etiological cause was thought to be intracranial vertebral artery occlusion with a baseline insitu atherosclerosis, in the presence of branches having their origin from one side and going to both PICA territories. [dusunenadamdergisi.org]
It is important to contrast these clinical manifestations with those involving strokes of the anterior circulation, as the etiology and treatment may differ. [casemed.case.edu]
Etiology: Most commonly caused by atherothrombotic occlusion of the vertebral artery (then posterior inferior cerebellar arteray and least often the medullary arteries. [medicine.uiowa.edu]
These findings highlight that the cause of cerebral infarction can be related not only cerebral ischemia but also other etiologies. [ommegaonline.org]
Epidemiology
Posterior Scleritis: Analysis of Epidemiology, Clinical Factors, and Risk of Recurrence in a Cohort of 114 Patients. Ocul Immunol Inflamm 2016;24:1: 6-15. 2. Auer, Herborn, Indocyanine green angiographic features in posterior scleritis. [reviewofophthalmology.com]
Epidemiology, Etiology & Prognosis A study reviewing 25 cases of Wallenberg Syndrome found the incidence to be highest in middle-aged men at 55.06 years of age [2]. [physio-pedia.com]
Pathophysiology
In Barnet HJM (and others, Eds), Stroke: Pathophysiology, Diagnosis and Management. New York: Chrchill-Livingstone, pp 549-619, 1986 Faught E, Oh SJ. Brainstem auditory responses in brainstem infarction. [dizziness-and-balance.com]
Palinopsia, micropsia, and macropsia These are illusory phenomena that are of uncertain pathophysiology. Palinopsia describes the persistence of a visual image for several seconds to days in a partially blind hemifield. [emedicine.medscape.com]
Epidemiology, pathophysiology, diagnosis and management of intracranial artery dissection. Lancet Neurol. 2015;14:640–54. 5. Matsumoto J, et al. [bmcneurol.biomedcentral.com]
Metabolic syndrome: Definition, pathophysiology, and mechanisms. Am Heart J. 2005;149:33–45. [PubMed] [Google Scholar] 7. Olofsson SO, Wiklund O, Boren J. [ncbi.nlm.nih.gov]
Pathophysiology Atherosclerosis: the most common vascular disease affecting the vertebrobasilar system[1]: This affects large vessels, causing narrowing and occlusion. [patient.info]
Prevention
Neck clipping was performed via a midline suboccipital approach in the prone position to prevent re-rupture 2 months after admission [ Figure 3 ]. [surgicalneurologyint.com]
See also the separate Stroke Prevention article. [patient.info]
We provide two case presentations where the outcome was predicted and certain morbidities prevented with the employment of a multimodal neuromonitoring paradigm. [cureus.com]
Conclusions: Coiling of ruptured distal PICA aneury, with or without parent vessel occlusion, was feasible, relatively safe and effective in preventing early/medium-term rebleeding. [ajol.info]