World Neurosurg
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The authors report a case of lateral posterior choroidal artery pseudoaneurysm that caused a spontaneous thalamic hemorrhage. The case supports obtaining computed tomographic angiography (CTA) even in seemingly routine cases of hypertensive hemorrhage and demonstrates a possibly unreported type of aneurysm causing thalamic hemorrhage. ⋯ The case shows the need to carefully review CTA after ICH, even in cases of seemingly typical hypertensive ICH.
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Case Reports
Shunt-related intracranial abscess caused by Staphylococcus lugdunensis in a hydranencephalic patient.
Staphylococcus lugdunensis is a coagulase-negative staphylococcus with aggressive and rapidly progressive infectious behavior. This organism has emerged as an important pathogen implicated in both community-acquired and nosocomial infections, including meningitis, brain abscess, catheter-related bacteremia, and ventriculoperitoneal shunt infection. ⋯ This case suggests that if Staphylococcus lugdunensis is identified, a virulent and prolonged clinical course with the production of destructive lesions, similar to those with S. aureus, should be expected. A course of antibiotic therapy and aggressive management that may include surgical treatment will be needed.
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We described our endovascular techniques for the recanalization of chronic occlusions of the brachiocephalic and subclavian arteries. Given their large caliber, origins from the aorta, and proximity to the carotid and vertebral arteries, various complex endovascular techniques are required to achieve revascularization. Navigation of distal embolic protection devices into the carotid and vertebral arteries mandates varied catheter approaches. ⋯ Endovascular recanalization of the great vessels with the use of distal embolic protection devices requires multiple catheters and complex endovascular techniques but is feasible and safe. A significant percentage of these occlusions can likely be reopened through endovascular techniques.
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Venous thrombembolism is a significant cause of mortality in patients after subarachnoid hemorrhage (SAH). After screening a cohort of SAH for this complication, we proposed a refinement for risk stratification of venous thromboembolism. ⋯ Finding our SAH patients to be the largest group screened for DVT on the basis of our literature review, we confirmed many known risk factors for DVT and observed that smokers who abruptly quit lowered their risk of DVT. Our findings may be used for risk stratification when determining DVT chemoprophylaxis after SAH.
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Sphenoid wing region dural arteriovenous fistulas (DAVFs) are rare lesions that are typically fed by middle meningeal artery feeders and that drain via the sphenoparietal sinus or middle cerebral vein. We describe a unique case of a medial sphenoid wing fistula draining exclusively via the basal vein of Rosenthal. ⋯ Sphenoid wing DAVFs may drain via the deep venous system and have a complex arterial feeding network. Key features of the fistula, including deep venous drainage, presence of venous varices, and retrograde leptomeningeal venous drainage, make this an aggressive lesion with a high risk of rupture based on the available natural history data.