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Omar Tanweer,Stephen P. Kalhorn,Jamaal T. Snell,Taylor A. Wilson,Bryan A. Lieber,Nitin Agarwal,Paul P. Huang,Kenneth M. Sutin 대한뇌혈관외과학회 2015 Journal of Cerebrovascular and Endovascular Neuros Vol.17 No.4
Intracranial hypotension (IH) can occur following lumbar drainage for clipping of an intracranial aneurysm. We observed 3 cases of IH, which were all successfully treated by epidural blood patch (EBP). Herein, the authors report our cases.
Omar Tanweer,Taylor A. Wilson,Eleni Metaxa,Howard A. Riina,Hui Meng 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.4
Objective : Cerebral aneurysms (CAs) and abdominal aortic aneurysms (AAAs)are degenerative vascular pathologies that manifest as abnormal dilationsof the arterial wall. They arise with different morphologies in differenttypes of blood vessels under different hemodynamic conditions. Althoughtreated as different pathologies, we examine common pathways in theirhemodynamic pathogenesis in order to elucidate mechanisms of formation. Materials and Methods : A systematic review of the literature was performed. Current concepts on pathogenesis and hemodynamics were collected andcompared. Results : CAs arise as saccular dilations on the cerebral arteries of the circleof Willis under high blood flow, high wall shear stress (WSS), andhigh wall shear stress gradient (WSSG) conditions. AAAs arise as fusiformdilations on the infrarenal aorta under low blood flow, low, oscillatingWSS, and high WSSG conditions. While at opposite ends of the WSSspectrum, they share high WSSG, a critical factor in arterial remodeling. This alone may not be enough to initiate aneurysm formation, but mayignite a cascade of downstream events that leads to aneurysm development. Despite differences in morphology and the structure, CAs and AAAs sharemany histopathological and biomechanical characteristics. Endothelial celldamage, loss of elastin, and smooth muscle cell loss are universal findingsin CAs and AAAs. Increased matrix metalloproteinases and otherproteinases, reactive oxygen species, and inflammation also contribute tothe pathogenesis of both aneurysms. Conclusion : Our review revealed similar pathways in seemingly differentpathologies. We also highlight the need for cross-disciplinary studies toaid in finding similarities between pathologies.
Posterior Spinal Artery Aneurysm Presenting with Leukocytoclastic Vasculitis
Travis C. Hill,Paul P. Huang,Omar Tanweer,Cheddhi Thomas,John Engler,Maksim Shapiro,Tibor Becske 대한뇌혈관외과학회 2016 Journal of Cerebrovascular and Endovascular Neuros Vol.18 No.1
Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature.