R. BADEA, O. OLARU, A. RIBIGAN, A. CIOBOTARU, B. DOROBAT, Ovidiu A. BAJENARU and Florina ANTOCHI

ABSTRACT

Giant intracranial aneurysms (ICGA) represent 3 to 5% of all intracranial aneurysms in adults. They are defined as arterial dilatations, with more than 25 mm in diameter. Despite important advances in the research of endovascular techniques of treating giant intracranial aneurysms, the management of these vascular malformations still poses great difficulties for neurologists and interventional radiologists. In particular, these challenges arise from the difficult and modified cerebral anatomy of patients with ICGA. Choosing the best treatment for patients with ICGA involves not only finding the perfect balance between the potential risks and benefits of endovascular treatment, but also taking into consideration the patient’s biological condition and associated diseases.
The aim of this paper is to describe the decisional algorithm of treating patients with giant intracranial aneurysms and factors which could influence the choice of endovascular technique.
We report a clinical case of a 63-year-old female with cardio-vascular risk factors (atrial fibrillation, high blood pressure), diagnosed with a symptomatic giant aneurysm of the right internal carotid artery and multiple cerebral micro-bleeds. Given the very large size of the aneurysm, its characteristics as well as patient’s associated comorbidities, it was decided to exclude the ICA aneurysm from circulation by occluding the parent vessel (right internal carotid artery) by using endovascular techniques.
Also, a review of the literature on the currently available endovascular methods for treating patients with giant intracranial aneurysms was performed in order to see the indications and possible long-term complications of each method.
In selected cases, the risks of serious complications associated with occluding a large cervical-cerebral vessel (as the internal carotid artery) are far exceeded by the risk for rupture of giant aneurysms, which is fatal in many cases. Nevertheless, it is of utmost importance to mention that, although the use of endovascular methods leads to a significant increase in life expectancy, a severe decline in quality of life might be experienced by these patients.
Keywords: unruptured giant cerebral aneurysm, interventional neuro-radiology, occlusion of internal carotid artery (ICA), review of the literature, cerebral microhaemorrhages

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Catalina COCLITU, Athena MERGEANI, Teodora PARVU, Octaviana RUSU, Andrei CIOBOTARU, Ovidiu BAJENARU and Florina ANTOCHI

ABSTRACT

Considering that currently Romania has the highest tuberculosis incidence in Europe, the recognition of the infection is an acknowledged health issue. Central nervous system tuberculosis accounts for approximately 1% of all cases of tuberculosis. Longitudinally extensive transverse myelitis is a contiguous inflammatory lesion of the spinal cord which involves three or more spinal segments. In tuberculosis, spinal cord involvement is rare and is usually rather due to radiculomyelitis or spinal tuberculoma, and only very rare due to longitudinally extensive transverse myelitis.
We present the case of a 52-year-old man referred to our department for progressive neurological deficits due to a longitudinally extensive transverse myelitis. After a thorough work-up we diagnosed the patient with longitudinally extensive transverse myelitis secondary to infection with Mycobacterium tuberculosis.
Keywords: Central nervous system tuberculosis, longitudinally extensive transverse myelitis

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Cristina TIU, Elena TERECOASA, Nicolae GRECU, Raluca NISTOR, Smaranda FRANGU and Florina ANTOCHI

ABSTRACT

Arterial dissections are among the most frequent causes of stroke in young adults. Usually they are associated with trauma, but as the modern imaging tools are evolving, more dissections are being diagnosed and more etiologies are being described. Vertebral artery dissections (VADs) have the distinct particularity that they can cause ischemic stroke (in the brainstem, cerebellum or even the spinal cord), but also subarachnoid hemorrhage, when the dissection occurs in the intracranial segment of the vertebral artery. We present a review of the literature, going over etiology, clinical aspects, diagnosis and treatment of VADs and we illustrate the theory with three different types of VAD from our clinical experience.

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Adina ROCEANU, Florina ANTOCHI and Ovidiu BAJENARU

ABSTRACT

Arteriovenous malformations (AVMs) of the brain consist in a network of dilated vessels that form an abnormal communication between the arterial and venous system. The clinical presentation of AVM could be with acute haemorrhagic stroke, due to their rupture or with seizures or recurrent headache.

We present the case of 12 year old male child who was admitted in our clinic for „migraine with visual aura”-like episodes with visual positive phenomena. On cerebral MRI (T1, contrast enhancement) we found a right occipital arterio-venous malformation of 2-3 cm in diameter. The patient was referred to gamma knife stereotactic radiosurgery treatment.

Keywords: arteriovenous malformations, symptomatic migraine, gamma knife

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