Tag Archives: cerebral aneurysm

Case Presentation: Unusual Association Between Possible Bilateral Intraventricular Xanthogranulomas, Postero-inferior Cerebellar Artery Aneurysm and Thrombophilia

DOI: 10.2478/amma-2018-0027

Introduction: Xanthogranulomas are rare, benign, usually asymptomatic, cutaneous tumors most frequently seen in children (juvenile xanthogranulomas). Some lesions can be found accidentally at randomly performed cerebral computer tomography (CT) or magnetic resonance imaging (MRI) or even on autopsy.
Case report: We present the case of a 44 year-old woman, known with a thrombophilic disorder (PAI-1 gene mutation, MTHFR C677T and A1298C) on chronic anticoagulant treatment. The onset of symptoms was in 2010, when she presented paresthesia and lower limbs weakness. Two years later the patient presents with severe intermittent headache and left hemicrania and a cerebral angio-MRI is performed showing a left postero-inferior cerebellar artery aneurysm and two choroid plexus intraventricular masses in the lateral ventricles. The patient developed a new symptom, dysarthria in 2014 and in 2015 has multiple episodes of loss of consciousness, interpreted as epileptic seizures. Routine blood tests were within normal range, except for a high cholesterol level. The patient was tested for autoimmune, infectious, endocrine and metabolic diseases that were negative. Surgical treatment and biopsy from the lesion was proposed, however the patient refused both procedures.
Conclusions: There is an association between xanthogranulomas localization and the choroid plexus, the most frequent CNS origin being in the trigon of the lateral ventricle. Our case does not resemble with any other case published, mostly because the unusual presentation, symptomatology and the association between xanthogranulomas, thrombophilia and postero-inferior cerebellar artery aneurysm which were never reported before in other cases of xanthogranulomas from the literature.

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Ten Years’ Experience in Early Cerebral Aneurysm Clip Occlusion

Background: The study follows the complete series of patients surgically treated in the past 10 years at Targu Mures Neurosurgery Department and the effects of the surgical experience over the clinical outcome.
Material and method: This is a retrospective study including 382 patients operated in our department between 2001 and 2011 by a team of 5 neurosurgeons.
Results: Out of the 382 patients included in the study 62.17% were female, 37.83% were male with a mean age of 51±30 years. The majority of operated aneurysms were located in the anterior circulation: 363 cases (95%) with the following locations: anterior communicating artery, 167 cases (43.65%), middle cerebral artery, 100 cases (26.3%), posterior communcating artery, 61 cases (16%). In the posterior circulation a number of 19 aneurysms have been operated with the majority (7) being top basilar aneurysms. 86.80% of cases have been admitted in Hunt-Hess I-III, 13.2% being in Hunt-Hess IV-V. A number of 244 patients (64%) have been admitted and operated in first 96 hours from aneurysm rupture, 92 patients (24%) have been operated between 5 to 14 days, and the rest of 46 patients (12%) have been operated two weeks after the first SAH. Outcome has been calculated using the GOS scale: 57.23% of patients have been discharged with GOS 5, 17% with GOS 4, 10% with GOS 2 and 3, while overall mortality was 15.8%.
Conclusions: Multimodality and multidisciplinarity treatments of cerebral aneurysms have improved significantly the outcome of patients but still the surgical treatment represents a major option. In our opinion early surgery represents the gold standard in the treatment of cerebral aneurysms.

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