Clin Neurol Neurosurg. 2011 Dec 29.
Tarnaris A, Haliasos N, Watkins LD.
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC 1N 3BG, UK.
Abstract
OBJECTIVE AND IMPORTANCE: Subarachnoid haemorrhage in pregnancy has traditionally been treated by surgical clipping however lately cases of successful coiling have been reported. Nevertheless, the long-term outcome of coiling is not well known in pregnant women. Mortality due to rebleeding of an incompletely treated aneurysm remains high. Only 15 cases of successful endovascular coiling during pregnancy have been reported so far.
CLINICAL PRESENTATION: We report the case of a pregnant woman who presented with aneurysmal subarachnoid hemorrhage (WFNS Grade III) due to rupture of a right posterior communicating artery aneurysm.
INTERVENTION: The patient underwent endovascular coiling successfully followed by an elective caesarian section and delivery of a healthy baby. However, during the course of a 2-year follow up the patient had suffered two relapses of the coiled aneurysm which required additional treatment. These events have affected her choice of extending her family.
CONCLUSION: The small risk of recurrence and the potential impact on future pregnancies should be explicitly communicated to patients in cases of endovascular coiling.
Sunday, 18 March 2012
Virchow-Robin spaces in idiopathic normal pressure hydrocephalus: a surrogate imaging marker for coexisting microvascular disease?
Acta Neurochir Suppl. 2012;113:33-7.
Tarnaris A, Tamangani J, Fayeye O, Kombogiorgas D, Murphy H, Gan YC, Flint G.
SourceDepartment of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK. andrewtarnaris@gmail.com
Abstract
BACKGROUND: Virchow-Robin spaces (VRSs) surround perforating cerebral arteries and are reported to be found with increasing frequency with advancing age. In addition, some studies indicate an association between VRSs and vascular dementias. The present study examined the incidence of VRSs in patients with idiopathic normal pressure hydrocephalus (INPH) and considered their use as a potential surrogate imaging marker of coexisting microvascular disease in patients with this condition.
METHODS: The MRI incidence of VRS in the centrum semiovale (CS), basal ganglia (BG), mesencephalon (MES), and the subinsular (SI) region was measured in 12 patients with INPH and in 12 control subjects, using the scoring system proposed by Patankar et al. (Am J Neuroradiology 26:1512, 2005). Historical control data were also used for further comparison.
RESULTS: All 12 INPH patients had clearly visible VRSs, distributed in the CS (all 12), basal ganglia (11/12), SI region (9/12), and MES region (6/12). The mean Patankar scores of the INPH group were BG 2.25, CS 1.66, SI 0.91, and ME 0.5. The respective scores for our control group were 1.41, 1.5, 1.16, and 0.16, and for historical controls were 1.46, 0.51, 0.96, and 0.51. There were, however, no statistically significant differences between the INPH patients and either of the control groups. No correlation was found between age and the overall incidence of VRS.
CONCLUSION: This preliminary study suggests that there may be a higher incidence of VRSs in patients with INPH, when compared with normal patients of similar age, but our small numbers prevent us from demonstrating statistical significance, and larger studies are clearly required.
Tarnaris A, Tamangani J, Fayeye O, Kombogiorgas D, Murphy H, Gan YC, Flint G.
SourceDepartment of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK. andrewtarnaris@gmail.com
Abstract
BACKGROUND: Virchow-Robin spaces (VRSs) surround perforating cerebral arteries and are reported to be found with increasing frequency with advancing age. In addition, some studies indicate an association between VRSs and vascular dementias. The present study examined the incidence of VRSs in patients with idiopathic normal pressure hydrocephalus (INPH) and considered their use as a potential surrogate imaging marker of coexisting microvascular disease in patients with this condition.
METHODS: The MRI incidence of VRS in the centrum semiovale (CS), basal ganglia (BG), mesencephalon (MES), and the subinsular (SI) region was measured in 12 patients with INPH and in 12 control subjects, using the scoring system proposed by Patankar et al. (Am J Neuroradiology 26:1512, 2005). Historical control data were also used for further comparison.
RESULTS: All 12 INPH patients had clearly visible VRSs, distributed in the CS (all 12), basal ganglia (11/12), SI region (9/12), and MES region (6/12). The mean Patankar scores of the INPH group were BG 2.25, CS 1.66, SI 0.91, and ME 0.5. The respective scores for our control group were 1.41, 1.5, 1.16, and 0.16, and for historical controls were 1.46, 0.51, 0.96, and 0.51. There were, however, no statistically significant differences between the INPH patients and either of the control groups. No correlation was found between age and the overall incidence of VRS.
CONCLUSION: This preliminary study suggests that there may be a higher incidence of VRSs in patients with INPH, when compared with normal patients of similar age, but our small numbers prevent us from demonstrating statistical significance, and larger studies are clearly required.
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