presentation number: ep - 34. “there are no actual or potential conflicts of interes related to...

Presentation Number:EP - 34

“There are no actual or potential conflicts of interes related to this presentation”

ONCOTIC ANEURYSMS WITH CEREBRAL INFARCTIONS, CHRONIC ISCHEMIA AND

DEVELOPMENT OF SYNANGIOSIS

Institute of Neurosurgery Dr. Alfonso Asenjo Santiago. Chile

Neuroradiology Department

BRAVO E, RIVEROS R, SORDO J, RIVERA R

Purpose

• To present a clinical case with oncotic aneurysms, cerebral infarctions, chronic ischemia and synangiosis.

Case Report

• Female 53 yo

• Atrial myxoma in 2000

• Spontaneus subarachnoid hemorrhage in 2005

• Several catheter angiograms with multiple intracranial aneurysms.

Multiple Intracranial Aneurysms (2D angiography)

Right Internal Carotid ArteryAP view

Right Internal Carotid ArteryLateral view

Multiple Intracranial Aneurysms (2D angiography)

Left Internal Carotid ArteryAP view

Left Internal Carotid ArteryLateral view

Multiple Intracranial Aneurysms (2D angiography)

Left Vertebral ArteryAP view

Left Vertebral ArteryLateral view

Multiple Intracranial Aneurysms (3D rotational angiography)

Right Internal Carotid Artery Left Vertebral Artery

Secuelar Brain Lesions(FLAIR)

CHRONIC ISCHEMIA?

Synangiosis(Catheter Angiogram)

Right External Carotid Artery

SynangiosisSynangiosis

Synangiosis(DynaCT)

Right External Carotid Artery

Synangiosis Synangiosis

Putative Mechanism

AJNR Am J Neuroradiol 2001;22:1349-1352

ATRIAL MYXOMA

ONCOTIC ANEURYSMS

CHRONIC ISCHEMIA SYNANGIOSIS

Putative Mechanism

Neurosci Lett 2006;409:118-123

Conclusions

• This is the first clinical case reporting the presence of multiple oncotic aneurysms, brain ischemia and the development of synangiosis.

• Chronic ischemia is the trigger for developing synangiosis.

• Previously, it has been related the presence of myxomatous aneurysms and chronic ischemia.

AJNR Am J Neuroradiol 2001;22:1349-1352