0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Images in Neurology |

Sensitivity of Computed Tomography Angiography vs Catheter Angiography in the Detection of a Ruptured Intracranial Infectious Aneurysm in a Pregnant Woman

Lin-Quan Sun, MD; Andrew P. Slivka, MD
Arch Neurol. 2012;69(2):270. doi:10.1001/archneurol.2011.870.
Text Size: A A A
Published online

Extract

A 29-year-old woman presented with a sudden onset of a headache and 3 generalized tonic-clonic seizures. She was 30 weeks' pregnant, used cocaine, and had poor dental hygiene. Computed tomographic scans of her head showed diffuse subarachnoid hemorrhage and a hematoma in the left distal temporal region (Figure, A and B). Magnetic resonance imaging scans of her brain showed subarachnoid hemorrhage and a focus of signal void in the left distal temporal region (Figure, C and D). Magnetic resonance angiographic scans of her brain failed to detect an aneurysm (Figure, E and F). Computed tomographic scans (Figure, G-J) and catheter digital subtraction angiographic scans showed an aneurysm (size, 1.6 × 1.7 cm) in a distal branch of the left middle cerebral artery (Figure, K and L). The coil was unable to be placed owing to the distal location of the aneurysm. A cerebrospinal fluid sample and a blood culture showed no microbial growth, and a transthoracic echocardiogram showed no evidence of endocarditis. Serial computed tomography angiographic scans and serial digital subtraction angiographic scans showed complete thrombosis of the aneurysm in about 1 month. At 32 weeks and 3 days' gestation, she delivered by cesarean section. The patient was treated with levetiracetam, vancomycin hydrochloride, aztreonam, clindamycin hydrochloride, and nimodipine. Both the mother and neonate did well.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure. Angiographic images of the head and distal branch of the left middle cerebral artery of a 29-year-old woman who presented with sudden onset of a headache and 3 generalized tonic-clonic seizures. Computed tomographic scans of her head show diffuse subarachnoid hemorrhage (A) and a hematoma in the left distal temporal region (B). Magnetic resonance imaging revealed a focus of signal void in the left distal temporal region on T1 (C) and T2 (D) sequences. Magnetic resonance angiography failed to detect an aneurysm (E and F). Computed tomography angiography (G-J) and digital subtraction angiography (K and L) revealed an aneurysm in a distal branch of the left middle cerebral artery. The white arrows show the aneurysm and/or its location.

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Clinical Scenario

Users' Guides to the Medical Literature
TIME Trial—Resolution

brightcove.createExperiences();