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EMQ Answers
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
B Dissecting aortic aneurysm ruptureThe typical features of dissecting aneurysm include sudden onset of severe chest or upper back pain often described as a tearing, ripping or shearing sensation that radiates to the neck or down the back a wide pulse pressure and systolic hypertension (if the patient is not already in shock). The pain tends to be central or interscapular and is often followed by sudden collapse. (Maternal Collapse in Pregnancy and the Puerperium. The Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 56, February 2011)
Death from natural causes
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
The damage caused by an atheromatous plaque can also result in an intimal defect and weakening of the media, allowing blood from the lumen to dissect into this weakened arterial wall. Once the dissection has started, the passage of blood under pressure extends the dissection along the aortic wall. The most common origin of a dissecting aneurysm is in the thoracic aorta and the dissection usually tracks distally towards the abdominal region, sometimes reaching the iliac and the femoral arteries. In fatal cases, the track may rupture at any point, resulting in haemorrhage into the thorax or abdomen. Alternatively, it can dissect proximally around the arch and into the pericardial sac, where it can produce a haemopericardium, cardiac tamponade and sudden death. Involvement of the renal arteries can result in renal failure.
The circulatory system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
Aneurysms that involve all three layers of the blood vessel wall are called true aneurysms to distinguish them from other types of arterial distention that may occur from external injury or trauma. A dissecting aneurysm is a very severe condition in which there is a tear in the inner layers of the blood vessel (tunica intima and tunica media) and, as a result, bleeding occurs in the space below the adventitia of the vessel. Figure 6.9 shows the forms of aneurysm that may occur.
A rare complication of flow diverter: delayed migration causing aneurysm expansion and brainstem compression
Published in British Journal of Neurosurgery, 2023
Youssef El Ouadih, Guillaume Coll, Betty Jean, Aurélien Coste, Rémi Chaix, Laurent Sakka, Jean-Jacques Lemaire
A 52-year-old woman with metastatic breast cancer was fortuitously diagnosed with a large aneurysm (8.7 mm × 6 mm) of the right posterior inferior cerebellar artery (PICA). The diameters of inflow and outflow vessels were respectively 2.3 mm and 2.5 mm. The inflow vessel showed a tapered shape evoking a dissecting aneurysm. Given the aneurysm size, wide neck morphologic feature, tobacco addiction and oncologic context, we decided to treat the aneurysm by coiling after a right PICA occlusion test. Embolization was performed without complication with three coils allowing about 80% occlusion. Three months later, as the coil packing shrunk, a complementary treatment by stenting was proposed. A 2.5-mm diameter and 10-mm length PED stent was deployed with correct neck covering (Figure 1). The patient was discharged four days later, without unexpected events.
Endovascular treatment of ruptured basilar artery trunk aneurysm in the acute period: risk factors for periprocedural complications
Published in Neurological Research, 2023
Sook Young Sim, Jai Ho Choi, Myeong Jin Kim, Yong Cheol Lim, Joonho Chung
Another characteristic of BA trunk aneurysm is frequent co-occurrence of fusiform and dissecting aneurysms. Fusiform aneurysms consist of chronic dolichoectatic segmental dilatation with a stretched and fragmented internal elastic lamina [11]. BA dissecting aneurysm is unique in its mechanism of development. BA dissecting aneurysms account for 1.0% of all cases of subarachnoid hemorrhage and 10.5% of posterior circulation aneurysms [18]. Although aneurysm types were not significantly associated with periprocedural complications in the present study, the type might be an important consideration when treating BA trunk aneurysms. In particular, BA dissecting aneurysms most commonly present with subarachnoid hemorrhage and sometimes with ischemic stroke caused by dissection-induced occlusion of cerebellar or perforating arteries or by thromboembolism [11,13,14]. Ruptured dissecting aneurysms are prone to rebleeding, resulting in high mortality and morbidity.
Gadolinium-induced Kounis syndrome including electrocardiographic considerations
Published in Baylor University Medical Center Proceedings, 2020
Nicholas G. Kounis, Ioanna Koniari, Grigorios Tsigkas, George D. Soufras, Panagiotis Plotas, Periklis Davlouros, George Hahalis
Recently, a unique electrocardiographic sign of ST elevation in lead aVR, with reciprocal ST depression in the majority of other leads, has been described in Kounis syndrome.6 The lead aVR, until recent years, was regarded as the “neglected lead.” However, ST segment elevation in lead aVR associated with widespread ST segment depression in inferolateral leads best identifies severe left main or three-vessel disease and denotes high-risk non–ST segment elevation acute coronary syndrome that requires urgent revascularization in addition to medical treatment that includes antiplatelets, aspirin, and heparin.7 The same electrocardiographic findings, however, can be present in a type A dissecting aneurysm affecting the ascending aorta that expands and presses the left main artery and the coronary ostia. Whereas the clinical picture is of acute myocardial infarction, the treatment is completely different and includes emergency surgery and avoidance of antiplatelets, aspirin, and heparin.8