Headache is a very common patient complaint but secondary causes for headache are unusual. Neuroimaging is both expensive and has a low yield in this group. Most patients with intracranial pathology have clinical features that would raise a "red flag". Appropriate selection of patients with headache for neuroimaging to look for secondary causes is very important. Red flags act as screening tools to help in identifying those patients presenting with headache who would benefit from prompt neuroimaging, and may increase the yield. The aim of this study is to evaluate clinical features in patients with headache using neuroimaging as a screening tool for intracranial pathology. 20 red flags were defined. A retrospective study of 111 patients was performed and the outcomes were divided into positive and negative. Abnormal neuroimaging was present in 39 patients. Results were analysed using the Logistic Regression model. Sensitivity and specificity of red flags were analysed to establish the cut-off point to predict abnormal neuroimaging and a receiver operating characteristic (ROC) curve plotted to show the sensitivity of the diagnostic test. Three red flag features proved to be statistically significant with the p-value of less than 0.05 on both univariate and multivariate analysis. These were: paralysis; papilloedema; and "drowsiness, confusion, memory impairment and loss of consciousness". In addition, if three or more red flags from the list were present, this showed strong indication of abnormal neuroimaging, from cut-off point of ROC curve (area under the curve =0.76).

Background: The incidence of intracranial aneurysm in childhood is rare, especially in infancy. In the literature, most of childhood intracranial aneurysms occur in the posterior and middle cerebral circulation. We report a case of a ruptured giant left distal anterior cerebral artery aneurysm in a 2-month-old baby. This report will discuss the rarity of this case as well as the diagnostic and surgical challenges in treating this condition. Case Report: A 2-month-old baby girl presented to our centre with a 1-day history of multiple afebrile seizures. A CT scan of her brain showed a large frontal interhemispheric acute bleed with intraventricular extension and acute hydrocephalus. An external ventricular drain was inserted and she was nursed in the Paediatric Intensive Care Unit. Subsequent CT angiogram and 4-vessel angiogram showed a giant aneurysm originating from the A3 segment of the left anterior cerebral artery. She underwent craniotomy and clipping and excision of the giant aneurysm. Discussion: Giant distal anterior artery aneurysms are very rare in infants. They are more commonly associated with the posterior and middle cerebral arteries. The aneurysms in infants tend to be larger compared to adults and they commonly present with subarachnoid haemorrhage and seizures. CT angiogram and 4-vessel cerebral angiogram are important diagnostic tools in this case. The angiogram demonstrated no distal runoff from the aneurysm and this assisted in our planning for surgical treatment of the aneurysm. A bifrontal craniotomy was done and the giant aneurysm was approached interhemispherically. The proximal and distal parent vessel was clipped and the aneurysm wall was excised. The baby recovered from surgery and did not require any cerebrospinal fluid diversion. Conclusion: Giant distal anterior cerebral artery aneurysms are rare in infants. Detailed angiographic investigation is important. Surgery is the treatment of choice, although there may be a role for endovascular intervention.

Introduction: Acute cerebral ischemic stroke is a life-threatening emergency with high incidence of mortality and morbidity. Endovascular revascularization has been increasingly used as one of the treatment options. In this article, we report our outcomes of endovascular intervention for the treatment of ischemic stroke and highlight some technical experiences. Materials and methods: A cross-sectional descriptive study was conducted on all cerebral ischemic stroke patients who came to Can Tho University of Medicine and Pharmacy Hospital within 8 hours from the first symptom would be included. National Institute of health stroke (NIHSS) scale was used for stroke grading which should be 10 or above. The vascularization procedure would be performed with the thrombus aspiration systems or stent retrievers with or without angioplasty and stenting. Postprocedure care would be conducted for at least 2 weeks before discharge. Results: A total of 53 patients were recruited from 1st of January 2018 to 30th December 2020 (24 months). Male to female ratio was 1.54:1. Ages ranged from 38 to 90 (mean 64). NIHSS scores ranged from 12-25. Approximately 98%  of patients had comorbidities with hypertension, diabetes, atrial fibrillation , mitral valve stenosis and valvular insufficiency, A-V block. Totally there were 44 patients experiencing thrombectomy with catheter-based distal aspiration (35), stent retrievers (03), aspiration and stent retriever combination (06). The total technical success rates for all procedures were 47/53 (88.6%)). The total death rate was 15/53 (28.3%) due to combining comorbiditiese. There were 31/53  patients (58.4%) who had significant recovered in muscle movement, language and cognition after 2 weeks. Conclusion: Endovascular intervention is a one of the good options for the management of acute ischemic stroke, which has a high revascularization rate (88.6%) and can save up to 58.4% of patients out of disability. Successful revascularization is the crucial first step to salvage the patients and obtain a better prognosis.

Dural arteriovenous malformation (DAVM) is relatively rare and defined as abnormal connections or shunts between the arterial and the venous side of vascular tree located within the dura mater. Spontaneous closures of DAVM are rare and have been scarcely reported. This case report will describe the neuroimaging findings and classification of DAVM. A 50 year old lady presented with headache. Neuroimaging showed prominent serpinginous flow-void structures, cerebral angiogram confirmed the presence of DAVM at the occipital region. She had defaulted treatment and follow up for 3 years. On second admission, she had a cerebral angiogram which showed normal findings with no evidence of fistulas or malformation. She was discharged well. Causes of spontaneous closure of DAVM are discussed.

Hepatic artery pseudoaneurysms (HAP) is a result of injury to the hepatic artery and must be treated due to its high risk of rupture. Endovascular treatment of pseudoaneurysm is effective and minimally invasive. We describe four cases of HAPs that presented with gastrointestinal (GI) bleed. The HAPs developed as a consequence of surgery for carcinoma, infection, trauma due to motor-vehicle accident and biliary instrumentation. Diagnoses were made using CT and conventional angiography. Embolisations were done either to the pseudoaneurysm or the parent artery using glue, Onyx or coils via microcatheter systems. Postembolisation runs showed no opacification of the pseudoaneurysms and the GI bleed resolved with no recurrence. The final outcome differs according to each patient’s underlying illness. We highlight our experience in the endovascular management of HAP using various embolic agents and in particular, Onyx. To the best of our knowledge, this is the first reported case of Onyx embolization of HAP.