A 63-year-old man presented with hypoglycemia-induced hemiparesis manifesting as diffusion-weighted magnetic resonance (MR) imaging changes in the splenium of the corpus callosum and internal capsule which disappeared after glucose administration. Clinicians should be aware that hypoglycemia can cause reversible splenium abnormalities on MR imaging, although the underlying mechanism still remains unclear, as this may be helpful in the differential diagnosis of hypoglycemia-induced hemiparesis and stroke.

A 52-year-old woman presented with a partially thrombosed giant aneurysm of the vertebral artery (VA) manifesting as a 3-month history of left hemiparesis. She developed subarachnoid hemorrhage during hospitalization and underwent emergency surgery for surgical proximal clipping and ventricular drainage with decompressive suboccipital craniectomy. She underwent additional surgery for endovascular coil embolization of the aneurysm and the affected distal VA on the 7th postoperative day. Although she suffered transient lower cranial nerve pareses and respiratory failure, her neurological condition improved gradually and she returned home with only slight ataxia and hoarseness 3 months after surgery. Magnetic resonance imaging obtained 28 months postoperatively revealed a remarkable decrease in the size of the aneurysm as well as reduction of the mass effect on the brainstem. Combined proximal clipping and internal trapping can solve the problems associated with treatment of giant aneurysms of VA by either direct surgery or endovascular surgery, and should be considered as a therapeutic option for giant aneurysms of the VA.

No abstract

Summary:Although the treatment of SAH has been much improved recently, the prognosis in elderly patients remains poor due to problems related to the aging. In order to consider future strategy to improve treatment results, it is important to know the character of SAH specific to elderly patients.The clinical features in 65 SAH patients aged between 70 and 88 years, treated between 1997 and 2002, were investigated. The results of clipping in the acute stage were analyzed in relation to tolerability to the active treatments in elderly patients.The effect of operation in the acute stage showed remarkable contrast in each group of clinical condition: in the severe group only 16% in their 70s and 0% in their 80s showed good recovery but in the mild group it was 84% in those in their 70s and 83% in those in their 80s, which was comparable to the outcome in younger patients. The clinical condition in patients with poor outcome was characterized by the presentation of disturbance in higher cortical function, indicating the presence of generalized damage in the brain in elderly patients.SAH in elderly patients is characterized clinically by distinction of 2 groups: one in which the effect of SAH easily resulted in generalized brain damage and the other in which patients could withstand the effect of SAH. The latter group can be treated aggressively. For the former group, treatments consisting of palliative measures such as embolization and meticulous general care are essential.