A 70-year-old obese retired patient with an extensive list of underlying medical conditions, including ischemic heart disease with coronary artery bypass grafting in 1999, hypertension, chronic renal failure, and atrial fibrillation was admitted to hospital in August 2008. He was diagnosed with subcutaneous abscess in the infraclavicular region of the right shoulder plus the left hallux metatarsophalangeal gout with secondary infection. He had a raised C-reactive protein (CRP) at 450 and was septic with positive blood culture for Staphylococcus aureus on admission. He underwent arthroscopic washout of the shoulder plus drainage of the foot abscess. He was commenced on antibiotics with a good initial response. However, he started spiking temperature with a raised CRP again. As transthoracic echocardiography (TTE) could not rule out infective endocarditis, he underwent transesophageal echocardiography (TEE), which showed a few indistinct echoes on the left ventricular side of the posterior mitral valve leaflet. Hence, he was treated for infective endocarditis with Teicoplanin and Clindamycin. He was discharged after the completion of his antibiotic treatment.

A 54-year-old man was referred to our hospital because of severe excruciating acute colicky central abdominal pain. The pain was associated with nausea, postprandial vomiting, and constipation. He had history of 15 kg weight loss during the last two months. He was opium addict, and cigarettes smoker (20 packsyear) with a negative history of diabetes mellitus and hypertension. He underwent a surgical operation two months before, when he had a similar attack of abdominal pain. The surgery was then revealed small bowel necrosis for which resection of 30 cm of small bowel was performed. General physical examination was unremarkable. There was mild tenderness in deep palpation of periumbilical area. Laboratory data including serum amylase were reported to be normal. The initial abdominal ultrasonography was normal. Upper gastrointestinal endoscopy and colonoscopy were also normal. On account of his severe abdominal pain, a multislice helical abdominal computerized tomography with contrast was requested (Figure1).    

A 57 year old female presented with acute onset headache started from 1 month before the current visit. The headache was located on the left frontotemporal area and had increased during the month. On brain CT scan, there were bilateral round hyperdense lesions in the sylvian fissure which were flow void on brain MRI indicating ANEURYSMs.

Splenic artery ANEURYSM (SAA) is rare, often with no sign patient, discovered accidentally in ultrasonography and imaging studies. A healthy 45-year-old woman was referred to us by abdominal pain in the epigastric region-imaging showed a large mass located between the spleen, stomach, and pancreas. CT scan showed two true ANEURYSMs of a 4 mm and 12 mm diameter in the middle third and distal part of the splenic artery. SAAs that are lesser than 2cm can be controlled; however, our patient was given an open surgery, and splenectomy with the removal of the ANEURYSM has done.

Giant intracranial ANEURYSM is defined as the one larger than 2.5 cm in diameter Giant anemysms represent 2% to 5% of all intracranial ANEURYSMs. Most patients who become symptomatic in the fourth through Sixth decades of life are found in all locations; 5-18 % of them presented in middle cerebral artery (MCA morphology of giant anemysms can be either fusiform or saccular.Significant proportion of giant anemysms has been associated with intraluminal thrombosis. As many as 60% in some series may initially be evaluated for SAH, signs and symptoms related to a mass effect develop in approximately two thirds. Mass effect can be manifested as pain, visual field and acuity defects, and extra ocular dysfunction. Dementia and mental disturbances, as well as hemiparesis and ep ilepsy, have also been described Current treatment options for these lesions include direct surgical techniques, endovascular techniques, and combined approaches. Indirect surgical techniques include proximal occlusion and trapping of the ANEURYSM using clips or ligature above and below the lesion. If the patient is unable to tolerate occlusion of the parent vessel in relation to a giant ANEURYSM, an extracranial to intracranial bypass procedure can be performed with subsequent trapping or proximal occlusion of the vessel A 32 year old woman presented with acute severe headache and mild hemiparesis in emergency ward. Her brain CT scan showed sub arachnoid hemorrhage with giant right temporal mass effect Brain MRI and angiography showed partial thrombosed giant ANEURYSM without visible neck The patient was checked in supine position and slight head rotation and extension. Curvilinear right incision, then pterional craniotomy was done and then dura was opened. After that, brain relaxed with csf drainage.Sylvain cistern was opened widely.then with intermittent proximal control neck dissection was done and clipping with advanced clipping (creeping) was done little by little and then after the removal of temporary clip, the ANEURYSM wall and clot was resected and then the papaverin used Patient was recovered and post-operative CT angiography showed any residue or vessel compromise

Ascending aortic ANEURYSM is a relatively rare complication of Takayasu's arteritis. We report a 54 year old lady, a known case of Takayasu's syndrome, who was operated for the second time because of aneurismal change in the ascending aorta.

Introduction: Subarachnoid hemorrhage (SAH) is the most common presentation of spontaneous rupture of cerebral ANEURYSMs but in some cases the only manifestation of cerebral ANEURYSM rupture is either intraventricular hemorrhage or intracerebral hemorrhage (with or without SAH). In this study different prognostic factors are discussed. Material and Methods: During a 7 year period, 100 patients with cerebral ANEURYSMs were evaluated retrospectively and the results were analyzed in this article. Results: The sex ration was 3/2 with a female predominance: (62% female and 39% male), median age was 45 years, and the average Glascow Coma Scale (GCS) at admission was 12.4. Forty-two percent of the patients had hypertension; 9% were opium addicted and 11% had diabetes mellitus. Average Hunt and Hess grade was 2.8. Most of patients had delayed operation. 17% of the patients had rebleeding and 18% had vasospasm. The results of operations were excellent in 61%, good in 22% with 5% falling bad results and 7% dead. Conclusion: The incidence of SAH is not uncommon in Iran. In order to prevent complications and reduce the risk factors in the patients with SAH rapid diagnosis and appropriated management (medical or surgical) should be done.

Introduction & Objective: In this study we evaluated 110 patient with ruptured ANEURYSM and reviewed their surgical complications and outcomes retrospectively also we estimated the correlation time of surgery and surgical complication.Material & Methods: The study consists of retrospective review of charts, images, and notes from follow-up visits of 110 patients with SAH who were surgically treated during 4.5-year period in Imam – Hossein neurosurgical center.A surgical complication was determined based on findings of a clinical and or radiological study in the absence of confounding factors such as the initial SAH ictus, hydrocephaly, vasospasm, and septic status.Functional outcome was assessed 1 month post-SAH by using the Glasgow Outcome Scale (GOS).Results: A procedure-related surgical complication was diagnosed in 35 (31.81%) of 110 patients studied. A brain tissue injury, including contusion, infarct, and cerebral edema was diagnosed in 23 (20.9%)of patients, intra operative ANEURYSM rupture in 7 (6.3%) of patients, cranial nerve deficit in 5(4.54%) of patients, craniotomy related complication in 5 (4.54%) of patients and an unpredicted residual ANEURYSM neck in 4(3.63%) patients. Functional outcome was good in 57.14% of patients with surgical complications and 94.66% of patients without surgical complications.Unfavorable outcomes was seen in 42.85% of patients with surgical complications and 5.33% of patients without surgical three days post-SAH was 66.66%, in surgery in 3 till 14 days post-SAH was 22.97%. Death due to surgical complications occurred in 6.36% of 110 patients.Conclusions: Surgical complications are fairy prevalent. They may have been overlooked in our center but functional outcomes in patients was relatively good.

Background: The existence of residual ANEURYSM after intracranial ANEURYSM clipping bears the risk of re-bleeding, which worsens with the passage of time. Digital subtraction angiography (DSA) is accepted as the gold standard for evaluation of residual ANEURYSM, but it is invasive, costly, and serious complications are possible. Objectives: The aim of this study was to compare DSA to 64-slice CT angiography for assessing residual ANEURYSM. Patients and Methods: Forty patients with 43 clipped ANEURYSMs from which 36 were torn, were evaluated by DSA after improvement in clinical status, and after a month they were evaluated by 64-slice CT angiography. The pictures were assessed by two neuroradiologists separately, in terms of quality, artifact due to the clips, and the completion of ANEURYSM closing. Results: In multislice computed tomographic angiography (MSCT) analysis, 36 pictures (90%) had good quality and four pictures (10%)hadpoor quality. In case of goodquality pictures inMSCTandangiography, the 2-and3-millimeter residual ANEURYSMs were approved fortwopatients basedonwhich, sensitivity, featureandpositive/negative predictive value for diagnosis of residual ANEURYSM was 100 for good-quality pictures by MSCT. The level of agreement between the two neuroradiologists was 1 for diagnosing residual ANEURYSM and 0. 86 for vasospasm. The average time for doing MSCT was 12 minutes compared to 45 minutes for DSA angiography, which was cost effective. Conclusion: CT angiography is a less invasive method with high sensitivity and capabilities for diagnosing residual ANEURYSM. It is cheaper, quicker and can be accomplished for critical patients. Therefore, it can be taken as the first choice and a replacement for DSA in post-surgery evaluation of patients with clipped brain ANEURYSM.