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Congenital cervicofacial vascular anomalies are extremely rare and present many difficulties in diagnosis and treatment requiring a multidisciplinary approach. Firstly, there is little consensus on this subject among head and neck specialists. There are two main types of vascular anomalies: vascular tumors and vascular malformations. Vascular malformations are also divided into malformations with slow blood flow (veins, lymphatics, capillaries or combined) and malformations with a fast blood flow (arteriovenous malformations and fistula). Vascular tumors like hemangiomas are known for their spontaneous involution with aging, while vascular malformations grow in dimensions with age. It is very important to choose the correct differential diagnosis between cervicofacial hemangiomas and vascular malformations for proper therapy management. Anamnesis and clinical exams help in raising suspicions about the real nature of a cervico-vascular anomaly. Furthermore, imaging brings in-depth details of the anomaly, ranging from ultrasound and contrast CT to MRI scanning and minimally invasive angiography. Angiography with selective embolization is rarely a curative procedure for arteriovenous malformations, being more suitable as a preliminary step before attempted surgical removal. Surgery is clearly necessary when there are aesthetic and functional deficits. Slow-flow vascular malformations present a reduced morbidity, and in cases without involution, the surgical ablation is reserved for the cases with aesthetic dysfunctions or psychological trauma. Lymphatic malformations must undergo surgical ablation when they are associated with mass effects and compression of great vessels or aerial viscera. The prognosis after surgical removal is good, with a low rate of recurrence or morbidity. Fast-flow vascular malformations require a combined approach, with embolization and excision in the next 48 h for safety reasons. Removal may be followed by reconstructive surgery depending on the location and dimensions of the malformation, with a possible secondary recovery of the normal microscopic vessels. Some of the masses may hinder the normal airflow and swallowing. Pathology is the gold standard for confirming the clinical and imaging diagnosis. [ABSTRACT FROM AUTHOR]

Hysterectomy is the most common gynecologic procedure performed all over the world and various complications may appear depending on the surgical route. Delayed postoperative hemorrhage is a rare, life threatening complication. It requires timely management and recently the surgical reinterventions tend to be replaced by minimally invasive techniques. Transcatheter arterial embolization shows good results as a treatment strategy for massive vaginal bleeding post hysterectomy, when vaginal vault suturing fails to achieve hemostasis. We report a case of right uterine artery bleeding occurring 30 days after vaginal hysterectomy that was successfully treated by transcatheter arterial embolization. [ABSTRACT FROM AUTHOR]

PURPOSE. TO REPORT A CASE OF A YOUNG WOMAN WITH RECURENT EPISODES OF HEAVY VAGINAL BLEEDING THAT ALTERNATED WITH PERIODS OF MODERATE BLEEDING. THE PATIENT HAS BEEN DIAGNOSED WITH UTERINE ARTERIOVENOUS MALFORMATION IN THE RADIOLOGY DEPARTMENT OF THE UNIVERSITY EMERGENCY HOSPITAL BUCHAREST. GONADOTROPIN-RELEASING HORMONE AGONISTS HAVE BEEN USED AS AN ADJUNCT TO EMBOLIZATION. SUBSEQUENT UTERINE VEINS EMBOLIZATION RESULTED IN COMPLETE DISAPPEARANCE OF THE ARTERIO-VENOUS MALFORMATION, AND NORMAL CYCLES WERE RESUMED TWO MONTHS LATER. DESIGN. CASE REPORT. PATIENT. 28 YEARS OLD WOMAN WITH RECURRENT METRORRHAGIAS. EXPECTED OUTCOME. DISAPPEARANCE OF AN INTRAUTERINE ARTERIOVENOUS MALFORMATION TREATMENT. GONADOTROPIN-RELEASING HORMONE AGONISTS AND UTERINE VEINS EMBOLIZATION. DIAGNOSIS. UTERINE ARTERIOVENOUS MALFORMATION. CONCLUSION. SUBSEQUENT UTERINE VEINS EMBOLIZATION RESULTED IN COMPLETE DISAPPEARANCE OF THE ARTERIO-VENOUS MALFORMATION, AND NORMAL CYCLES WERE RESUMED TWO MONTHS LATER. [ABSTRACT FROM AUTHOR]

PURPOSE. TO REPORT A CASE OF A YOUNG WOMAN WITH RECURRENT EPISODES OF HEAVY VAGINAL BLEEDING THAT ALTERNATED WITH PERIODS OF MODERATE BLEEDING. THE PATIENT HAS BEEN DIAGNOSED WITH UTERINE ARTERIOVENOUS MALFORMATION IN THE RADIOLOGY DEPARTMENT OF THE UNIVERSITY EMERGENCY HOSPITAL BUCHAREST. GONADOTROPIN-RELEASING HORMONE AGONISTS HAVE BEEN USED AS AN ADJUNCT TO EMBOLIZATION. SUBSEQUENT UTERINE VEINS EMBOLIZATION RESULTED IN COMPLETE DISAPPEARANCE OF THE ARTERIO-VENOUS MALFORMATION, AND NORMAL CYCLES WERE RESUMED TWO MONTHS LATER. DESIGN. CASE REPORT PATIENT. 28 YEARS OLD WOMAN WITH RECURRENT METRORRHAGIAS EXPECTED OUTCOME. DISAPPEARANCE OF AN INTRAUTERINE ARTERIOVENOUS MALFORMATION TREATMENT. GONADOTROPIN-RELEASING HORMONE AGONISTS AND UTERINE VEINS EMBOLIZATION DIAGNOSIS. UTERINE ARTERIOVENOUS MALFORMATION CONCLUSION. SUBSEQUENT UTERINE VEINS EMBOLIZATION RESULTED IN COMPLETE DISAPPEARANCE OF THE ARTERIO-VENOUS MALFORMATION, AND NORMAL CYCLES WERE RESUMED TWO MONTHS LATER. [ABSTRACT FROM AUTHOR]

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Spinal vascular malformation consists of normal or enlarged arteries feeding into venous channels without passing throught capillaries. We present the case of a 50 years old man who was reffered to our clinic with a suspicion of spinal arteriovenous fistulae-(AVF) and a clinical course of progressive myelopathy. [ABSTRACT FROM AUTHOR]

Introduction. Atherosclerotic occlusive disease of the innominate artery (IA) represents a rare entity, comprising less than 2% of all extracranial causes of altered cerebral blood flow. This type of lesion is associated with adaptative hemodynamic changes increasing the risk of developing both cerebral and upper extremity ischaemia. Subclavian steal syndrome is a serious complication that may occur with occlusive lesions of the innominate artery and may represent an indication for revascularization. Case presentation. In the current paper we present the case of a patient who was admitted in our clinic for further investigations regarding episodes of dizziness and a difference of 30mmHg in the systolic blood pressure between his arms. On duplex ultrasonography scanning, an IA stenosis suspicion was raised, with associated retrograde flow through the right vertebral artery (VA) at light efforts of the right upper extremity. An angiographic evaluation confirmed the sub-occlusive lesion and reversed flow through the right VA. A decision was reached to undertake percutaneous transluminal angioplasty and stenting. There was no report of periprocedural complications, the intervention has been considered successful with no restenosis and no neurologic symptoms at 9 months follow-up. Discussion. Until recently, surgical treatment was the only option in the management of atherosclerotic disease of the IA, a procedure with high complication, morbidity and mortality rate. Therefore, endovascular treatment gained more ground and is considered today as the first line of treatment for this type of lesion. Conclusion. PTA and stenting of the IA still remains challenging mainly due to complex anatomy and the rarity of this pathology and we must keep in mind that the decision for the revascularization technique is personalized. This present case brings new evidence that percutaneous transluminal angioplasty is a safe and efficient method to manage an atherosclerotic lesion of the brachiocephalic artery. [ABSTRACT FROM AUTHOR]

Introduction. Non-saccular aneurysms are independent vascular entities, characterized by particular pathogenesis, localization, natural history and treatment. The fusiform subtype comprises an estimated tenth of all intracranial aneurysm, while the dolichoectatic subtype has different reported prevalence values, owing to several proposed diagnostic criteria (Smoker et al. criteria1 being the most widely used). The most frequent initial clinical presentations are ischemic stroke and transient ischemic attack, due to different hemodynamics and mechanism of formation. Prognosis is usually poor and progression can be demonstrated in almost half of ectatic vessels. Treatment can be either conservative in asymptomatic or ischemic presentations or by endovascular or microsurgical conduit in other cases. Case presentation. We report the case of a hypertensive 63-year old male patient with multiple intracranial vascular anomalies; he was initially admitted for ischemic stroke, with right hemiplegia and mixt aphasia. Non-contrast CT demonstrated a thrombosed left posterior cerebral artery aneurysm and contrast enhanced CT revealed a middle cerebral artery saccular aneurysm, two saccular and fusiform right PCA aneurysms and vertebrobasilar dolichoectasia. Cerebral angiography confi rmed the previous fi ndings and revealed lack of contrast at the level of the left PCA in the P2 segment. The patient was treated conservatively with aspirin and high-dose statins and had a favorable outcome, regaining part of his right-side function, object-naming and simple sentence construction capabilities. Conclusions. Upon ischemic presentation in the case of non-saccular aneurysms, a conservative attitude is recommended. These aneurysms commonly have an unfavorable prognosis, demanding periodic follow-up for detecting recurrent ischemic events, possible hemorrhage and progression. [ABSTRACT FROM AUTHOR]

Objectives. The carotid-cavernous fistula (CCF) represents an abnormal communication developed between the internal and/or the external carotid artery (ICA, ECA) or their branches and the cavernous sinus (CS). We report this case in order to highlight the course and an alternative to treatment of a CCF. Material and methods. A 47-year old male patient with medical history of subarachnoid hemorrhage and cranio-facial comminuted fractures due to a motorcycle accident-induced craniofacial traumatism (4 months prior to admission) was referred to our clinic for further investigation regarding a potential CCF. Results. The cerebral digital substraction angiography showed a direct CCF type A. The Neurology and Interventional Radiology team opted for endovascular stent-grafting of the right ICA. Conclusions. This case is presented in order to highlight that angioplasty with stent-graft is a safe and effective procedure in selected cases of CCF. [ABSTRACT FROM AUTHOR]

In Bucharest University Emergency Hospital every day we deal with difficult cases either presented per primam in our setting or, even more difficult situations, cases that were intended to be treated in other hospitals but due to lack of infrastructure are sent towards our multidisciplinary hospital, as a final stop. Conditions that our teams have to deal in a very restricted amount of time in the Emergency Room are: submucous myoma with heavy bleeding acquired uterine arteriovenous fistulae, ovarian ruptured cyst, ovarian hyperstimulation syndrome, adnexal torsion, tuboovarian abscess, classical tubal ectopic pregnancy, Cesarean scar ectopic pregnancy, molar pregnancy, incomplete abortion, ruptured uterus post minimally invasive procedures performed before pregnancy, placental abruption, placenta praevia with heavy bleeding, and the PAS – Placenta Accreta Spectrum. All these conditions recquire a rapid differential diagnosis where ultrasonography is useful in adopting a tailored management either conservative or radical, in avoidance of haemorhagic accidents or even death and, when needed, in fertility sparing. [ABSTRACT FROM AUTHOR]

Arteriovenous malformation is a frequent cause of hemorrhagic stroke in young adults and children, with not so many therapeutic options. We present the case of a 26-year-old woman who suffered from a hemorrhagic stroke from an arteriovenous malformation. She underwent radiosurgery three years after the acute event. Two years later, the malformation is excluded from the cerebral circulation. [ABSTRACT FROM AUTHOR]

Introduction: Nucleoplasty, the most advanced form of percutaneous discectomy developed to date, has important advantages as compared to other surgical methods: minimal tissue trauma, faster recovery time, local anesthetic, short duration and a painless rehabilitation period. Aim: Since the method is newly adopted in Romania, the aim of our study is to centralize the benefits and the side effects of the method in order to spread it on national level. Material and methods: A 12-month prospective, nonrandomized, human clinical study was started in the Neurology Department of the Emergency University Hospital, Bucharest, covering one year time interval (December 2006 - December 2007). The study included 60 patients presenting lumbar pathology at more than one level. The used method was the Dekompressor, a highly efficient method for removal of intervertebral disc nucleus pulposus under fluoroscopic control. Periprocedural the patients received antibiotics treatment. Results: Up to now there were no procedure related complications. 89% of patients reported improvement of the simptomatology with almost 60% the first 6 months postprocedural while 92% of patients were satisfied with results for 12 months, reporting the reduction of the analgesic intake. In 4% of cases no benefit was reported. The follow-up of the patients is still on-going. Conclusion: The results of our study confirm that nucleoplasty provides the therapeutic benefits of earlier percutaneous disc decompression techniques without many side effects. Clinical results are very promising when the inclusion criteria are strictly respected and therefore we encourage the patients to expect rapid and sustained pain reduction after the procedure. [ABSTRACT FROM AUTHOR]

The carotid stenosis treatment implies medical approaches or surgery treatment such as endarterectomy (CEA) or angioplasty/ stenting (CAS). In our paper we report the experience of the Neurology Clinics of the Emergency University Hospital in carotidian stenting. The study includes over 60 patients stented during a three years period of time (2005 - 2007) with good clinical outcome. As complications we registered only one case of contralateral ICA dissection and one case of restenosis. The results of our study are confirming the efficiency of CAS for patients with symptomatic over 70% ICA stenosis in the absence of CEA criteria. [ABSTRACT FROM AUTHOR]

Unruptured intracranial aneurysms are diagnosed with increased frequency as cerebral imaging techniques are more easily available. In spite of this, there is still no standardized approach to the patient with such pathology. We present the case of a 56 year-old woman presenting with ongoing headaches, who had a giant unruptured intracranial aneurysm of the left internal carotid artery. [ABSTRACT FROM AUTHOR]

Carney complex (CNC) is a rare autosomal dominant syndrome. Spotty skin pigmentation is the major clinical manifestation of CNC, followed by cardiac myxomas, benign tumors that usually present with features from the classical triad of obstructive cardiac, embolic and non-specific constitutional symptoms (NCS). NCS are caused by the overproduction of interleukin-6 (IL-6), a pro-inflammatory cytokine which mediates the induction of intercellular adhesion molecule 1 (ICAM-1) and promotes endothelial dysfunction and atherosclerosis. Thus, myxomas may be directly linked to an increased risk of atherosclerotic events. We report here a case of a 74-year-old woman with left atrial myxoma, skin pigmentary abnormalities, thyroid disorder and extensive atherosclerosis, with non-embolic occlusion of infrarenal abdominal aorta. [ABSTRACT FROM AUTHOR]

The authors present two cases of subarachnoid hemorrhage, both women, middle aged who developed almost the whole spectrum of complications of this type of intracranial bleeding. We briefly review the management of the subarachnoid hemorrhage and we emphasize the importance of the interventional therapy (treatment of the aneurysm by endovascular coiling or intraarterial catheterization and administration of Nimodipine for vasospasm) for the good prognosis of the patients. [ABSTRACT FROM AUTHOR]

Nucleoplasty, the most advanced form of percutaneous discectomy developed to date, has important advantages as compared to other surgical methods: minimal tissue trauma, faster recovery time, local anesthetic, short duration and a painful rehabilitation period. Since the method is newly adopted in Romania, the aim of our study is to centralize the benefits and the side effects of the method in order to spread it on the national level. Material and methods: A 12-month prospective, nonrandomized, human clinical study was started in the Neurology Department of the Emergency University Hospital, Bucharest, covering one year time interval (December 2006-December 2007). The study included 60 patients presenting lumbar pathology at more than one level. The used method was the Dekompressor, a highly efficient method for removal of intervertebral disc nucleus pulposus under fluoroscopic control. Periprocedural the patients received antibiotics treatment. Results: Up to date there were no procedure related complications. 89% of patients reported improvement of the simptomatology with almost 60% the first 6 months postprocedural while 92% of patients were satisfied with results for 12 months, reporting the reduction of the analgesic intake. In 4% of cases no benefit was reported. The follow-up of the patients is still on-going. Conclusion: The results of our study confirm that nucleoplasty provides the therapeutic benefits of earlier percutaneous disc decompression techniques without many side effects. Clinical results are very promising when the inclusion criteria are strictly respected and therefore we encourage the patients to expect rapid and sustained pain reduction after the procedure. [ABSTRACT FROM AUTHOR]

Located under the cerebral hemispheres and draining the anterior and central regions of the brain into the sinus of the posterior cerebral fossa, the vein of Galen aneurysmal malformation is considered to be a rare cause of hydrocephaly. The presence of this condition in the neonatal period typically includes intractable heart failure and a poor prognosis. We report a case of aneurysm of the vein of Galen diagnosed prenatally at 28 weeks of gestation, with the delivery at term by caesarean section of a female infant. Sonographically, the vein of Galen appeared in the mid-sagittal plane, large, supratentorial, non-pulsatile; on color Doppler, the structure filled with bright color, reflecting a turbulent venous flow. A low grade of ventriculomegaly was present during the evolution of pregnancy; regarding the cardiovascular function, an intrauterine right cardiac insufficiency overlapped a tricuspid regurgitation and right atrial dilatation. A multidisciplinary committee decided a neonatal embolization of the aneurysm as an emergency requirement due to increased pulmonary hypertension developed in the next 24 hours after birth. After the embolization of the two main drainage vessels, the cardiac dysfunction persists. Two days later the evolution became unfavorable, leading to the necessity of the second embolization, which resulted in a 48 hours' coma and death, due to a cerebral hemorrhage secondary to thrombosis and fissure of the embolized aneurysm. The prognosis for the neonate with malformation of the Galen vein depends upon the severity of the cardiovascular status. Embolization represents actually the treatment of choice with the best results of these cases, but the mortality remains as high as 50 percent even in the most specialized centers of the world. As far as we know this is the only case of Galen aneurysmal malformation in Romania which beneficiated of embolization by interventional treatment in neonatal period.