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Washington University Experience | MISCELLANEOUS | Gossypiboma, Textiloma & Neurosurgical Foreign Material | 4A0 Case 4 - History
Case 4 History ---- (AANP Diagnostic Slide Session, 1969, Case 1) ---- A patient collapsed while changing a tire and was thought to have struck his head. He was resuscitated several times following cardiac arrest in route to the hospital, but stabilized during the following four days. A sudden turn for the worse occurred, characterized by a lessened responsiveness and semi-coma. A spinal fluid examination revealed bloody, xanthochromic fluid. The physical examination revealed nuchal rigidity, slow eye movements, hypoactive reflexes and Babinski signs bilaterally. A bilateral carotid arteriogram revealed a broad based, left anterior communicating cerebral artery aneurysm which was fusiform and did not have a saccular neck. When the aneurysm was dissected free, a small pin-point hole was found to be present posteriorly and medially. Suction was placed over the bleeding point in an attempt to control the bleeding; however, a temporary clip had to be placed along and across the left anterior cerebral artery. Since the bleeding was not reduced by this procedure a winged Olivecrona clip was placed across the aneurysm, which included the left anterior cerebral artery at its most distal point. This controlled the bleeding. Subsequent to the surgical procedure the patient never fully recovered consciousness. He was transferred to a long-term nursing home for care where he died of intercurrent infection 8 months after surgery.
