Giant aneurysm of the pericallosal artery causing acute subdural hematoma--case report

A 66-year-old female presented with a very rare giant aneurysm of the distal pericallosal artery. She lost consciousness and was admitted. Computed tomography demonstrated a subdural hematoma over the left cerebral convexity and a mass in the frontal lobe. Cerebral angiography disclosed a giant aneurysm located on the distal segment of the right pericallosal artery. The subdural hematoma was removed and the aneurysmal neck was clipped, but she died 15 days after the operation. Autopsy found the giant aneurysm (33 x 30 x 27 mm) on the distal segment of the right pericallosal artery. Highly atheromatous changes were recognized in part of the aneurysmal wall, the arteries near the circle of Willis, and the distal anterior cerebral artery (ACA) adjacent to the aneurysm. There were no anomalous vessels such as azygos ACA. Giant aneurysms situated beyond the genu of the corpus callosum are extremely rare. Atherosclerosis was probably a major etiological factor in this case.     

Giant aneurysm of the azygos anterior cerebral artery--case report

A 77-year-old female presented with a giant aneurysm of the azygos anterior cerebral artery (ACA) manifesting as acute onset of akinetic mutism caused by enlargement of the aneurysm resulting from rapid thrombus formation within the aneurysmal sac. Thrombus removal to obtain decompression of the aneurysmal bulk and tension was performed before parent artery occlusion to prevent thromboembolic events. The aneurysmal neck was completely clipped with preservation of the parent artery and all branches. This strategy for direct neck clipping of a giant thrombosed distal ACA aneurysm can reduce the possibility of ischemic sequelae.     

Meningioma associated with subdural hematoma--case report.

The case of a 49-year-old female with a left parietal convexity meningioma associated with an acute subdural hematoma is described. She was admitted because of sudden onset of severe headache accompanied by nausea and vomiting. She was also confused, and 6 hours after admission she developed lethargy, right hemiplegia, and left mydriasis with no pupillary reaction to light. Computed tomography disclosed a round, extra-axial mass in the left parietal region; it was heterogeneously enhanced. Emergency craniotomy, performed after carotid angiography, revealed a tumor with a massive underlying subdural hematoma. The histological diagnosis was meningotheliomatous meningioma, and there were many meningothelial cells within the hematoma.     

Ruptured infectious aneurysm of the distal middle cerebral artery manifesting as intracerebral hemorrhage and acute subdural hematoma--case report

A 21-year-old woman with severe mitral valve regurgitation due to infectious endocarditis was transferred to our institute in a deep coma with intracerebral hemorrhage and acute subdural hematoma. She had no history of head injury. Brain computed tomography revealed left frontoparietal intracerebral hematoma and adjacent acute subdural hematoma that were evacuated on the day of admission, but the distal middle cerebral artery (MCA) aneurysm remained undetected. Follow-up cerebral angiography demonstrated the distal MCA aneurysm, which had enlarged by 25% at 2 weeks following the first operation. The aneurysm originated from a branch of the angular artery and was successfully resected on Day 22. Histological examination of the aneurysm section showed no infectious nature, but the final diagnosis was infectious intracranial aneurysm based on the presence of infectious endocarditis.     

Aneurysm of distal anterior cerebral artery associated with azygos anterior cerebral artery

Summary An aneurysm arising from the distal anterior cerebral artery distal to the bifurcation of the azygos anterior cerebral artery is reported. A review of the literature emphasizes the rarity of this lesion.     

Giant aneurysm of an azygos anterior cerebral artery: report of two cases and review of the literature

The authors present two cases of a largely thrombosed giant aneurysm of an azygos anterior cerebral artery. An aneurysm of an azygos artery is rare, and a giant aneurysm in this location is extremely rare.     

Medullary venous malformation with azygos anterior cerebral artery aneurysm: a case report

A case of medullary venous malformation with azygos anterior cerebral artery aneurysm is reported, which was associated with the leptomenigeal angiomatosis on the cortex of the right frontal lobe. A 62-year-old female was admitted to the Kurume University Hospital on June 21, 1985, because of a convulsive seizure. On admission, neurological and general examinations, except for slightly liver function disorder, was no abnormality. Plain CT scan showed the cortical atrophy and two small high-density areas in the right frontal lobe. Enhanced CT scan showed a high-density area in the genu of the corpus callosum. MRI (magnetic resonance imaging), on T2 weighted image, showed a high signal intensity area in the right paraventricular deep white matter and the right frontal region. A right internal carotid angiogram in the venous phase showed numerous enlarged medullary veins in the deep frontal region, converging into a single large draining vein that empties into the basal vein of Rosenthal. An azygos anterior cerebral artery was visualized on the right and left carotid angiograms. The aneurysm was situated at the distal end of the azygos artery. Twenty eight days after admission, a right frontal cranioplastic craniotomy was performed. During operation, the surface of the right frontal lobe was covered by fine, vascular networks, which was reddish brown. A right frontal lobectomy, including venous malformation and vascular networks, was performed. The aneurysm was clipped via an interhemispheric approach. Histologically, the malformation vessels had spread into the subarachnoid space.(ABSTRACT TRUNCATED AT 250 WORDS)     

Distal anterior cerebral artery aneurysm causing acute subdural hematoma: report of two cases

We report two cases of distal anterior cerebral artery aneurysms (distal ACA-aneurysm) causing acute subdural hematomas, which were diagnosed preoperatively. Case 1: 56 y.o. female who presented with stupor and right hemiparesis, was operated on 8 hrs. post-ictus. Case 2: 51 y.o. female who presented with semi-coma, anisocoria and decerebrate posture was operated on 5 hrs. post-ictus. She is alive in fair condition at present. Incidence of acute subdural hematomas in association with ruptured cerebral aneurysms has been reported as variously as 0.5 to 7.9% (clinical cases), with their source of bleeding being either IC or MCA aneurysms. Acute subdural hematomas as complication of ruptured distal ACA aneurysms are rare, and to the authors' knowledge, only 6 cases have been reported so far. Review of the literature regarding mechanism of formation of subdural hematoma, clinical course and treatment of choice are also reported.     

Hemichorea associated with ipsilateral chronic subdural hematoma--case report.

Left-sided hemichorea developed suddenly in a 73-year-old male. Computed tomography revealed a left subdural hematoma (SDH) and infarction in the right corona radiata and temporo-occipital region. Hemichorea subsided completely after removal of the SDH. Postoperative single photon emission computed tomography with technetium-99m-hexamethyl-propyleneamine oxime revealed a global low-perfusion area in the right cerebral hemisphere. Right carotid angiography demonstrated severe stenosis of the trunk of the right middle cerebral artery. The cerebral blood flow in the right cerebral hemisphere had probably already decreased to nearly the critical level and was reduced further by the left SDH, inducing the left-sided hemichorea due to dysfunction of the right cerebral hemisphere. This case shows that when hemichorea ipsilateral to a SDH is present, it is important to ascertain whether there is a pre-existing ischemic lesion in the contralateral cerebral hemisphere, particularly in the basal ganglia, thalamus, or corona radiata.     

Giant aneurysm of the distal anterior cerebral artery: associated with an anterior communicating artery aneurysm and a dural arteriovenous fistula.

We describe an unusual case of a giant pericallosal artery aneurysm, producing psychomotor depression from mass effect, associated with a smaller aneurysm of the anterior communicating artery, a dural arteriovenous fistula, and a meningioma. Magnetic resonance imaging (MRI) and cerebral angiography demonstrated the giant aneurysm and the meningioma. Cerebral angiography provided a detailed appreciation of the cerebral circulation, including both aneurysms, the dural arteriovenous fistula, and the potential collateral supply to the involved anterior cerebral distribution. The anterior communicating artery aneurysm was successfully clipped as was the distal anterior cerebral branch supplying the giant aneurysm before its resection. The patient made a full recovery but with persisting, slight dysphasia. We conclude that computed tomography, cerebral angiography, and MRI are of specific value in the assessment of giant aneurysms, but only angiography can provide detailed characterization of the aneurysm and demonstrate other possible cerebrovascular pathology such as multiple aneurysms and arteriovenous fistulas.     

Bilateral distal anterior cerebral artery aneurysm associated with supreme anterior cerebral artery: case report]

A 67-year-old woman presented with bilateral distal anterior cerebral artery aneurysms manifesting as consciousness disturbance. Computed tomography revealed subarachnoid hemorrhage in the interhemispheric fissure, right sylvian fissure, and a hematoma in the right frontal lobe and lateral ventricles. Angiography showed bilateral symmetrical aneurysms located on the pericallosal artery at the bifurcation of the callosomarginal artery. The operation was performed on the day the patient was admitted. The aneurysms were clipped via the interhemispheric approach, and the hematoma was aspirated. Operative view demonstrated rupture of the left aneurysm, and supreme anterior cerebral aneurysm. Postoperative angiography showed disappearance of the aneurysms and an intact bilateral anterior cerebral artery. The patient was discharged with mild organic mental syndrome. However, a few days later, she was admitted again with a high fever and died of complications due to sepsis. Pathological view showed clipped aneurysms and the connection of the bilateral distal anterior cerebral artery with the so-called supreme anterior communicating artery.     

Giant middle cerebral artery aneurysm with parent artery occlusion--case report.

A 54-year-old female was admitted with consciousness disturbance and right hemiparesis. Computed tomographic (CT) scans and angiograms revealed diffuse subarachnoid hemorrhage, a partially thrombosed, giant middle cerebral artery aneurysm (5 x 5 x 4 cm), and occlusion of the parent artery at the aneurysm site. Despite conservative treatment, a generalized convulsion occurred. Emergency CT scans revealed irregular enlargement of the left temporal high-density mass and severe mass effect due to cerebral infarction. Barbiturate coma therapy was administered, but she did not recover and died 9 days after admission. Only two cases of ruptured aneurysm with simultaneous occlusion of the major cerebral vessels have been reported, both with poor outcome. In this case, the mechanism of parent artery occlusion is unclear, but thrombus protrusion from the giant aneurysm into the parent artery may have been involved.     

An infected partially thrombosed giant aneurysm of the azygos anterior cerebral artery

The authors report a case of partially thrombosed giant aneurysm which was secondarily infected with purulent meningitis. The relationship between the infection of the aneurysm, the rapid growth of the aneurysm and the development of severe cerebral edema was discussed. A 53 year-old man was admitted on September 1, 1986, with a diagnosis of bacterial meningitis. On his admission, his body temperature was 39 degrees C, and he showed mental confusion but no neurological deficits. Laboratory data revealed signs of infection in white blood cell count, CRP, and erythrocyte sedimentation rate. Computerized tomographic (CT) scan and magnetic resonance (MR) imaging showed a massive round mass with perifocal edema measuring 40mm in the maximum diameter in the left paramedian frontal region. T1 weighted MR image also showed the presence of pus accumulation in the left ventricle. Cerebral angiography demonstrated a giant aneurysm at the distal portion of the azygos anterior cerebral artery, and irregular narrowing of both the supraclinoid segment of the carotid artery and its main branches indicating arteritis due to purulent meningitis. The patient was treated with ventricular drainage and administration of antibiotics. Culture of the purulent CSF was negative. The patient's lab data, CSF finding and neurological status improved progressively. However, follow-up CT scan and angiogram a month later showed enlargement of the aneurysm, dilatation of the patent lumen and perifocal edema. On October 8, the patient suddenly became comatose with anisocoria. A CT scan showed massive edema with marked midline shift. Emergency bifrontal craniotomy was carried out, and clipping was completed after removal of the thrombosed portion of the aneurysm, and thromboendarterectomy of the aneurysmal neck.(ABSTRACT TRUNCATED AT 250 WORDS)     

Giant anterior communicating artery aneurysm infiltrated with a primary cerebral lymphoma: case report

OBJECTIVE AND IMPORTANCE: Central nervous system lymphomas exhibit angiotropic characteristics. Nevertheless, direct association with an intracranial aneurysm is very rarely reported. We present a case of a giant aneurysm infiltrated with a large cell non-Hodgkin's lymphoma. The incidence of primary central nervous system lymphoma is increasing, and similar cases may become more frequent in the future. CLINICAL PRESENTATION: A 65-year-old man had presented with a giant anterior cerebral artery aneurysm, new onset of seizures, aphasia, and hemiparesis. The aneurysm was treated with Guglielmi detachable coils. Six months later, the patient exhibited fever and neurological deterioration. Magnetic resonance images suggested an enhancing lesion posterior to the neck of the aneurysm. Antibiotic treatment given elsewhere was unsuccessful. INTERVENTION: A craniotomy for a suspected abscess was performed, with removal of the aneurysm and clipping of the neck. The aneurysm sac appeared to be filled with thrombus and pus. The results of aerobic, anaerobic, and fungal cultures were negative. Postoperative magnetic resonance images demonstrated a residual mass, posterior to the aneurysm within the striatum and the internal capsule. Histological examination of the aneurysm wall revealed a large B-cell lymphoma. The diagnosis was confirmed by a stereotactic biopsy. Radiation therapy resulted in a transient decrease in the size of the lesion. CONCLUSION: Although the tumor was not apparent on the initial imaging studies, it may have been the cause of the patient's presenting symptoms. Infiltration of the aneurysm wall by the lymphoma also raises the possibility of a causal relationship. As the incidence of primary central nervous system lymphoma is reported to be on the increase, awareness this uncommon association of an aneurysm and malignant lymphoma is of value.     

Two cases of distal anterior cerebral artery aneurysm associated with accessory anterior cerebral artery

An accessory anterior cerebral artery (accessory ACA) is a rare anomalous vessel arising from the anterior communicating artery as a median artery of triplicated ACA. It is considered a large median artery of the corpus callosum and distributes to one or both hemispheres. The cases of an accessory ACA aneurysm are extremely rare; however, we experienced two cases of unruptured aneurysm growing at the distal portion of an accessory ACA. Two females, aged 66 and 67 years, respectively, separately consulted our hospital as a result of chronic headaches. Brain MR angiography and following DSA in the first patient demonstrated a triplicated ACA and an aneurysm located just above the corpus callosum growing from the distal portion of the accessory ACA. MRI and MR angiography in the second patient depicted a triplicated ACA and an aneurysm from the accessory ACA as with the first case. Neck clipping of the aneurysm was performed using an interhemispheric approach in both cases. These aneurysms appeared to present the same intraoperative findings as other unruptured aneurysms growing at the usual positions.