Introduction
: The incidence of intracranial aneurysms in the pediatric population ranges from 1 to 3 per million inhabitants. Within this population, aneurysms are even rarer in lactating patients. Unlike the adult population, the male gender is predominant, and the incidence is more significant in the posterior circulation, with a higher percentage in the middle cerebral artery. Microsurgical and endovascular treatment has been described as feasible treatment in these cases.
Methods
: Methodology: Description of a case report of a patient admitted to the Pediatric Intensive Care service of the Hospital Materno Infantil in Tegucigalpa, Honduras. We took informed consent from parents for the patient’s treatment and subsequent academic dissemination of the clinical and neuroimaging data.
Results
: Case report: A two‐year‐old male patient presented to the pediatric emergency department with a 24‐hour evolution of sudden headache of severe intensity, accompanied by nausea and multiple episodes of vomiting. At hospital arrival, the patient presented an episode of generalized epileptic seizures. At the initial clinical neurological evaluation with altered consciousness somnolent. Motor examination revealed a right facial and body hemiparesis and Hunt and Hess of 1. Noncontrast cerebral tomography (NCCT) showed Fisher IV subarachnoid haemorrhage, left frontal lobar intraparenchymal hematoma and acute hydrocephalus (Fig 1A).
Consequently, we placed an external ventricular shunt, for which the patient was admitted to the pediatric intensive care unit. The computed tomography angiography (CTA) showed a giant aneurysm in the anterior communicating artery (Fig. 1B). The patient underwent an endovascular procedure with the placement of coils with a successful result (Fig. 1C and Fig. 1D).
Conclusions
: Giant aneurysms are sporadic in children. They are commonly associated with the posterior circulation and, to a lesser extent, the middle cerebral artery is more commonly affected with the anterior circulation. Aneurysms in children tend to be more extensive compared to their adult counterparts. Clinically, they present with subarachnoid haemorrhage and seizures, as in our case. This case is a pediatric patient with a giant brain aneurysm at a less common age and rare localization. Endovascular management was successful, adding information to the therapeutic spectrum in these cases. It is essential to perform a detailed angiographic investigation. Surgery is the treatment of choice; however, clinical trials are needed to clarify endovascular versus microsurgical management.
Successful endovascular recanalization of acute accessory middle cerebral artery occlusion; A case report and literature review
