Background: Aneurysms of the anterior communicating artery are the most frequently encountered intracerebral aneurysms in routine
neurosurgical practice. Management of intracerebral aneurysm involves aneurysm clipping or endovascular coil aneurysm embolisation.
However, to the best of our knowledge, there is no reported case of an isolated ipsilateral middle cerebral artery infarction following clipping of
anterior communicating artery aneurysm.
Case Description: A 65-year-old female with hypertension presented with a history of giddiness, fall and altered sensorium. The patient had a
Glasgow Coma Scale (GCS) score of 12, and further investigation of the magnetic resonance imaging on suspicion of stroke revealed subarachnoid
haemorrhage in the bilateral parietal sulcus, left Sylvain ssure, left ambient and quadrigeminal cisterns with intra-ventricular extension. The
patient was subsequently referred for neurosurgery consultation. Computed tomography (CT) angiogram conrmed the presence of a ruptured
anterior communicating artery aneurysm. The neurological assessment showed reduced responsiveness to verbal commands, with a Hunt and Hess
score of 3. The patient underwent uneventful clipping of the aneurysm. Postoperatively, the patient did not wake up from anaesthesia and had
persistently elevated blood pressure and right-sided hemiplegia. On the third day of postoperative care, a CT head scan revealed a left middle
cerebral artery infarction with a midline shift. Decompressive craniotomy was performed, and following this procedure, the patient improved in
sensorium with residual right-sided hemiplegia
Conclusion: This case report presents an undetected new micro embolism or postoperative cerebral vasospasm as possible causes for the
development of cerebral infarct in patients with subarachnoid haemorrhage following an aneurysm rupture.
Von Recklinghausen's Disease associated with Occlusion of Bilateral Middle Cerebral Artery, Moyamoya Phenomenon, and an Anterior Communicating Artery Aneurysm
