scholarly journals Rapid de novo aneurysm formation after clipping of a ruptured middle cerebral artery aneurysm in an infant with an MYH11 mutation

2016 ◽  
Vol 18 (4) ◽  
pp. 463-470 ◽  
Author(s):  
Vijay M. Ravindra ◽  
Michael Karsy ◽  
Richard H. Schmidt ◽  
Philipp Taussky ◽  
Min S. Park ◽  
...  

The authors report the case of a previously healthy 6-month-old girl who presented with right arm and leg stiffening consistent with seizure activity. An initial CT scan of the head demonstrated acute subarachnoid hemorrhage in the basal cisterns extending into the left sylvian fissure. Computed tomography angiography demonstrated a 7 × 6 × 5–mm saccular aneurysm of the inferior M2 division of the left middle cerebral artery. The patient underwent left craniotomy and microsurgical clip ligation with wrapping of the aneurysm neck because the vessel appeared circumferentially dysplastic in the region of the aneurysm. Postoperative angiography demonstrated a small remnant, sluggish distal flow, but no significant cerebral vasospasm. Fifty-five days after the initial aneurysm rupture, the patient presented again with an acute intraparenchymal hemorrhage of the left anterior temporal lobe. Angiogram revealed a circumferentially dysplastic superior division of the M2 branch, with a new 5 × 4–mm saccular aneurysm distinct from the first, with 2 smaller aneurysms distal to the new ruptured aneurysm. Endovascular parent vessel occlusion with Onyx was performed. Genetic testing revealed a mutation of the MYH11. To the authors' knowledge, this is the first report of rapid de novo aneurysm formation in an infant with an MYH11 mutation. The authors review the patient's clinical presentation and management and comprehensively review the literature on this topic.

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONSE297-ONSE298 ◽  
Author(s):  
Tetsu Kurokawa ◽  
Kei Harada ◽  
Hideyuki Ishihara ◽  
Hirosuke Fujisawa ◽  
Shoichi Kato ◽  
...  

Abstract Objective: Aneurysm formation is a complication of superficial temporal arterymiddle cerebral artery bypass surgery occurring as pseudoaneurysms caused by technical failure, but also as true aneurysms discovered after long-term follow-up. Clinical Presentation: A 53-year-old woman presented with a left internal carotid artery cavernous aneurysm manifesting as double vision. Superficial temporal artery-middle cerebral artery bypass, internal trapping of the internal carotid artery, and embolization were performed. Three years later, angiography disclosed a distal middle cerebral artery aneurysm. A 70-year-old man who had undergone right superficial temporal artery-middle cerebral artery bypass after internal carotid artery occlusion died of subarachnoid hemorrhage from a ruptured anterior spinal artery aneurysm 21 years later. Angiography and postmortem examination revealed de novo aneurysm formation on a middle cerebral artery branch adjoining the anastomotic site. Both patients had hypertension and multiplicity of aneurysms. Interpretation: Both cases were de novo true aneurysms caused by hemodynamic stress because of saccular to fusiform shape, location extending to the middle cerebral artery, high perfusion pressure, projection along the hemodynamic stress, and presence of common risk factors. Conclusion: Bypass surgery is increasingly performed in patients with complicated aneurysms if sacrifice or temporary occlusion of any major vessel is required. Therefore, de novo aneurysm formation may not be rare in patients with risk factors such as hypertension or multiple aneurysms. Extended follow-up examination is required in such patients.


2019 ◽  
Vol 25 (4) ◽  
pp. 442-446 ◽  
Author(s):  
Eric S Nussbaum ◽  
Collin M Torok ◽  
Jason Carroll ◽  
Allicia M Gunderman

A 50-year-old female patient with hyperimmunoglobulin E syndrome (HIES) presented initially at the age of 48 years with subarachnoid hemorrhage (SAH) from a ruptured left middle cerebral artery (MCA) bifurcation aneurysm, which was treated successfully with coiling and microsurgical clipping. Angiography and cross-sectional imaging did not indicate evidence of any additional intracranial aneurysm. However, the patient presented two years later with SAH secondary to a new ruptured right MCA bifurcation aneurysm, which was treated successfully with microsurgical clipping. This case provides further evidence that HIES places the cerebral vasculature at increased risk for cerebral aneurysm formation and that special considerations are indicated in managing and monitoring these patients.


2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Patricia Almeida ◽  
Jaclyn Railsback ◽  
James Benjamin Gleason

To date,S. alactolyticusendocarditis complicated by middle cerebral artery aneurysm has not been reported. We describe the case of a 65-year-old female with a history of hypertrophic cardiomyopathy with left ventricular outflow tract obstruction presenting with confusion and a apical holosystolic murmur. Angiography of the brain identified new bilobed left middle cerebral artery aneurysm. Serial blood cultures grewS. alactolyticus, and aortic and mitral valve vegetation were discovered on transesophageal echocardiography. The patient was treated with antimicrobial therapy, mitral and aortic valve replacements, and microsurgical clipping of cerebral aneurysm. This case serves to highlight the pathogenicity of a sparsely described bacterium belonging to the heterogenousS. boviscomplex.


2018 ◽  
Vol 128 (4) ◽  
pp. 1028-1031
Author(s):  
Rafael Martinez-Perez ◽  
David M. Pelz ◽  
Stephen P. Lownie

The objective of this paper was to report a rare complication of basilar artery (BA) tourniquet treatment of a giant basilar tip aneurysm, and to discuss possible causes for the formation of a de novo giant posterior cerebral artery (PCA) aneurysm. A 34-year-old woman underwent satisfactory treatment of a ruptured giant basilar bifurcation aneurysm by BA ligation (Drake tourniquet) in 1985. She presented 25 years later with a new aneurysm in the left PCA, successfully treated by coil embolization. To the authors’ knowledge, this is the first case of de novo aneurysm formation on a PCA, and the first de novo aneurysm reported as a complication of BA ligation therapy by Drake tourniquet. Long-term follow-up is necessary in patients with treated cerebral aneurysms, particularly those occurring in young patients, those with multiple aneurysms, those with complex posterior circulation aneurysms, and those undergoing flow diversion or flow-altering therapies.


2021 ◽  
Vol 22 ◽  
Author(s):  
Ahmad F. Tamimi ◽  
Nosaiba T. Al Ryalat ◽  
Malik E. Juweid ◽  
Rahma M. Doudeen ◽  
Qutada Al-Soub ◽  
...  

2009 ◽  
Vol 110 (3) ◽  
pp. 540-542 ◽  
Author(s):  
Keun Young Park ◽  
Jung Yong Ahn ◽  
Jae Whan Lee ◽  
Jong Hee Chang ◽  
Seung Kon Huh

Vascular complications, including vessel occlusion and hemorrhage, can arise after radiosurgery; however, hemorrhage due to a ruptured de novo aneurysm after Gamma Knife radiosurgery (GKS) for tumor is extremely rare. To the authors' knowledge, only a single case of de novo aneurysm formation after GKS for vestibular schwannoma has been previously reported. In this study, they describe their experience with the treatment of a 74-year-old woman with subarachnoid hemorrhage limited to the cerebellopontine cistern, who had undergone GKS for vestibular schwannoma 5 years earlier. Cerebral angiography demonstrated a left distal anterior inferior cerebellar artery aneurysm; coil embolization was attempted and failed. However, self-resolution of the aneurysm was revealed on follow-up angiography.


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