A CASE OF MIDDLE CEREBRAL ARTERY INFARCT FOLLOWING UNEVENTFUL CLIPPING OF ANTERIOR COMMUNICATING ARTERY ANEURYSM

2021 ◽  
pp. 6-7
Author(s):  
T S Vasan ◽  
Rahul Vyas ◽  
Karan Mathur
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Middle Cerebral Artery Infarction ◽  
Anterior Communicating Artery Aneurysm ◽  
Ct Angiogram

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 conrmed 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.

Anterior Communicating Artery Aneurysm Rupture After Intravenous Thrombolysis for Acute Middle Cerebral Artery Thromboembolism

Neurosurgery ◽  
2011 ◽  
Vol 70 (6) ◽  
pp. E1603-E1607 ◽  
Author(s):  
Stylianos K. Rammos ◽  
David M. Neils ◽  
Kenneth Fraser ◽  
Jeffrey D. Klopfenstein
Keyword(s):  
Middle Cerebral Artery ◽  
Intracranial Hemorrhage ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Intravenous Thrombolysis ◽  
Vascular Lesions ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Anterior Communicating Artery Aneurysm ◽  
Left Middle

Abstract BACKGROUND AND IMPORTANCE: The use of intravenous recombinant tissue plasminogen activator (IV rtPA) has become an integral part of modern acute ischemic stroke management; however, its use has been associated with the development of intracranial hemorrhage in 6.4% of patients. It is possible that underlying and unsuspected vascular lesions, such as cerebral aneurysms, may lead to intracranial hemorrhage after IV rtPA thrombolysis. CLINICAL PRESENTATION: We present a previously unreported case of a 51-year-old woman who presented with subarachnoid hemorrhage from an acutely ruptured a nterior communicating artery aneurysm after IV rtPA treatment for acute left middle cerebral artery thromboembolism. The patient underwent mechanical thromboembolectomy of the left middle cerebral artery occlusion with resultant TIMI (Thrombolysis In Myocardial Infarction) grade I recanalization, followed by coil embolization of the anterior communicating artery aneurysm. The patient never improved neurologically, and she ultimately died. CONCLUSION: Screening to identify patients at risk for development of hemorrhagic complications from underlying structural vascular lesions before the use of IV rtPA with computed tomography angiography should be considered.

Analysis of Anterior Cerebral Artery Tortuosity: Association with Anterior Communicating Artery Aneurysm Rupture

2019 ◽  
Vol 122 ◽  
pp. e480-e486 ◽  
Author(s):  
Roger M. Krzyżewski ◽  
Kornelia M. Kliś ◽  
Borys M. Kwinta ◽  
Małgorzata Gackowska ◽  
Krzysztof Stachura ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm

scholarly journals Emergency Extracranial-to-Intracranial Bypass after Thromboembolic Occlusion of the Middle Cerebral Artery following GDC Embolization of a Ruptured ACoA Aneurysm

2004 ◽  
Vol 10 (3) ◽  
pp. 257-263 ◽  
Author(s):  
H. Standhardt ◽  
A. Gruber ◽  
H. Ferraz-Leite ◽  
G. Bavinzski
Keyword(s):  
Cerebral Infarction ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Fibrinolytic Therapy ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm

We report a case of thromboembolic occlusion of the middle cerebral artery after endovascular treatment of a ruptured anterior communicating artery aneurysm. When fibrinolytic therapy failed to recanalize the occluded vessel, an emergency extracranial-to-intracranial bypass was performed. This intervention rescued our patient from cerebral infarction. This case demonstrates the importance of the offering this procedure at neurointerventional centers.

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