An Unruptured Cerebral Aneurysm at the Origin of the Duplicated Middle Cerebral Artery

Abstract OBJECTIVE Although arachnoid cysts and intracranial aneurysms are very common lesions, their association in the same patient is rare. We present a case of a middle cerebral artery aneurysm ruptured into an arachnoid cyst. We found only six cases with intracystic hemorrhage reported in the literature. The presence of an arachnoid cyst can mislead clinical presentation. The patient presented a paradoxically small temporal fossa and thickening of the temporal and sphenoid bone. The authors suggest that this uncommon association (arachnoid cyst, atypical cranial vault, and “mirror-like” cerebral aneurysm) could represent a form of dysplasia. CLINICAL PRESENTATION A 46-year-old patient presented with a 3-week history of slight headaches, which had worsened in the last 3 days before presentation. Computed tomographic scans showed a cystic lesion located in the middle cranial fossa and sylvian fissure with suspected aneurysm dilation inside. Magnetic resonance imaging scans showed an intracystic hemorrhage but not subarachnoid hemorrhage. Paradoxically, changes in the cranial vault around the cyst were noted. Digital subtraction angiography showed bilateral “mirror” middle cerebral artery aneurysms. INTERVENTION A large right pterional craniotomy was performed with full microsurgical removal of the arachnoid cyst walls and aneurysm clipping. The aneurysm was in the medial wall of the arachnoid cyst with its dome inside the cyst. The contralateral aneurysm was clipped 2 weeks later. The follow-up period was uneventful, and the patient returned to normal life. CONCLUSION Rupture of a cerebral aneurysm into an arachnoid cyst is rare. Clinical presentation may be unusual because the cyst can prevent subarachnoid hemorrhage. A middle fossa cranial arachnoid cyst in the presence of temporal bone depression, small middle fossa, and thickness of squamous temporal bone and the lesser wing of sphenoid is rare and suggests that congenital factors may play an important role in their development. The exceptional association between “mirror” aneurysms and arachnoid cyst with bone changes suggests a possible congenital form of dysplasia.

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Influence of Medial Collagen Organization and Axial In Situ Stretch on Saccular Cerebral Aneurysm Growth

Journal of Biomechanical Engineering ◽

10.1115/1.3200911 ◽

2009 ◽

Vol 131 (10) ◽

Cited By ~ 13

Author(s):

Thomas Eriksson ◽

Martin Kroon ◽

Gerhard A. Holzapfel

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Aneurysm ◽

Cerebral Artery ◽

Collagen Fibers ◽

Circumferential Direction ◽

Thickness Increase ◽

Aneurysm Wall ◽

Aneurysm Growth ◽

The Media

A model for saccular cerebral aneurysm growth, proposed by Kroon and Holzapfel (2007, “A Model for Saccular Cerebral Aneurysm Growth in a Human Middle Cerebral Artery,” J. Theor. Biol., 247, pp. 775–787; 2008, “Modeling of Saccular Aneurysm Growth in a Human Middle Cerebral Artery,” ASME J. Biomech. Eng., 130, p. 051012), is further investigated. A human middle cerebral artery is modeled as a two-layer cylinder where the layers correspond to the media and the adventitia. The immediate loss of media in the location of the aneurysm is taken to be responsible for the initiation of the aneurysm growth. The aneurysm is regarded as a development of the adventitia, which is composed of several distinct layers of collagen fibers perfectly aligned in specified directions. The collagen fibers are the only load-bearing constituent in the aneurysm wall; their production and degradation depend on the stretch of the wall and are responsible for the aneurysm growth. The anisotropy of the surrounding media was modeled using the strain-energy function proposed by Holzapfel et al. (2000, “A New Constitutive Framework for Arterial Wall Mechanics and a Comparative Study of Material Models,” J. Elast., 61, pp. 1–48), which is valid for an elastic material with two families of fibers. It was shown that the inclusion of fibers in the media reduced the maximum principal Cauchy stress and the maximum shear stress in the aneurysm wall. The thickness increase in the aneurysm wall due to material growth was also decreased. Varying the fiber angle in the media from a circumferential direction to a deviation of 10 deg from the circumferential direction did, however, only show a little effect. Altering the axial in situ stretch of the artery had a much larger effect in terms of the steady-state shape of the aneurysm and the resulting stresses in the aneurysm wall. The peak values of the maximum principal stress and the thickness increase both became significantly higher for larger axial stretches.

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Effect of Methylene Blue on Middle Cerebral Artery Flow Velocity in a Patient With Severe Sepsis Following Clipping of a Cerebral Aneurysm

Neurocritical Care ◽

10.1385/ncc:2:1:039 ◽

2005 ◽

Vol 2 (1) ◽

pp. 039-042 ◽

Cited By ~ 4

Author(s):

David A. Zygun ◽

Peter G. Bradley ◽

David K. Menon

Keyword(s):

Methylene Blue ◽

Severe Sepsis ◽

Middle Cerebral Artery ◽

Flow Velocity ◽

Cerebral Aneurysm ◽

Cerebral Artery ◽

Artery Flow

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Subarachnoid Hemorrhage: The Incidence and Correlation of CT Pattern and the Location of Cerebral Aneurysm

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.01.11431 ◽

2021 ◽

Vol 104 (1) ◽

pp. 68-72

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracerebral Hemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Aneurysm ◽

Cerebral Artery ◽

Artery Aneurysm ◽

Middle Cerebral Artery Aneurysm ◽

Cerebral Angiogram ◽

Cerebral Artery Aneurysm ◽

Anterior Communicating Aneurysm

Background: Subarachnoid hemorrhage has a high mortality and morbidity rates, and the cerebral aneurysm is the most common cause. The location of the ruptured cerebral aneurysm is diagnosed by cerebral angiogram and by computed tomography (CT) pattern of the subarachnoid hemorrhage. Objective: To find the incidence of CT pattern of each cerebral aneurysm and the correlation between CT pattern of subarachnoid hemorrhage and each location of cerebral aneurysm. Materials and Methods: The 126 patients with ruptured cerebral aneurysm were included in the present study. The information of the patients and CT were recorded and analyzed. Results: There were 49 male and 77 female patients. The highest location of cerebral aneurysm is anterior communicating aneurysm (59 patients, 47.6%). There were correlations between A region and anterior cerebral and anterior communicating aneurysm, and left D legion and the other location aneurysm. There were correlations between intracerebral hemorrhage and anterior communication, posterior communication cerebral, and anterior cerebral and middle cerebral artery aneurysm. Conclusion: The common location of cerebral aneurysm is anterior communicating artery aneurysm. There are correlations between the most thickness region of A and D region with anterior communicating aneurysm and the posterior circulation aneurysm, and the correlation between intracerebral hemorrhage and anterior communicating aneurysm, posterior communicating aneurysm, and middle cerebral artery aneurysm. Keywords: Subarachnoid hemorrhage, Cerebral aneurysm, Intracerebral hemorrhage, Thickness

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Occlusion of the Anterior Cerebral Artery Mimicking a Cerebral Aneurysm: Clinical Presentation and Literature Review

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1722272 ◽

2021 ◽

Author(s):

Yang Liu ◽

Gaochao Guo ◽

Zhu Lin ◽

Liming Zhao ◽

Juha Hernesniemi ◽

...

Keyword(s):

Literature Review ◽

Middle Cerebral Artery ◽

Cerebral Aneurysm ◽

Moyamoya Disease ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Clinical Presentation ◽

Disease Patient ◽

Extensive Literature ◽

The Right

Abstract Background Intracranial aneurysms may be misdiagnosed with other vascular lesions such as vascular loops, infundibulum, or the stump of an occluded artery (very rare and reported compromising only the middle cerebral artery and the posterior circulation territory). Our aim was to describe a unique case of occlusion of an anterior cerebral artery mimicking a cerebral aneurysm in a probable moyamoya disease patient, and to highlight its clinical presentation, diagnosis, and management, and to perform an extensive literature review. Case A 67-year-old man suffering from recurrent dizziness for 3 months. Previous medical history was unremarkable. Brain magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) demonstrated occlusion of the right middle cerebral artery (MCA) associated with a “probable moyamoya disease” and an aneurysm-like shadow protruding lesion at the anterior communicating artery (AcomA). Perfusion images showed ischemia along the right temporo-occipital lobe. Due to MCA occlusion with perfusion deficits and unspecific symptoms, we offered a right side encephalo-duro-myo-synangiosis (EDMS) and clipping of the AcomA aneurysm in one session. Intraoperatively, there was no evidence of the AcomA aneurysm; instead, this finding corresponded to the stump of the occluded right anterior cerebral artery (A1 segment). This segment appeared to be of yellowish color due to atherosclerosis and lacked blood flow. The patient underwent as previously planned a right side EDMS and the perioperative course was uneventful without the presence of additional ischemic attacks. Conclusion Arterial branch occlusions can sometimes present atypical angiographic characteristics that can mimic a saccular intracranial aneurysm. It is relevant to consider this radiographic differential diagnosis, especially when aneurysm treatment is planned.

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Complete Thrombosis of a Giant Distal Middle Cerebral Artery Aneurysm

Interventional Neuroradiology ◽

10.1177/159101990100700314 ◽

2001 ◽

Vol 7 (3) ◽

pp. 263-267 ◽

Cited By ~ 1

Author(s):

R. Lenthall ◽

G. Rodesch

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Aneurysm ◽

Cerebral Artery ◽

Artery Aneurysm ◽

Middle Cerebral Artery Aneurysm ◽

Spontaneous Thrombosis ◽

Giant Cerebral Aneurysm ◽

Complete Thrombosis ◽

Cerebral Artery Aneurysm ◽

Distal Middle Cerebral Artery

Complete thrombosis of a giant cerebral aneurysm is rarely reported and peripheral giant middle cerebral artery (MCA) aneurysms are similarly rare. We present a case of complete spontaneous thrombosis of a giant sylvian artery aneurysm that had previously been wrapped at surgery.

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