Risk factors for intracranial aneurysm rupture in pediatric patients

Pediatric anterior choroidal artery aneurysm successfully coiled after re-rupture

Pediatric cerebral aneurysms are rare, and pediatric anterior choroidal artery aneurysms are very rarely reported. A 14-month-old male with no personal or family history of connective tissue disorders or Moyamoya disease presented with a right temporal intracerebral hemorrhage with intraventricular extension. CTA was negative for vascular pathology, but digital subtraction angiography revealed an anterior choroidal artery aneurysm that was successfully coiled. This case underscores the importance of performing digital subtraction angiography in children presenting with intracerebral hemorrhage concerning for vascular pathology even if non-invasive vascular imaging is negative.

Saccular intracranial neonatal aneurysm

INTRODUCTION

Neonatal cerebral aneurysms are very rare condition and distinct from those of the adults.

CASE REPORT

We reported a 14-day-old male neonate who presented subarachnoid hemorrhage due to a ruptured anterior cerebral artery saccular aneurysm. In addition, we present a review of the relevant literature.

CONCLUSION

Intracranial hemorrhage due to cerebral aneurysm rupture in a newborn is an uncommon diagnosis, but it must be unequivocally excluded.

Traumatic intracranial aneurysms (TICA) in children: a description of two clinical cases of successful treatment and review of literature

OBJECTIVE

Traumatic intracranial aneurysms (TICA) across all age groups make up less than 1% of all aneurysms. Traumatic aneurysms in children occur from 10 to 39%, and their treatment requires special considerations. Even though readily diagnosed, the management of traumatic intracranial aneurysms in children is still a subject for discussion. Two cases of traumatic aneurysms following penetrating and blunt trauma are presented.

CASE DESCRIPTION

Two cases of traumatic aneurysms are presented. The first patient presented with an aneurysm of the distal M4 segment of the left middle cerebral artery (MCA) 1 week following blunt traumatic brain injury with skull fractures. The aneurysm was excised without complications. The second patient presented with a saccular aneurysm of the A2 segment of the left anterior cerebral artery (ACA) following penetrating traumatic brain injury with a metal rod. The aneurysm was discovered incidentally on computed tomography angiography (CTA) performed to exclude a brain abscess when the patient developed a persistent fever. After numerous unsuccessful attempts at endovascular embolization, microsurgical aneurysm clipping was performed without complications.

CONCLUSION

Traumatic intracerebral aneurysms are relatively more common in childhood. They commonly occur in the first 21 days post-trauma but can also occur in the late period. We, therefore, recommend that CTA or direct cerebral angiography should be performed within the first 3 weeks to exclude TICA and in all patients with sudden deterioration in the early postoperative period. Considering the high mortality rate associated with conservative management, surgical and/or endovascular management should be performed once the diagnosis is made.