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Yokoyama H, Nishihori M, Izumi T, Goto S, Kurimoto M, Kato M, Kanamori F, Uda K, Yokoyama K, Araki Y, Saito R. Ruptured Middle Cerebral Artery Aneurysm in an Infant: Case Report and Literature Review. NMC Case Rep J 2023; 10:177-183. [PMID: 37465251 PMCID: PMC10351959 DOI: 10.2176/jns-nmc.2022-0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/27/2023] [Indexed: 07/20/2023] Open
Abstract
Intracranial aneurysms (IA) in infants are reportedly rare at 0.5% to 4.5% of all aneurysms. Furthermore, subarachnoid hemorrhage in infants younger than three months are even rarer as it has been reported in approximately 20 cases only till date. A 3-month-old infant with seizures and impaired consciousness was admitted to our hospital. Three-dimensional computed tomography angiography (3D-CTA) revealed a dissecting aneurysm with a maximum diameter of 13 mm in the right M2. Internal trapping using detachable coil were successfully performed, following which he was discharged without significant neurological deficit after one month of onset. Thus, we have reported a rare case of a large ruptured dissecting IA in a 3-month-old infant, in the right middle cerebral artery (MCA), successfully treated with an endovascular therapy, along with a literature review.
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Affiliation(s)
- Hayato Yokoyama
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shunsaku Goto
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Michihiro Kurimoto
- Department of Neurosurgery, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Mihoko Kato
- Department of Neurosurgery, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Fumiaki Kanamori
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji Uda
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
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Wu Q, Li T, Li L, Chang K, Shao Q. Spontaneous healing and complete disappearance of an intracranial vertebral artery dissecting aneurysm: A case report. Medicine (Baltimore) 2022; 101:e31444. [PMID: 36451392 PMCID: PMC9704907 DOI: 10.1097/md.0000000000031444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Intracranial vertebrobasilar dissecting aneurysms (VBDAs) are associated with a greater tendency to rupture and a greater risk of worse outcomes than anterior circulation aneurysms. Spontaneous healing of a VBDA is very rare, and there have been very few case reports of spontaneous healing of an aneurysm. We describe a case of intracranial vertebral artery dissecting aneurysm that healed spontaneously and disappeared completely on follow-up images. PATIENT CONCERNS A 40-years-old woman was referred to the neurology department because of a persistent headache, especially in the left occiput. DIAGNOSES Magnetic resonance angiography and computed tomography angiography showed a left vertebral artery dissection-like aneurysm (4.5 × 2.0 × 2.5 mm in size) with proximal parent artery mild stenosis (40%). INTERVENTIONS Flunarizine hydrochloride was administered for symptomatic treatment and follow-up angiography was performed. OUTCOMES Digital subtraction angiography and magnetic resonance angiography showed that the aneurysm had completely disappeared at 3 months follow-up. High-resolution magnetic resonance vessel wall imaging revealed intimal thickening and mild stenosis in the left intracranial vertebral artery without an aneurysm signal. In addition, enhancement scanning revealed that the aneurysm area was moderately enhanced. MR-vessel wall imaging at 7 months follow-up showed that the enhancement was slightly reduced compared with the previous time. LESSONS This case illustrates the relatively plastic nature of a vertebral dissecting aneurysm, indicating that spontaneous healing remains possible.
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Affiliation(s)
- Qiaowei Wu
- Cerebrovascular Department of Interventional Center, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou, Henan, China
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tianxiao Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Li Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Kaitao Chang
- Cerebrovascular Department of Interventional Center, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Qiuji Shao
- Cerebrovascular Department of Interventional Center, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou, Henan, China
- * Correspondence: Qiuji Shao, Cerebrovascular Department of Interventional Center, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, No 7, Weiwu Road, Zhengzhou, Henan 450003, China (e-mail: )
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Cerebellar hemorrhage in a newborn: a case report in association with suspected arterial dissection of the posterior inferior cerebellar artery. Childs Nerv Syst 2021; 37:2905-2909. [PMID: 33506303 DOI: 10.1007/s00381-021-05056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
We herein report a 5-day-old baby boy presented with a massive cerebellar hemorrhage due to suspected posterior inferior cerebellar artery (PICA) dissection. He was born by vacuum extraction at the gestational age of 41 weeks with 3370 g birth weight. On the fifth day of life, he developed dyspnea with worsening vital signs. CT of the head showed massive cerebellar hemorrhage and then transferred to our hospital. External ventricular drainages were emergently placed for his hydrocephalus on the first day of hospitalization, then cerebellar hematoma was evacuated with suboccipital craniotomy on day 11. Under microscopic observation, the left PICA was swollen with dark red discoloration at the caudal loop, being a confirmative finding of arterial dissection. By these findings, we suspected ruptured arterial dissection as a cause of cerebellar hemorrhage. The right PICA looked intact. He required a ventriculoperitoneal shunt on day 59 due to his persistent hydrocephalus, resulting in remarkable improvement of his neurological condition. An MRI, a CT angiography/venography, or blood tests showed no abnormalities such as tumors, vascular anomalies, or coagulopathies. We discuss the significantly rare case of cerebellar hematoma in a newborn, most likely caused by ruptured PICA dissection.
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Grover PJ, Harris L, Qureshi AM, Rennie A, Robertson F, James G. Occult posterior inferior cerebellar artery dissection requiring endovascular treatment following pediatric head trauma: case report. J Neurosurg Pediatr 2021; 27:643-648. [PMID: 33836497 DOI: 10.3171/2020.11.peds18324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/02/2020] [Indexed: 11/06/2022]
Abstract
This is the eighth case report of a pediatric dissecting posterior inferior cerebellar artery aneurysm. The authors present the case of a 13-year-old boy who presented with posttraumatic posterior fossa subdural, subarachnoid, and intraventricular hemorrhage with hydrocephalus. Initial vascular imaging findings were negative; however, a high level of suspicion is necessary. The aneurysm was identified on day 20, after recurrence of hydrocephalus, and was treated with endovascular vessel sacrifice. The patient made a good recovery. It is important to consider arterial dissection in pediatric traumatic brain injury, especially with suspicious findings on initial CT scan and clinical presentation out of proportion to the mechanism of injury. Delayed vascular imaging is imperative for appropriate management.
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Affiliation(s)
- Patrick J Grover
- 1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
| | - Lauren Harris
- 1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
| | - Ayman M Qureshi
- 1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
| | - Adam Rennie
- 2Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
| | - Fergus Robertson
- 2Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
| | - Greg James
- 2Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
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Successful microsurgical treatment of intracranial aneurysms in infants: a retrospective study and literature review. Acta Neurochir (Wien) 2018; 160:783-792. [PMID: 29307023 DOI: 10.1007/s00701-017-3457-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/28/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Intracranial aneurysms are extremely rare in infants, especially less than 1 year old. This study aimed to analyze the frequency of infantile intracranial aneurysm in our department and investigate the clinical characteristics, treatment strategies, and outcomes of this disease. METHODS Six infants under 1 year old in 4350 patients with intracranial aneurysms were retrospectively analyzed from January 2010 to December 2016. RESULTS The patients (5 females and 1 male) ranged in age from 2 to 11 (mean age, 4.67) months. Four patients presented with generalized seizure and vomiting, 3 showed lethargy, 1 presented eye deviation, and 1 had right-sided hemiparesis. Radiographically, two aneurysms were localized in the middle cerebral artery (MCA) of the M2 segment, two were located in the M3 segment of MCA, one was located at left MCA bifurcation, and one was located at the nonbranching site of the left supraclinoid internal carotid artery. All these lesions were successfully managed with aneurysm clipping or resection, and the improvement of neurological deficits was achieved in all patients. CONCLUSION Intracranial aneurysms should be considered in the differential diagnosis of infants who present with acute raised intracranial pressure. An improvement of neurological deficits is noted in infants who are managed promptly with microsurgical techniques of clipping during the long-term follow-up.
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Ghali MGZ, Srinivasan VM, Cherian J, Kim L, Siddiqui A, Aziz-Sultan MA, Froehler M, Wakhloo A, Sauvageau E, Rai A, Chen SR, Johnson J, Lam SK, Kan P. Pediatric Intracranial Aneurysms: Considerations and Recommendations for Follow-Up Imaging. World Neurosurg 2017; 109:418-431. [PMID: 28986225 DOI: 10.1016/j.wneu.2017.09.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pediatric intracranial aneurysms (IAs) are rare. Compared with adult IAs, they are more commonly giant, fusiform, or dissecting. Treatment often proves more complex, and recurrence rate and de novo aneurysmogenesis incidence are higher. A consensus regarding the most appropriate algorithm for following pediatric IAs is lacking. METHODS We sought to generate recommendations based on the reported experience in the literature with pediatric IAs through a thorough review of the PubMed database, discussion with experienced neurointerventionalists, and our own experience. RESULTS Digital subtraction angiography (DSA) was utilized immediately post-operatively for microsurgically-clipped and endovascularly-treated IAs, at 6-12 months postoperatively for endovascularly-treated IAs, and in cases of aneurysmal recurrence or de novo aneurysmogenesis discovered by non-invasive imaging modalities. Computed tomographic angiography was the preferred imaging modality for long-term follow-up of microsurgically clipped IAs. Magnetic resonance angiography (MRA) was the preferred modality for following IAs that were untreated, endovascularly-treated, or microsurgically-treated in a manner other than clipping. CONCLUSIONS We propose incidental untreated IAs to be followed by magnetic resonance angiography without contrast enhancement. Follow-up modality and interval for treated pediatric IAs is determined by initial aneurysmal complexity, treatment modality, and degree of posttreatment obliteration. Recurrence or de novo aneurysmogenesis requiring treatment should be followed by digital subtraction angiography and appropriate retreatment. Computed tomography angiography is preferred for clipped IAs, whereas contrast-enhanced magnetic resonance angiography is preferred for lesions treated endovascularly with coil embolization and lesions treated microsurgically in a manner other than clipping.
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Affiliation(s)
- Michael George Zaki Ghali
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Louis Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - M Ali Aziz-Sultan
- Vascular and Endovascular Neurosurgery, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Froehler
- Department of Neurology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Ajay Wakhloo
- Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Eric Sauvageau
- Baptist Neurological Institute, Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Ansaar Rai
- Department of Interventional Neuroradiology, West Virginia University, Morgantown, West Virginia, USA
| | - Stephen R Chen
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sandi K Lam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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Dinc G, Oguz S, Eyuboglu I, Guven S. Ruptured dissecting PICA aneurysm with spontaneous thrombosis during pregnancy with long-term follow-up. J OBSTET GYNAECOL 2015; 36:345-6. [PMID: 26503898 DOI: 10.3109/01443615.2015.1060209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- G Dinc
- a Medical Park Hospital, Obstetrics and Gynecology Clinic , Trabzon , Turkey
| | - S Oguz
- b Karadeniz Technical University, Faculty of Medicine , Department of Interventional Radiology , Trabzon , Turkey
| | - I Eyuboglu
- b Karadeniz Technical University, Faculty of Medicine , Department of Interventional Radiology , Trabzon , Turkey
| | - S Guven
- c Karadeniz Technical University, Faculty of Medicine , Department of Obstetrics and Gynecology , Trabzon , Turkey
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