Giant Basilar Artery Aneurysm with Intramural Hemorrhage and Then Disastrous Hemorrhage: Case Report

Koyama, Shinichiro; Kotani, Akio; Sasaki, Jun

doi:10.1097/00006123-199607000-00039

Cited by 28 publications

(18 citation statements)

References 30 publications

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“…In a case report by Koyama et Al an intramural hemorrhage (that presented as a convexshaped high-density lesion on CT) suggestive of dissection between the layers of the aneurysm wall or the periphery of the thrombus could be appreciated 13 .…”

Section: Neuroimagingmentioning

confidence: 97%

Growth and Rupture Mechanism of Partially Thrombosed Aneurysms

et al. 2007

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Within the group of giant and large aneurysms the subgroup of the so-called “partially thrombosed” aneurysms can be differentiated according to clinical and neuroimaging findings. The present study was carried out to determine the site of bleeding of these aneurysms and what implications concerning their pathomechanism can be drawn from these findings. Twenty patients aged two to 77 (mean 44) years who exhibited a partially thrombosed aneurysm that had recently bled were included. Images (MRI including T1 pre- and postcontrast and T2 weighted images in multiple planes, CT and digital subtraction angiography) and patients' charts were reviewed. MRI showed an onion-skin appearance of the thrombus in 19 patients, rim enhancement of the aneurysm wall (either partial or complete) in 17, and a perifocal edema in 16 patients. The acute hemorrhage was typically crescent-shaped and located at the periphery of the aneurysm, distant from the perfused lumen of the aneurysm within the thrombosed part of the aneurysm. The current denomination “partially thrombosed” intracranial arterial aneurysms leads to the presumption that thrombus is present endoluminal whereas in fact the site of hemorrhage is within the vessel wall. A more accurate nomination would, therefore, be “aneurysms with intra mural hemorrhage”. The enhancing wall and the edematous reaction of the adjacent brain parenchyma might be a sign for an inflammatory pathomechanism which is reinforced by histological and pathophysiological studies. This disease should be regarded as a clinical entity separate from saccular or non-thrombosed giant or large aneurysms.

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Section: Neuroimagingmentioning

confidence: 97%

Growth and Rupture Mechanism of Partially Thrombosed Aneurysms

et al. 2007

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“…These histologiocal findings are further backed by imaging studies that suggest that the formation of intracranial partially thrombosed giant artery aneurysms is due to a subacute recurrent dissection processes with repeated subadventitial haemorrhages 16,17 . In the vast majority of patients with partially thrombosed aneurysms, a hyperintensity on non-enhanced T1-weighted images indicative of fresh hemorrhage is present within the thrombus along the aneurismal wall and away from the patent lumen 18 . An enhancing rim can be perceived with perifocal edema and an onion-skin appearance of a multilayered thrombus wall is present 3,19 .…”

Section: Dissections and "Giant Partially Thrombosed" Aneurysmsmentioning

confidence: 99%

The Many Faces of Intracranial Arterial Dissections

Krings

Choi

2010

Interv Neuroradiol

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Intracranial arterial dissecting diseases are rare and challenging diseases with a high associated morbidity and mortality. Their common pathomechanic origin is related to blood entering the vessel wall via an endothelial and intimal tear. Depending on the fate of the thus established intramural hematoma, different symptoms may ensue including mass effect, subarachnoid hemorrhage or ischemia. If the mural hematoma ruptures all vascular layers of the intradural artery, a subarachnoid hemorrhagic will occur. If the intramural hematoma reopens distally into the parent vessel on the other hand, ischemic embolic events may happen following intramural clot formation. If the mural hematoma does neither open itself into the parent vessel nor into the subarachnoid space, the vessel wall may dilate leading to occlusion of perforator branches and local ischemia. Organization of the mural hematoma may result in a chronic dissecting process which may eventually lead to formation of a “giant partially thrombosed” aneurysm with thrombus of varying ages within the vessel wall, ingrowth of vasa vasorum and recurrent dissections with subsequent growth of the aneurysm from the periphery. Treatment strategies of these diseases should take the underlying pathomechanism into consideration and include, depending on the presentation medical treatment, parent vessel occlusion, flow reversal or diversion, surgical options or a combined treatment protocol.

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“…16 On the other hand, aneurysms with domes extending into the ventricle have been described in either the third or fourth ventricle in a few cases (Table 1). More specifically, aneurysms in the third ventricle arise from a major branch point of the circle of Willis, [1][2][3]5,7,[9][10][11]15,17,18,21,25,28,29,31 and lesions in the fourth ventricle arise from a distal branch of the PICA. 20,30 In the present case, we reported on a distal ACA aneurysm whose dome extended into the lateral ventricle cavity, which is the first case in the literature.…”

Section: Discussionmentioning

confidence: 99%

Aneurysm of the distal anterior cerebral artery radiologically mimicking a ventricular mass

Şanlı

Çekirge

Şekerci

2011

JNS

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The ventricular system is a rare localization for intracranial aneurysms. Most ventricular aneurysms arise from a distal branch of the choroidal arteries and a major branch point of the circle of Willis. A 41-year-old-man suffering from dizziness of 2 weeks' duration was admitted to the clinic. On radiological examination, he had a well-circumscribed mass involving the frontal horn of the right lateral ventricle without radiological evidence of a prior or recent hemorrhage. Localization and radiological appearance were not typical of a ventricular mass and did not allow diagnosis. After cerebral angiography, an aneurysm arising from the distal anterior cerebral artery was incidentally found in an intraventricular location. This unruptured aneurysm was successfully treated via the endovascular route. The authors describe the unusual case of a distal anterior cerebral artery aneurysm with a dome extending into the right lateral ventricle, which appears to be the first such case in the literature. Angiography may be helpful to neurosurgeons in avoiding the disastrous complications of a biopsy procedure in such unusual cases.

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Giant Basilar Artery Aneurysm with Intramural Hemorrhage and Then Disastrous Hemorrhage: Case Report

Abstract: It seems probable that intramural hemorrhage of the aneurysmal wall may cause both the growth and rupture of intracranial giant aneurysms.

Cited by 28 publications

References 30 publications

Growth and Rupture Mechanism of Partially Thrombosed Aneurysms

Growth and Rupture Mechanism of Partially Thrombosed Aneurysms

The Many Faces of Intracranial Arterial Dissections

Aneurysm of the distal anterior cerebral artery radiologically mimicking a ventricular mass

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