Intracerebral Hemorrhage Caused by Ruptured Intracavernous Carotid Artery Aneurysm -Case Report-

Abstract

A 76-year-old woman presented with an enlarged right intracavernous carotid artery aneurysm first identified incidentally when she was hospitalized for thalamic hemorrhage. She was managed conservatively for 1 year, then suffered right total ophthalmoplegia associated with enlargement of the aneurysm. Two months later, she became comatose due to intracerebral hemorrhage in the right temporal lobe. Magnetic resonance imaging demonstrated further enlargement of the aneurysm. Emergency craniotomy found the lateral dural wall of the cavernous sinus was markedly expanded and torn by compression from the aneurysm. Rupture of the aneurysm into the intradural space through this dural defect was confirmed. The aneurysm was trapped after high-flow bypass, but the patient did not recover and died. Symptomatic enlarged intracavernous carotid artery aneurysm is potentially fatal and may indicate prompt surgical management.

Endovascular treatment of carotid-cavernous vascular lesions

“…This situation is in agreement with the existing publications 19,20 , although there is no known explanation for this. These lesions usually affect patients in the 5th and 6th decades of life 20 , and are commonly manifested by CNs compressive symptoms 19 . In this sample, the mean age at symptoms presentation was 52.2 years 20,21 .…”

“…This is the most common presentation [19][20][21] . Thus, the patients According to Vasconcellos et al 20 , the most commonly encountered IcCAA symptoms were, in decreasing order of frequency: headache, diplopia due to CN IV dysfunction, retro-orbital pain, visual deficit and photophobia.…”

Republished: Spontaneous subarachnoid hemorrhage due to ruptured cavernous internal carotid artery aneurysm after medical prolactinoma treatment

“…Several mechanisms have been proposed. Dural erosion from giant intracavernous aneurysms has been reported during autopsy7 and craniotomy,6 although intracavernous aneurysms as small as 1.5 cm have been associated with SAH 9. Dural erosion is more likely to occur in cases of giant aneurysms, aneurysms arising from the anterior genu of the carotid siphon and those eroding into the sella turcica 3.…”

Spontaneous subarachnoid hemorrhage due to ruptured cavernous internal carotid artery aneurysm after medical prolactinoma treatment

“…2 3 There are, however, multiple case reports of SAH from cavernous ICA aneurysms. [4][5][6][7][8] In one report, 4 SAH occurred after the dura was opened during a craniotomy to treat a cavernous ICA aneurysm, which coexisted with a prolactinoma under cabergoline treatment; the authors suggested that an aperture to the subarachnoid space was created by shrinkage of the prolactinoma by cabergoline. We report a case of spontaneous SAH due to rupture of a cavernous ICA aneurysm in a patient whose large prolactinoma had shrunk following cabergoline treatment.…”