Multiple intracranial aneurysms following radiation therapy for nasopharyngeal carcinoma

Abstract

imaging (MRI) showed a lesion with epicenter at the left side of the nasopharynx with extension into adjoining left sided nasal cavity, left sided paranasal sinuses (sphenoid, ethmoid, and maxillary sinuses) and left parasellar region [Figure 1]. The patient received external beam radiotherapy (EBRT) with a total dose of 60 Gy in 30 divided doses over a 6 weeks period. The radiation field comprised left side of nasopharynx, left nasal cavity and left maxillary antrum. Clinicoradiological follow-up showed no local residual lesion/recurrence. Eight years later, in 2012, this patient presented to the neurosurgical emergency with sudden onset severe headache, nausea and vomiting. Neck rigidity was present on examination. A plain computed tomography scan [Figure 2] showed SAH involving the perimesencephalic cisterns, sylvian cistern and along the tentorium (Fisher Grade 3). His Glasgow coma scale score was 15 and World Federation of Neurological Surgeons grade was Grade 1. A four vessel angiogram revealed six cerebral aneurysms. There was a fusiform terminal left internal carotid artery (ICA) aneurysm with extension in proximal A1 and proximal M1 segments of left anterior cerebral artery and middle cerebral artery (MCA). A saccular