Rupture of lenticulostriate artery aneurysms

Abstract

The authors report on 3 rare cases of ruptured lenticulostriate artery (LSA) aneurysms that were heralded by deep cerebral hematomas. The hematomas were unilateral in 2 cases and bilateral in 1; in the bilateral case, only a single LSA aneurysm could be identified on the right side of the brain. Because of their small size (≤ 2 mm), fusiform aspect, and deep location within the brain, all of the aneurysms were treated conservatively. There was no hemorrhage recurrence, and followup angiography demonstrated spontaneous thrombosis in 2 of the 3 cases. The clinical course was favorable in 2 of the 3 patients. The course in the patient with the bilateral hematoma was marked by an ischemic event after the initial episode, resulting in an aggravation of deficits. The cause of this second event was uncertain.Because our knowledge about the natural history of LSA aneurysms is incomplete, there is no consensus con cerning a therapeutic strategy. The authors' experience in 3 reported cases leads them to think that a conservative ap proach involving close angiographic monitoring may be proposed as first-line treatment. If the monitored aneurysm then persists or grows in size, its occlusion should be considered. Nonetheless, other studies are needed to further strengthen the legitimacy of this strategy. (http://thejns.org/doi/abs/10.3171/2013.8.JNS13608) key WOrDs • lenticulostriate artery • aneurysm • cerebral hemorrhage • intracerebral hematoma • stroke • vascular disorders Abbreviations used in this paper: AVM = arteriovenous malfor mation; CTA = CT angiography; IVH = intraventricular hemor rhage; LSA = lenticulostriate artery; MRA = MR angiography; mRS = modified Rankin Scale; SAH = subarachnoid hemorrhage.

Aneurysm of lenticulostriate artery in a patient presenting with hemorrhage in the caudate nucleus and lateral ventricle-delayed appearance and spontaneous resolution

“…Previous reports described that spontaneous obstruction was observed between 5 days and 2 years. [ 7 8 13 18 43 44 ] In our case, the aneurysm disappeared in a relatively early period compared with previously reported cases. The aneurysm was located at the distal portion of this thin artery, and blood flow in the artery might be weak compared with that of the main arteries.…”

“…[ 18 33 35 ] Among them, 52 cases of distal lenticulostriate artery aneurysms including our case are summarized in Table 1 . [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 ] Patients' ages varied from 2 months to 81 (average 41.9) years. Patients were relatively young compared to those of the cases with common saccular aneurysms.…”

The Role of digital subtraction angiography in the ventricular spot sign on the computed tomography angiography

“…Lee A. Tan et al reported that a ruptured lenticulostriate artery aneurysm, of which fewer than 50 cases have been reported in the literature8), with the spot sign was clipped17). Other authors published a case report on endovascular treatment of a pseudoaneurysm that formed due to rupture of an anterior communicating artery aneurysm10).…”

Lenticulostriate Artery Aneurysm Presenting as Subarachnoid Haemorrhage

“…If the monitored aneurysm then persists or grows in size, its occlusion should be considered. However studies are needed to strengthen this strategy [9]. Definitive treatment of LSA aneurysms involves both surgical and endovascular methods [3,8].…”