Ruptured Proximal Lenticulostriate Artery Fusiform Aneurysm Presenting With Subarachnoid Hemorrhage

Eddleman, Christopher S.; Surdell, Daniel L.; Pollock, Glen; Batjer, H. Hunt; Bendok, Bernard R.

doi:10.1227/01.neu.0000255439.21495.bb

Cited by 28 publications

(35 citation statements)

References 6 publications

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“…Although these modalities offer good sensitiv ity, 29 LSA aneurysms are nonetheless difficult to detect. Of the 46 cases reported in the literature, there were 8 CTA studies 4,7,8,16,19,22,39,43 of which 3 were negative 4,8,19 and 3 MRA studies 17,25,32 of which 1 was negative. 32 All 3 of our patients underwent MRI with an angiographic se quence during the acute phase of the hematoma, but only in 1 case was there evidence of a suspected aneurysm, which was later confirmed on angiography.…”

Section: Discussionmentioning

confidence: 99%

Rupture of lenticulostriate artery aneurysms

Heck¹,

Anxionnat

Lacour

et al. 2014

JNS

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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.

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Section: Discussionmentioning

confidence: 99%

Rupture of lenticulostriate artery aneurysms

Heck¹,

Anxionnat

Lacour

et al. 2014

JNS

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“…[1][2][3][4][5][6] Aneurysms of LSA artery most often involve either the junction of the MCA trunk or are distal, frequently located within the basal ganglia parenchyma. 3,5,7,8 A single trunk arising from the MCA is rarely found.…”

Section: Discussionmentioning

confidence: 99%

“…Surgery is challenging owing to anatomical features and endovascular options may be limited. 2,4,6 The present cases detail clinical presentations in 2 patients.…”

mentioning

confidence: 81%

“…Approximately 10% to 20% of strokes are hemorrhagic, and a small number of hemorrhagic strokes result from ruptured LSA aneurysms. 1,2,4,5 Conservative, endovascular, and surgical treatments have been described primarily through case reports and individual author's experience. Surgery is challenging owing to anatomical features and endovascular options may be limited.…”

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confidence: 99%

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Lenticulostriate Brain Aneurysms

Aguiar

Santiago

Zicarelli

et al. 2010

Neurosurgery Quarterly

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Objective: Lenticulostriate artery (LSA) aneurysms are rare. We present 2 cases of LSA aneurysm, their clinical presentation, diagnosis, surgical treatment, and postoperative follow-up, with a review about the topic.Case Report: We report 2 female cases of LSA aneurysms among 194 surgically treated aneurysms in Santa Paula and Sa˜o Camilo Hospital, who underwent the same surgical treatment. The first patient is a 48-year-old, Latin American woman whose aneurysms were detected incidentally in an angiographic study performed owing to a cavernous sinus thrombosis. Both cerebral angiogram and magnetic angioresonance were performed and demonstrated a left lenticulostriate aneurysm and 2 parassylvian aneurysms. The other patient is a 62-year-old, Japanese, hypertensive patient who presented with subarachnoid hemorrhage, Fisher scale 2, and Hunt-Hess classification 2. Her angiogram demonstrated a right LSA, left middle cerebral artery, and anterior communicating artery aneurysms. No other pathology or infectious etiology was noted. Both patients were treated by opening of the sylvian fissure, allowing the visualization of lenticulostriate vessels, and aneurysm clipping. Postoperative angiographies were performed in both the cases. During 2-year follow-up the younger patient remained just with distal right arm paresis and Rankin scale score 1; the older patient developed normal pressure hydrocephalus, needing peritoneal ventricular drainage.Conclusions: LSA aneurysms are uncommon. Subarachnoid hemorrhage and intracranial sinus thrombosis are quite more common pathologies nevertheless the underlying vascular abnormality is rarely identified. The most common clinical presentation is intraparenchymal hemorrhage. Microsurgical treatment is often the chosen modality of intervention. Elderly people are more likely to develop postoperative complications before and after hospital discharge, which may be associated to microscopic alterations in vessels. They are also under higher risk of more severe vasospasm and risk of hydrocephalus development in cases of ruptured aneurysms.

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“…These lesions have been reported in the setting of a diverse array of pathologies including tumors, vascular malformations, various vasculitides (including moyamoya and lupus), and hypertension. [1][2][3][4] Although the microsurgical and endovascular treatment of almost 20 ruptured aneurysms of the lenticulostriate artery has been reported, [1][2][3][4][5][6][7][8][9] we found no case that reported successful microsurgical clipping of an unruptured lenticulostriate aneurysm. We now describe a rare unruptured aneurysm of the lenticulostriate artery treated with microsurgical clipping in a woman with moyamoya disease.…”

Section: Introductionmentioning

confidence: 99%