Coexistence of ruptured basilar artery perforator aneurysm undetected on initial angiogram and unruptured anterior cerebral artery saccular aneurysm: Case report and literature review

IF 1.3 Q4 CLINICAL NEUROLOGY

Brain Hemorrhages Pub Date : 2025-06-01 DOI:10.1016/j.hest.2024.07.008

Hideki Nakajima , Yu Sato , Tetsushi Yago , Kazuhiko Tsuda , Hidenori Suzuki

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Abstract

Objective

Ruptured basilar artery perforator aneurysm (BAPA) is a rare cause of subarachnoid hemorrhage (SAH) and is difficult to diagnose.

Case presentation

A 60-year-old male was rushed to our hospital due to severe headache. Computed tomography (CT) showed diffuse SAH, and 3-dimensional CT angiography (CTA) showed a saccular aneurysm in the left anterior cerebral artery (ACA), which was treated with clipping. However, intraoperative findings showed little SAH around the aneurysm and neither a rupture point nor a white thrombus on the aneurysm. Postoperative CT showed a marked decrease in SAH in the prepontine cistern, and digital subtraction angiography (DSA) showed disappearance of the ACA aneurysm and no other lesions. SAH in the prepontine cistern re-increased on CT on the 6th postoperative day, when CTA failed to show the cause. On the 12th postoperative day, CT showed further increased SAH in the prepontine cistern, and DSA revealed a BAPA. Stent-assisted coil embolization was planned at the chronic phase, but the patient went into cardiac arrest the next day, presumably due to a third re-rupture of the BAPA.

Conclusion

The coexistence of a ruptured BAPA and an unruptured saccular aneurysm is extremely challenging in terms of both diagnosis and treatment strategy.

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初次血管造影未发现的基底动脉穿孔动脉瘤破裂与未破裂的大脑前动脉囊状动脉瘤同时存在：病例报告和文献综述

目的破裂的基底动脉穿支动脉瘤（BAPA）是一种罕见的蛛网膜下腔出血（SAH）的病因，诊断困难。病例介绍一名60岁男性因严重头痛被紧急送往我院。计算机断层扫描（CT）显示弥漫性SAH，三维CT血管造影（CTA）显示左侧大脑前动脉（ACA）有囊状动脉瘤，经夹持治疗。然而，术中发现动脉瘤周围几乎没有SAH，动脉瘤上既没有破裂点，也没有白色血栓。术后CT显示癌前池SAH明显减少，DSA显示ACA动脉瘤消失，无其他病变。术后第6天，CT显示术前池SAH再次升高，CTA未能显示原因。术后第12天，CT显示术前池SAH进一步升高，DSA显示BAPA。计划在慢慢期进行支架辅助线圈栓塞，但患者第二天心脏骤停，可能是由于BAPA第三次再次破裂。结论破裂的BAPA与未破裂的囊状动脉瘤共存，在诊断和治疗策略上都是极具挑战性的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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