Case StudiesSuccessful Resection of a Growing Distal Medial Lenticulostriate Artery Pseudoaneurysm Presenting with Isolated Intraventricular Hemorrhage
Introduction
Distal medial lenticulostriate artery (LSA) aneurysms associated with isolated intraventricular hemorrhage (IVH) are extremely rare with only 3 case reports in which the existence of the distal medial LSA aneurysm was confirmed by the initial angiography.1, 2, 3 We experienced a very rare case of the isolated IVH due to the rupture of the distal medial LSA pseudoaneurysm that was not visible at the initial angiography but later emerged and grew. Also, we successfully resected the lesion via the transsulcal transventricular approach.
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Case Report
A 61-year-old woman was referred to our hospital because of sudden onset of severe headache and mild consciousness disturbance. She had a history of hypertension but no evidence of coagulation disorders or collagen diseases. The computed tomography (CT) scan revealed IVH occupying symmetrically bilateral lateral ventricles (Fig 1, A). CT angiography and digital subtraction angiography (DSA) showed no evidence of abnormal vessels (Fig 1, B). Initial conservative treatment was performed, and her
Discussion
Distal medial LSA aneurysms associated with isolated IVH are extremely sparse. Ellis et al reported a 71-year-old woman with a history of hypertension, hyperlipidemia, congestive heart failure, and atrial fibrillation.1 Srivastava et al reported a 45-year-old woman without any history of disease.2 Kim et al reported a 28-year-old man with a history of bipolar disorder.3 The present case was a 61-year-old woman with a history of hypertension. Although the number of patients with distal medial
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Cited by (4)
Aneurysm of Distal Medial Lenticulostriate Artery: Report of 2 Cases
2020, World NeurosurgeryCitation Excerpt :In case 1, the aneurysm was not identified on the first CAG, and repeated evaluations were necessary for detection. A few cases of delayed appearance of distal MLSA aneurysms have been reported.13,14 These cases suggest that there may be hidden distal MLSA aneurysms rupture—which remain unrecognized—when the patients have IVH or caudate nucleus hematomas.
Embolization of Ruptured Distal Lenticulostriate Artery Aneurysms
2018, World NeurosurgeryCitation Excerpt :Aneurysms of the LSA are rare. Since 1987, 44 cases of ruptured LSA aneurysm have been reported in the literature (Table 1).3-11,13-37 Multiple factors have been associated with formation and rupture of LSA aneurysms.1-4
Intracranial Pseudoaneurysms: Evaluation and Management
2020, Frontiers in Neurology