Case Studies
Successful Resection of a Growing Distal Medial Lenticulostriate Artery Pseudoaneurysm Presenting with Isolated Intraventricular Hemorrhage

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Introduction

Distal medial lenticulostriate artery (LSA) aneurysms associated with isolated intraventricular hemorrhage (IVH) are extremely rare. We report 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.

Case Report

A 61-year-old woman with a history of hypertension had sudden onset of severe headache and mild consciousness disturbance. The computed tomography scan revealed the IVH, but the initial angiographies showed no evidence of aneurysm. The follow-up magnetic resonance imaging revealed that an intraventricular mass, arising from the right distal medial LSA, emerged and grew into the right anterior horn. Considering the risk of rebleeding, we resected the mass lesion via the transsulcal transventricular approach. The postoperative imaging showed complete obliteration of the mass lesion. Histopathological analysis indicated the pseudoaneurysm. The patient was discharged without any neurological deficit.

Conclusions

The careful and repetitive follow-up imaging should be done in the cases with isolated IVH even if the initial image evaluations are unrevealing. The transsulcal transventricular approach can be the most minimally invasive surgical option for intraventricular lesion.

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.

Section snippets

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

References (5)

  • J.A. Ellis et al.

    Medial lenticulostriate artery aneurysm presenting with isolated intraventricular hemorrhage

    Surg Neurol Int

    (2011)
  • T. Srivastava et al.

    Lenticulostriate artery aneurysm presenting as primary intraventricular haemorrhage

    BMJ Case Rep

    (2013)
There are more references available in the full text version of this article.

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    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.

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    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

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