Elsevier

World Neurosurgery

Volume 129, September 2019, Pages 526-530.e1
World Neurosurgery

Case Report
Thrombotic Aneurysm of Posterior Inferior Cerebellar Artery

https://doi.org/10.1016/j.wneu.2019.04.245Get rights and content

Background

Spontaneous thrombosis of an intracranial aneurysm is rare but is common in fusiform or large cystic aneurysms, which result in subarachnoid hemorrhage after rupture. This case reports a 47-year-old woman with subarachnoid hemorrhage who developed spontaneous thrombosis of an aneurysm due to rupture of the posterior inferior cerebellar aneurysm.

Case Description

The patient was admitted to the hospital with history of sudden headache and vomiting for 3 days. According to early imaging findings, she was initially diagnosed as having a cavernous hemangioma with hemorrhage in the left cerebellum, but according to the intraoperative pictures and postoperative pathologic results, the diagnosis was an aneurysm with thrombosis.

Conclusions

This case represents a rare but important complication of ruptured intracranial aneurysm, which can be easily misdiagnosed or ignored. It should be given great attention and considered in patients with subarachnoid hemorrhage who are negative for imaging examinations.

Section snippets

Background

Spontaneous thrombosis of an intracranial aneurysm is rare but is common in fusiform or large cystic aneurysms, which result in subarachnoid hemorrhage (SAH) after rupture. Large (>15 mm) and giant (>25 mm) aneurysms are more prone to undergo spontaneous aneurysmal thrombosis.1 Most such aneurysmal thromboses are partial, and only 13%−20% of the patients undergo complete thrombosis.2, 3 This case reports a 47-year-old woman with subarachnoid hemorrhage who developed spontaneous thrombosis of

Case Presentation

The patient was admitted to the hospital with history of sudden headache and vomiting for 3 days. Admission physical examination findings were blood pressure 153/85 mm Hg, R18 beats/minute, P80 beats/minute, T37°C, conscious, mentally acceptable, fluent in language, normal visual acuity, equally large and round in bilateral pupils, diameter 2.5 mm, and existing light reflection. Both eyes had normal movement and no nystagmus. The corner of the mouth was not skewed, the nasolabial fold was

Discussion

The patient was initially diagnosed with a left cerebellar hemisphere cavernous hemangioma and hemorrhage. What we saw during the operation explained why the patient had no obvious abnormalities on CTA and DSA before surgery. The left cerebellar hemisphere showed mixed-signal lesions on MRI of the brain and were confirmed to be thrombosis in the aneurysm.

Reports about thrombosis after aneurysm rupture are rare, and regardless of age or location, the percentage of spontaneous thrombosis reported

Conclusion

In summary, this case represents a rare but important complication of ruptured intracranial aneurysm, which is easily misdiagnosed or ignored. It should be given great attention and considered in patients with subarachnoid hemorrhage who are negative for imaging examinations, and the periodic angiography is also necessary.

Acknowledgment

We wish to thank Alkhazraji Maadh Wisam at Wuhan University/College of Medicine for language help.

References (10)

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Cited by (1)

  • Surgical treatment of image disguised thrombosed giant cerebral aneurysms (TGCAs): A single center experience

    2023, Interdisciplinary Neurosurgery: Advanced Techniques and Case Management
    Citation Excerpt :

    Second, it involves a limited number of cases. In the same direction, the data available in the literature was predominantly case reports [6,14–16]. Studies concerning TGCAs should be conducted on a larger scale.

Supplementary digital content available online.

Conflict of interest statement: This work was supported by the National Natural Science Foundation of China (81572489, 81372683, and 81502075). The project supports the costs associated with publishing.

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