J Korean Neurosurg Soc.  2013 Sep;54(3):236-238. 10.3340/jkns.2013.54.3.236.

Rupture of De Novo Anterior Communicating Artery Aneurysm 8 Days after the Clipping of Ruptured Middle Cerebral Artery Aneurysm

• Ha SK
• Lim DJ
• Kim SD
• Kim SH

• KMID: 2190904
• DOI: http://doi.org/10.3340/jkns.2013.54.3.236

Abstract

Rapidly developed de novo aneurysm is very rare. We present a rapidly developed and ruptured de novo anterior communicating aneurysm 8 days after the rupture of another aneurysm. This de novo aneurysm was not apparent in the initial 3-dimensional computed tomography and digital subtraction angiography. We reviewed the literature and discussed possible mechanisms for the development of this de novo aneurysm.

Keyword

De novo aneurysm; Subarachnoid hemorrhage; Aneurysm formation; Computed tomography angiography; Digital subtraction angiography

MeSH Terms

Aneurysm
Angiography, Digital Subtraction
Intracranial Aneurysm*
Middle Cerebral Artery*
Rupture*
Subarachnoid Hemorrhage

Figure

• 

  Fig. 1 A : Initial brain computed tomography (CT) showing subarachnoid hemorrhage in basal cistern and left sylvian fissure. B : A 64-detector 3-dimensional CT angiogram showing a saccular aneurysm on the left M1 portion of middle cerebral artery. There is no abnormal finding in anterior communicating artery. C : 1 day after clipping, diffusion weighted magnetic resonance image showing ischemic change of left posterior limb of internal capsule. D : 1 day after clipping, the trans-femoral catether angiography showing no abnormality in anterior communicating artery except mild vasospasm in peripheral arteries (not shown).

• 

  Fig. 2 A : Eight day after clipping, follow-up brain CT showing intraparenchymal hematoma in the frontal lobe. B : Eight days after clipping, follow-up trans-femoral catether angiography (TFCA) showing the anterior communicating artery aneurysm (4.9×4.9 mm) that was not existed in previous images with a massive general vasospasm. C : Simultaneously with TFCA, anterior communicating artery aneurysm was obscured by coil embolization and intra-arterial nimodipine injection was performed. D : Four weeks after the coil embolization, follow-up CT showing new developed cerebral infarction in the middle cerebral artery territory due to vasospasm and hemorraghic transformation.

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