J Korean Neurosurg Soc.  2015 Aug;58(2):137-140. 10.3340/jkns.2015.58.2.137.

Concurrent Ruptured Pseudoaneurysm of the Internal Carotid Artery and Cerebral Infarction as an Initial Manifestation of Polycythemia Vera

• Choi KS
• Kim JM
• Ryu JI
• Oh YH

• KMID: 2191322
• DOI: http://doi.org/10.3340/jkns.2015.58.2.137

Abstract

The most common neurologic manifestations of polycythemia vera (PV) are cerebral infarction and transient ischemic attacks, while cerebral hemorrhage or intracranial dissection has been rarely associated with PV. Here we report the first case of a 59-year-old patient with intracranial supraclinoid internal carotid artery (ICA) dissection causing cerebral infarction and concomitant subarachnoid hemorrhage due to pseudoaneurysm rupture as clinical onset of PV. This case report discusses the possible mechanism and treatment of this extremely rare condition.

Keyword

Polycythemia vera; Cerebral infarction; Pseudoaneurysm; Dissection; Acquired von Willebrand disease

MeSH Terms

Aneurysm, False*
Carotid Artery, Internal*
Cerebral Hemorrhage
Cerebral Infarction*
Humans
Ischemic Attack, Transient
Middle Aged
Neurologic Manifestations
Polycythemia Vera*
Polycythemia*
Rupture
Subarachnoid Hemorrhage

Figure

• 

  Fig. 1 Intracranial imaging. A : Initial head CT scan shows subarachnoid hemorrhage on left basal cistern. Magnetic resonance imaging showing an acute ischemic lesion in the territory of the left middle cerebral artery with restricted diffusion on diffusion-weighted sequences (B and C) and apparent diffusion coefficient map (D and E). Digital subtraction angiography with 3D-reconstructed imaging shows an irregularly shaped aneurysm arising from supraclinoid internal carotid artery with moderate stenosis of proximal region (F), and its delayed opacification (G) and stagnation of contrast medium in the aneurysm sac (arrows) even during the venous phase (H).

• 

  Fig. 2 A : Operative photograph showing a pulsatile, thin walled aneurysm (white arrows) adherent to the adjacent tissue in the anterior wall of supraclinoid internal carotid artery (black arrow), optic nerve (thick arrow). B : Three curved clips were applied with a crosswise fashion to close the torn gap and to maintain patency of the parent vessel. C and D : Aneurysmal body was composed of organized blood clot (black arrow) and recent thrombus (white arrow) surrounded by fibrous connective tissue (arrowheads) (hematoxylin-eosin stain & Masson-trichrome stain, original magnification ×12.5). E : Follow-up digital subtraction angiography at 6 months after surgery reveals no sign of regrowth of the pseudoaneurysm and an improved degree of the stenosis.

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