J Cerebrovasc Endovasc Neurosurg.  2024 Jun;26(2):174-180. 10.7461/jcen.2023.E2023.08.010.

Two consecutive ruptured intracranial aneurysm in patient with multiple intracranial aneurysms

• Seong J
• Kim J
• Lee S
• Kim B

• KMID: 2556979
• DOI: http://doi.org/10.7461/jcen.2023.E2023.08.010

Abstract

When aneurysmal subarachnoid hemorrhage due to multiple aneurysms is suspected, identifying the rupture site is essential to determine the exact surgical site, but it may not be easy. Even if embolization is adequately performed, complications may remain. Typical complications include rebleeding and hydrocephalus in the early phase and delayed cerebral ischemia in the delayed phase. Herein, we describe a case of rupture of an intracranial aneurysm after performing embolization for a different ruptured intracranial aneurysm in a patient with multiple intracranial aneurysms. Patients with multiple intracranial aneurysms need to be considered for closer observation than those with a single ruptured intracranial aneurysm, even if the patient’s prognosis is good.

Keyword

Intracranial aneurysms; Ruptured aneurysm; Therapeutic embolization; Multiple intracranial aneurysms; Rupture site

Figure

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  Fig. 1. Initial radiographic findings. (A) CT scan showing subarachnoid hemorrhage in the basal cistern. (B) CT angiography showing an aneurysm arising from the proximal A1 segment. CT, computed tomography

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  Fig. 2. DSA before and after endovascular treatment. (A) Anteroposterior view of the digital subtraction angiography showing an aneurysm arising from the proximal A1 segment. It is irregular shape of aneurysm with height of 3.66 mm and transverse diameter is 1.68 mm, with a neck size of 3.04 mm. (B) Oblique view of the digital subtraction angiography showing an aneurysm arising from the proximal A1 segment. (C) Anterolateral working view of the digital subtraction angiography suggests the presence an aneurysm from right distal M1 segment. (D) Postoperative DSA. Red colored area indicates the embolization materials (Coil). DSA, digital subtraction angiography

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  Fig. 3. (A) MRA on the third day after endovascular treatment. It showed that there was no significant change in aneurysm in both aneurysms. (B and C) DSA on the 7th day after endovascular treatment. It showed that there was no significant change in both aneurysms. Anteroposterior view (B) and working view (C). DSA, digital subtraction angiography

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  Fig. 4. CT and DSA on the 23th day after endovascular treatment, immediately after sudden mental change. (A) CT scan showing intracerebral hemorrhage in the right frontal lobe. (B) CT angiography showing a newly noted 14 mm aneurysm in the right distal M1 portion with Irregular narrowing of the right MCA. (C) Postoperative DSA. Red colored area indicates the embolization materials (Coil). CT, computed tomography; DSA, digital subtraction angiography

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