Acute Recanalization of a Partially Thrombosed Large Intracranial Aneurysm.

Acute Recanalization of a Partially Thrombosed Large Intracranial Aneurysm.

World Neurosurg. 2018 Apr 12;:

Authors: Atallah E, Valle-Giler E, Elarjani T, Chalouhi N, Tjoumakaris S, Rosenwasser RH, Herial N, Gooch MR, Zarzour H, Jabbour P

Abstract
BACKGROUND: Thrombosed large intracranial aneurysms(TLIAs) are not continuously contemplated as stable lesions. Completely occluded large IAs' spontaneous recanalization has been previously described.
CASE DESCRIPTION: We report the case of a middle-aged patient presenting with agitation, acute headache, visual field defects and left hemiparesis. A large thrombosed Posterior Communicating (PCom) artery aneurysm was identified with an infarct at the same arterial territory on neuroimaging studies. Digital Subtraction Angiography(DSA), one week later, demonstrated complete recanalization of the TLIA. It was treated endovascularly with coils. Patient returns several days later with augmenting headaches explained by quadrigeminal system sub-arachnoid hemorrhage(SAH). Repeat DSA showed filling of the coiled aneurysm from the Internal Carotid Artery(ICA) injection. PCom was catheterized and deconstructed. Patient was discharged home with no additional neurological deficits.
CONCLUSIONS: TLIAs are insidious vascular lesions. They can cause nerve or vessel damage by mass effect only or ischemic stroke by emitting emboli into distal vasculature. We advise close and periodic radiological follow-up for TLIAs.

PMID: 29656154 [PubMed - as supplied by publisher]

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