Multiple intracranial aneurysms

Abstract

M. L. , a 49-year-old right-handed woman, had been well until she suddenly experienced pain on the left side of her face, became confused, and vomited. The following day she was taken to a district hospital where she was found to have no localizing signs, but lumbar puncture revealed uniformly bloodstained cerebrospinal fluid. She was transferred to Atkinson Morley’s Hospital 5 days later; she was fully conscious and exhibited no neurological deficit. She did have some neck discomfort on fiexion. Bilateral carotid and subclavian angiognams demonstrated left and right carotid, left vertebral, and basilar circulations. The right vertebral artery was not visualized, presumably because it arose from the aorta (6% of cases [4]) or was absent. Thirteen aneurysms were demonstrated: four in the left carotid circulation, three in the right carotid circulation, and six in the posterior circulation. Specifically, four aneurysms arose from the left middle cerebral artery (fig. 1A), two from the right middle cerebral artery (fig. 1B), one aneurysm from the right callosomarginal artery (fig. 16), three from the left posterior cerebral artery, two from the right anterior inferior cerebellar artery, and one from the left posterior inferior cerebellar artery (figs. 1C and 10). The largest aneurysm was one of the left middle cerebral lesions. It was associated with marked sunrounding vascular narrowing (fig. 1A). A CT scan showed a small localized hematoma in the anterior portion of the left sylvian fissure, consistent with hemorrhage from a left middle cerebral artery aneurysm. The patient was treated with an antispasmodic agent on a trial program and bed rest for 10 days. She remained fairly well, developing no focal neurologic signs. On the tenth day, left common carotid artery ligation was performed under local anesthesia. Following ligation, she was gradually mobilized for a 1 week period with no ill effects. The patient was discharged and has remained well for a follow-up period of 18 months.