Surgical treatment of ruptured aneurysm with intracerebral and subarachnoid hemorrhage in a 16-month-old infant.

Abstract

The relatively common incidence of aneurysms of the circle of Willis and adjacent vessels is well known, and the idea tha t practically all such aneurysms represent congenital defects is generally accepted in spite of the fact tha t they become evident clinically only rarely before the third decade of life. Hermann and Macgregor 1 reported the case of a 4i89 child who died of an intracerebral and subarachnoid hemorrhage secondary to rupture of a small aneurysm which had originated from a bifurcation of one of the deep branches of the anterior cerebral ar tery within the substance of the brain. In 1939, McDona ld and Korb 2 reviewed 1,1~5 collected cases of saccular aneurysms verified by operation or autopsy. Th i r ty were cases of aneurysms in children of which 13 were said to be embolic or thrombotic in origin or associated with endocarditls. In 1953, Ritchie and Haines 3 reviewed the literature and collected 81 cases of spontaneous intracranial hemorrhage, or aneurysmal or angiomatous malformations, in children in addition to the 30 cases reviewed by McDonald and Korb. I n ~5 of these additional 81 cases, the cause of the hemorrhage was undetermined, in 17 the hemorrhage was indicated to have been caused by a ruptured aneurysm, and in 39 form of angioma was the source of the hemorrhage. T h e y reported an additional 8 cases in children ranging in age from 6 to 13 years. Four of these patients were proven to have angiomatous malformations, 3 had hemorrhage of unknown source and 1 was believed to have had an ancurysm. :It is evident t ha t intracerebral or subarachnoid hemorrhage in infants and children is quite unusual, and in the great major i ty of cases reported the source of the hemorrhage was not determined or it was secondary to some type of arteriovenous anomaly.