Aneurysm Of Azygos Anterior Cerebral Artery Research Articles

Acute Paraparesis Syndrome after a Ruptured Aneurysm of the Azygos Anterior Cerebral Artery (P12-5.016)

<h3>Objective:</h3> To describe a rare case of acute paraparesis syndrome (APS) after a ruptured aneurysm of the azygos anterior cerebral artery (ACA). <h3>Background:</h3> The incidence of APS within 24 hours after subarachnoid hemorrhage is very rare. Additionally, the pathophysiology of this syndrome remains poorly defined. Nonetheless, the literature suggests it could emerge from a bilateral ACA vasospasm, acute hydrocephalus, or global cerebral edema and can be associated with poor clinical status. The azygos ACA is a rare variant whose unique anatomy intensifies the hemodynamic stress on the arterial wall, making aneurysm formation closely associated with this anomaly. <h3>Design/Methods:</h3> A 72-year-old man with a past medical history of hypertension presented to the hospital with the complaint of acute paraparesis after a thunderclap headache and transitory loss of consciousness. The physical exam showed paraparesis with brisk patellar and Achilles reflexes and a neutral response to bilateral plantar stimulation. No abnormalities were noticed on the cranial nerves, coordination, and sensory examination. <h3>Results:</h3> Routine laboratory studies were normal. Brain computed tomography revealed an acute punctate hemorrhage of an aneurysm located in the frontal interhemispheric fissure. Magnetic Resonance Imaging (MRI) of the spine was unremarkable. Brain MRI showed unspecific white matter abnormalities, and an MR angiography showed a 4.3 mm saccular aneurysm in the right ACA A3 segment in the bifurcation of an azygos ACA. The patient underwent coiling of the aneurysm and was able to walk unassisted nine weeks after the procedure. <h3>Conclusions:</h3> Acute paraparesis syndrome is a rare manifestation of a ruptured anterior communicating artery or anterior cerebral artery aneurysm. Here, we present an atypical etiology of APS caused by a ruptured aneurysm of the azygos ACA. To the best of our knowledge, this is the first description of an APS after a ruptured aneurysm of the azygos ACA. <b>Disclosure:</b> Dr. Moreno-Zambrano has nothing to disclose. Dr. Jimenez Zambrano has nothing to disclose. Jose Francisco Ortega Tola, MD has nothing to disclose. Dr. Yepez has nothing to disclose. Wilson Cueva has nothing to disclose.

A saccular aneurysm of an azygos anterior cerebral artery: A rare anatomical variation and review of literature

The azygos anterior cerebral artery (ACA) is a rare variation in the circle of Willis. Azygos ACAs often associated with other vascular or nonvascular anomalies. These aneurysms can be noninvasively imaged either by conventional computed tomography (CT) angiography or magnetic resonance angiography, but digital subtraction angiography is the gold standard for diagnosis. We report a case of saccular aneurysm of azygos ACA, diagnosed by multidetector CT cerebral angiography and treated by craniotomy and clipping of aneurysm. The clinical significance of the rare anomaly is highlighted. We report this rare clinical experience with review of the literature.

Endovascular Treatment of a Ruptured Aneurysm at a Very Rare Location

We describe a patient with a small ruptured azygos anterior cerebral artery aneurysm located at a non-bifurcation distal site on the artery treated successfully with simple coiling.

Azygos Anterior t'erebrat Artery Aneurysm

Two cases of azygos anterior cerebral artery aneurysm are reported. Case 1 was a 53-year-old male. He had an attack of left hemiparesis two months before admission. An enhanced computerized tomography (CT) scan demonstrated a ring enhancement in the right frontal lobe adjacent to the falx. An azygos anterior cerebral artery was visualized on the right and left carotid angiograms. The aneurysm was situated at the distal end of the azygos artery. The azygos artery was confirmed at the operation and the aneurysmal neck was wrapped without any serious deficit. Case 2 was a 60year-old male. He was suddenly seized with a headache and soon became unconscious. He was immediately hospitalized and a CT scan demonstrated a subarachnoid hemorrhage. The left carotid angiography with contralateral compression revealed an azygos artery and an aneurysm in its proximal portion. The azygos artery was confirmed at the operation and the aneurysmal neck was wrapped. After the operation, however, he developed mutism, paresis of the lower extremities and urinary incontinence. Frequent association of the azygos artery with aneurysm may suggest congenital factors in the development of cerebral aneurysms. From an anatomical point of view, circulatory disturbances followed by brain damage may develop in bilateral cerebral hemispheres by clipping the azygos anterior cerebral artery aneurysm. Therefore, care should be taken to avoid such a risk in operations.