Berry Aneurysms Research Articles

Branching and nonbranching intracranial aneurysms in the presence of a persistent stapedial artery and an aberrant internal carotid artery assessed with computational hemodynamics: illustrative case.

The mechanisms underlying the initiation and progression of bifurcation versus lateral wall aneurysms are not well understood. Computational fluid dynamics (CFD) can improve the understanding of these mechanisms and can consequently help identify patients at higher risk for developing aneurysms and monitor them more closely. A 36-year-old man presented with a ruptured anterior communicating artery aneurysm, which was successfully treated with microsurgical clipping. Imaging also revealed a persistent stapedial artery with an elongated and tortuous posterior communicating artery (PComA). Fourteen years later, he was readmitted for a ruptured aneurysm on a PComA loop. CFD helped identify considerable collateral circulation due to the aberrant internal carotid artery (ICA). High flow rates trigger both types of aneurysms, but nuances exist in the hemodynamic mechanisms that drive their growth. Berry aneurysms and lateral wall aneurysms initially start due to a high flow rate, a common underlying cause. However, the formation of true sidewall aneurysms is primarily characterized by locally increased wall shear stress, while the development of berry aneurysms is mainly linked to high local blood pressure at arterial bifurcations. An aberrant ICA can lead to supraphysiological compensatory flow in the anterior and posterior circulation, increasing the risk of intracranial aneurysm formation at both branching and nonbranching sites, underscoring the need for lifelong monitoring. https://thejns.org/doi/10.3171/CASE24421.

Multi-slice CT angiography of a ruptured MCA bifurcation berry aneurysm: Clinical images

Multi-slice CT angiography of a ruptured MCA bifurcation berry aneurysm: Clinical images

Ruptured Intracranial Vascular Aneurysm with Subarachnoid Haemorrhage: Autopsy Case Series and Literature Review

Background: Subarachnoid haemorrhage (SAH) is a severe condition where bleeding occurs in the subarachnoid space surrounding the brain. SAH can be caused by a ruptured aneurysm or head injury leading to a stroke (with associated disability or death). Common symptoms include severe (thunderclap) headache, neck pain, nausea, vomiting, and sensitivity to light. Case Presentations: Firstly, a 58-year-old man presented with a history of severe headaches and inability to use the left side of his body, with a possible hemorrhagic right-sided hemispheric stroke diagnosis. Following death, an autopsy revealed a ruptured intracranial Charcot Bouchard aneurysm, with SAH as the cause. Secondly, a 35-year-old woman presented with a sudden loss of consciousness and three episodes of generalised tonic-clonic convulsion during a coital activity at a guest house. Following death, an autopsy revealed a ruptured middle cerebral artery’s saccular (berry) aneurysm, causing SAH with bilateral tonsillar herniation as the cause. These case series highlight the importance of autopsy in diagnosing SAH.

Spontaneous thrombosis of unruptured berry aneurysm presenting as facial palsy

Spontaneous thrombosis of saccular unruptured intracranial aneurysm (UIAs) is a known occurrence in giant aneurysms. However, spontaneous complete or partial thrombosis of non-giant aneurysms is a rare event in the natural history of UIAs that can be discovered incidentally on advanced neuroradiologic studies. They occasionally present with ischemic stroke, which is rare entity. Parent artery occlusion due to local extension of the luminal thrombus, aneurysms ejecting emboli to distal arteries, or increased mass effect have been described as possible pathogenic mechanisms. Guidelines for the management of these patients were limited. We present a documented case of this unusual entity a case of non-giant intracranial aneurysm with spontaneous thrombosis presenting as Upper motor neuron type of facial palsy due to acute ischemic stroke.

Traumatic basal subarachnoid haemorrhage

Traumatic basal subarachnoid haemorrhage (TBSAH) refers to a severe basal centred bleed, almost invariably resulting from a micro-tear or in exceptional circumstances a more lengthy dissection of the intracranial vertebrobasilar arterial system. This is typically caused by an impact to the side of the upper neck, angle of jaw and/or ear/mastoid region. TBSAH is typically associated with an immediate comatose state, often accompanied by the intervention of cardiorespiratory arrest. Delayed presentations are rare but do occur and may be related to dissections or traumatic false aneurysms. The forensic approach to cases of suspected TBSAH can be a very rewarding exercise if carried out with due diligence and technique as this may yield evidence informative on (i) any predisposing vasculopathy enhancing susceptibility to tearing, (ii) whether undue force was implicated and (iii) incontrovertible, pathognomonic evidence of a mechanical basis of rupture confirming overstretching of the vessel, thus ruling out natural disease such as a berry aneurysm. The main focus of this presentation will be to discuss optimum techniques addressing these issues. Whilst the source of haemorrhage is intracranial, best practice includes examination of the extracranial vertebral arteries which does not need to be an onerous task.

A Retrospective Cohort Study of Cerebrovascular Fibromuscular Dysplasia

Fibromuscular dysplasia (FMD) is a rare vasculopathy for which limited data are available particularly from Europe. Our aim was to study the clinical characteristics of a regional cohort of carotid fibromuscular dysplasia patients to assess their clinical outcomes and the rate of vascular complications. A retrospective cohort study of all cases of carotid/cerebrovascular FMD presenting to our regional vascular service (catchment population approximately 2 million), between 1998 and 2020. Imaging reports and patient case notes were screened using the keywords "FMD", "Fibromuscular Dysplasia", and "carotid". From case-note and imaging review, all relevant clinical data were extracted and the anatomical extent of vascular disease recorded. Eighty six patients with a diagnosis of cerebrovascular fibromuscular dysplasia were identified on imaging (31 computed tomography angiography, 46 magnetic resonance angiography, and 9 digital subtraction angiography) by a neurovascular radiologist. The mean age was 64years, 78 (90%) patients were female, and 45/59 (75%) were Caucasian. Presenting clinical syndromes were Stroke/transient ischemic attack in 54 (63%) patients, symptomatic intracranial aneurysm in 6 (10%), and other neurological symptoms (headache/migraine, tinnitus) in 14 (16%), with 11 (13%) presenting incidentally. Six patients (7%) had a positive family history of FMD (2 patients) or other cerebrovascular event (4 patients: carotid dissection, intracerebral bleed, or stroke). Eight patients (9%) had a known or suspected hereditary connective tissue disorder (2 Ehlers-Danlos syndrome). Involved vessels were as follows: Carotid (mainly extracranial) in 79 (92%), vertebral 19 (22%), and a combination of these in 15 (17%) patients. Fifty eight (67%) patients had bilateral disease. Cerebrovascular complications were observed in 35 (41%) patients as follows: carotid dissection 11 (23%), carotid stenosis or occlusion 8 (9%), carotid aneurysm 8 (9%), cerebral aneurysm 9 (11%), vertebral aneurysm/dissection 2 (2%), and carotid-cavernous fistula 2 (2%). Of the 22 patients who had extracranial imaging, 14 (60%) had FMD affecting other beds-renal artery in 8 (36%) patients, other visceral arteries in 4 (18%), and aorta in 2 (9%). In addition, 4 (18%) patients had aneurysm or dissection affecting renal, splenic, and lower limb arteries. Overall, 67 (80%) patients had FMD affecting more than 1 vessel and 50 (58%) had multisite FMD (>/=2 vascular beds involved). Fifty nine (68%) patients were managed conservatively on close surveillance. Nineteen (21%) patients required carotid/cerebrovascular intervention and 9 (10%) required vascular intervention at other sites. Recurrent cerebrovascular events (stroke/transient ischemic attack, symptomatic Berry aneurysm) were seen in 20 (23%) patients. Overall mortality was 7% over a median follow-up period of 47months. Carotid FMD patients have a high rate of multisite involvement, extracerebral vascular complications, and evidence of hereditary vasculopathy, requiring careful screening and surveillance.

Multidisciplinary Management of Alagille Syndrome.

Alagille syndrome (ALGS) is an autosomal dominant disorder characterized by involvement of various organ systems. It predominantly affects the liver, skeleton, heart, kidneys, eyes and major blood vessels. With myriads of presentations across different age groups, ALGS is usually suspected in infants presenting with high gamma glutamyl transpeptidase cholestasis and/or congenital heart disease. In children it may present with decompensated cirrhosis, intellectual disability or short stature, and in adults vascular events like stroke or ruptured berry aneurysm are more commonly noted. Liver transplantation (LT) is indicated in children with cholestasis progressing to cirrhosis with decompensation. Other indications for LT include intractable pruritus, recurrent fractures, hepatocellular carcinoma and disfiguring xanthomas. Due to an increased risk of renal impairment noted in ALGS, these patients would require optimized renal sparing immunosuppression in the post-transplant period. As the systemic manifestations of ALGS are protean and a wider spectrum is being increasingly elucidated, a multidisciplinary team needs to be involved in managing these patients. Moreover, many basic-science and clinical questions especially with regard to its presentation and management remain unanswered. The aim of this review is to provide updated insights into the management of the multi-system involvement of ALGS.

Analysis of Risk Factors for Anterior Communicating Artery Aneurysm Rupture: A Single-Center Study

Congenital hypoplasia or aplasia of the A1 segment of the anterior cerebral artery is associated with an increased incidence of berry aneurysms at the anterior communicating artery (ACoA) complex. We analyzed the factors contributing to ACoA aneurysm rupture. We retrospectively analyzed the data of patients with ACoA aneurysms who had undergone cerebral angiography from July 2008 to January 2020. The risk factors for rupture were identified using univariate and multivariate logistic regression models. We used the imaging data of patients without intracranial aneurysms as the control population. We confirmed 253 aneurysms in 253 patients, including 137 men (54.2%) and 116 women (45.8%), with a mean age of 54.6 ± 12.7 years. Of the 253 aneurysms, 218 (86.2%) were ruptured and 35 (13.8%) were unruptured, with a mean diameter of 4.56 ± 1.96 mm and 3.24 ± 1.79 mm, respectively. Of the 253 aneurysms, 176 (69.6%) were <5 mm in diameter, 146 (83%) of which were ruptured. Of the 253 patients, 141 (55.7%) exhibited A1 segment hypoplasia or aplasia: 106 (41.9%) on the right side of the circle of Willis and 35 (13.8%) on the left. Multivariate logistic regression analysis identified the aneurysm diameter (odds ratio, 4.11; 95% confidence interval, 1.601-16.07; P= 0.003) and age <65 years (odds ratio, 0.17; 95% confidence interval, 0.062-0.48; P < 0.001) as independent predictors of rupture. ACoA aneurysms are small (<5 mm) and have a high risk of rupture. A1 segment hypoplasia or aplasia is a risk factor for ACoA aneurysm formation; however, it was uncorrelated with aneurysm diameter or rupture risk. The strongest independent risk factors for rupture were age <65 years and aneurysm diameter.

Internal Carotid Artery Blister Aneurysm: Review of Endovascular Techniques

AbstractCerebral blister aneurysms are very difficult vascular lesions in terms of accurate diagnosis as well as proper management strategy for vascular neurosurgeons and neurointerventionists. Histopathological analysis has revealed their nature to be more akin to pseudoaneurysms in comparison to the typical berry aneurysms. This explains their fragile nature, with high probability of rerupture and regrowth during the follow-up if not addressed properly. Even though surgical approaches have evolved over the years to minimize intraprocedural rupture and recurrence, they still have relatively high morbidity as well as mortality in comparison to endovascular treatment. Over the last few years, endovascular treatment has evolved significantly, with introduction of new devices and techniques. Focus of the endovascular management has shifted from the deconstructive techniques to reconstructive ones with parent artery preservation. Recent introduction of flow diverter technology has enabled neurointerventionists to manage these difficult lesions with more confidence in terms of avoiding rerupture and recurrence. Flow diverter (FD) use in blister aneurysm resulted in high-technical success, complete aneurysm occlusion, and less complications in comparison to other reconstructive techniques like simple coiling, stent assisted coiling, and overlapping/monotherapy stent placement. Few debatable issues like use of dual antiplatelets in the setting of acute subarachnoid hemorrhage (SAH), timing of drugs in relation to procedures, single/overlapping devices, and concerns during cerebral vasospasm phase need further detailed analysis and standardized protocols. In this article, we have done a review of different endovascular treatment options in the management of internal carotid artery blister aneurysms with special focus on FD and issues related to it.

Pericallosal berry aneurysm associated with azygous anterior cerebral artery – a case report

Introduction. Azygos anterior cerebral artery is a rare variant of the anterior segment of the circle of Willis caused by an unusual fusion of the normally paired A2 segments of the anterior cerebral artery (ACA). Despite its rare occurrence, it is associated with various vascular and structural cerebral abnormalities, particularly berry aneurysms. Aim. We aimed to present a case of a 41-year-old female patient who presented to our neurology department with complaints of headache. Description of the case. She had a positive paternal history of aneurysmal subarachnoid hemorrhage. Magnetic resonance angiography (MRA) of her brain revealed an azygos ACA (bifurcating into two pericallosal arteries) which was associated with a saccular aneurysm at its bifurcation point. She was referred to the interventional radiology department for preventive endovascular treatment. Conclusion. Azygos ACA carries a high risk of aneurysm development and its occlusion can potentially compromise blood supply to both cerebral hemispheres. It is therefore crucial for clinicians to be aware of its significance and to report its presence in angiographic studies.

An Overview on the Role of MRI in Diagnosis and Management of Berry Aneurysm

Berry aneurysms are also known as saccular aneurysms are pathological dilatations of intracerebral arteries, that are typically located within the anterior circulation of the brain. the exact etiology of their formation is still enigmatic, but it&rsquo;s postulated to be multifactual, through an interplay between familiar disposition, environmental factors, and degenerative processes. They are approximately found in around 3% of the general population. But the majority of cases are asymptomatic

Surgical management of Coarctation of the Aorta in the Pediatric Population: A fifteen-year experience

Coarctation of the aorta is one of the most commonly encountered congenital heart defects (CHD), in the pediatric population. It is defined as a hemodynamically significant stenosis of the descending aorta, typically at the site of insertion of ductus arteriosus. It has an estimated incidence of 4-6 cases per 100,000 births, accounting for 5-8% of all congenital heart defects [1-4]. According to The New England Regional Infant Cardiac Program (NERICP), coarctation of the aorta is the fourth most common defect requiring surgery during the first year of life [5]. It can present as an isolated lesion or coexist with other cardiac or extra-cardiac congenital defects. The most common one include bicuspid aortic valve, patent ductus arteriosus, ventricular septal defect, mitral stenosis, berry aneurysms in the circle of Willis [6-8]. Clinical presentation is heterogenous, varying from asymptomatic to congestive heart failure, acute pulmonary edema and cardiogenic shock, depending on the degree of coarctation, the development of collateral circulation and age at presentation [9]. During the neonatal period patients may present with circulatory collapse and pulmonary edema, reduced or absent peripheral pulses, tachypnea, lethargy and progressive metabolic acidosis [9-13]. In early childhood, they present primarily with symptoms of congestive heart failure (CHF) including tachypnea, irritability, sweating, feeding difficulties and failure to thrive [9-13]. In adolescence and adulthood patients may be asymptomatic, presenting with non-specific symptoms including exercise intolerance, fatigue and cramps in the lower limbs, recurrent headaches, epistaxis, vertigo, tinnitus, high blood pressure and difference in blood pressure between arms and legs and reduced or absent peripheral pulses [9-13]. Treatment options for coarctation of the aorta include both surgery and catheter-based procedures. Several surgical techniques have been developed including extended resection with end-to-end anastomosis, prosthetic patch aortoplasty, subclavian patch aortoplasty, interposition grafting and extraanatomic bypass grafting [9-11,13-18]. Catheter-based approaches include balloon angioplasty and stenting. The choice is based on the age at presentation, the type of coarctation, and the presence of associated anomalies, as well as other patient-specific characteristics.

Rupture of Berry Aneurysm -A Preventable Fatality

Berry aneurysm is one of the commonest cause of subarachnoid haemorrhage commonly seen in bifurcation sites of circle of Willis. Unruptured aneurysms are asymptomatic and are usually missed unless suspected, even with radiological methods. Common risk factors include Autosomal Dominant Polycystic Kidney Disease (AD-PKD), smoking, hypertension, connective tissue disorders etc.

A case of fatal intracranial haemorrhage due to ruptured berry aneurysm

Background: Sudden unexplained deaths in consequence of cerebral causes in adults are a critical section of the medicolegal practice. Berry aneurysms are eminent entities that cause a serious medical condition, like a haemorrhagic stroke, which leads to brain damage and may account for a quarter of cerebrovascular deaths. These aneurysms arise no symptoms for a protracted period or could rupture and bring out intracranial haemorrhage and sudden natural death, thus arousing suspicion. Aim of the study: This case highlights one of the causes of sudden natural death due to cranial haemorrhage. Methods: Our case was male 40 years old was found dead on the floor of the bathroom in his home. He has no history of smoking or medical record with an average body built, no risk factors were found. The prosecution report stated that the manner of death was unexplained. The case had undergone full external examination and X-ray for the whole body then medicolegal autopsy. Laboratory investigations were done to show if there was any drug was taken to assist or cause death. We had reviewed the literature concerning the case and attempted to confirm the legal scenario. Results: On external examination, abrasion was found on the nose and knee. The xray didn’t demonstrate any fractures or foreign body. Urine drug screen revealed negative results for the drug of abuse. The autopsy showed rupture of berry aneurysm at the circle of Willis which and subarachnoid haemorrhage in addition to intraventricular and pontine haemorrhages. Conclusions: Meticulous examination of such cases could lead to a more precise task of the reason for death, which may have significant implications for surviving family members, and could initiate a better comprehension of the natural history of these intracranial lesions. Keywords: Aneurysm; Circle of wills; Intracranial haemorrhage; Sudden death; Hypertension.

Il paziente con rene policistico negli ambulatori italiani

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease. PKD is a multisystem disorder associated with multiple bilateral renal cysts, slowly increasing kidney size and progressive chronic kidney disease. Approximately 50% of individuals with PKD will require renal replacement therapy by the sixth decade of life. More than 80% will also have multiple liver cysts, which can lead to local pressure effects. Cerebral haemorrhage, secondary to rupture of a berry aneurysm, occurs in up to 8% of individuals. Mitral valve prolapse occurs in up to 25% of patients. Patients with ADPKD have a worsening in the quality of life and a burden of disease similar to cancer patients. The quality of correct information given to patients and a warm reception have a positive impact on patients with ADPKD and contribute to an efficacious treatment program. AIRP conducted a survey to investigate the ADPKD patient journey, meaning the personal experience and expectations of people regarding factors such as disease management, relationships with the nephrologists and their team, and therapies. The survey was conducted on 370 people with ADPKD, using computer-assisted web interviewing (CAWI). The results show that patients with ADPKD with a good relationship with their care team, both nephrologist and nurse, respond better to therapies. Warm reception, dialogue, communication, support, clear explanation, reassurance and guidance altogether contribute to a successful treatment of every single person with ADPKD.

Il paziente con rene policistico negli ambulatori italiani

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease. PKD is a multisystem disorder associated with multiple bilateral renal cysts, slowly increasing kidney size and progressive chronic kidney disease. Approximately 50% of individuals with PKD will require renal replacement therapy by the sixth decade of life. More than 80% will also have multiple liver cysts, which can lead to local pressure effects. Cerebral haemorrhage, secondary to rupture of a berry aneurysm, occurs in up to 8% of individuals. Mitral valve prolapse occurs in up to 25% of patients. Patients with ADPKD have a worsening in the quality of life and a burden of disease similar to cancer patients. The quality of correct information given to patients and a warm reception have a positive impact on patients with ADPKD and contribute to an efficacious treatment program. AIRP conducted a survey to investigate the ADPKD patient journey, meaning the personal experience and expectations of people regarding factors such as disease management, relationships with the nephrologists and their team, and therapies. The survey was conducted on 370 people with ADPKD, using computer-assisted web interviewing (CAWI). The results show that patients with ADPKD with a good relationship with their care team, both nephrologist and nurse, respond better to therapies. Warm reception, dialogue, communication, support, clear explanation, reassurance and guidance altogether contribute to a successful treatment of every single person with ADPKD.

Endovascular management of pediatric neurovascular malformations – A single?center experience from South India

Background: Neurovascular malformations (NVMs) in pediatric population are highly challenging to manage and treatment options include open surgery, endovascular therapy, and radiosurgery or combined. Recently, there has been a gradual shift from conventional surgical approach toward endovascular therapies with increasing availability of technical expertise and gadgetry. Objective: We aimed to study the clinical profile and immediate outcome of children with NVMs, who underwent endovascular therapy. Materials and Methods: This retrospective observational study was conducted in a tertiary care center in South India between February 2017 and August 2018. We included children admitted in pediatric intensive care unit (PICU) with NVM and needed neuroradiological intervention. Children with thromboembolism or other NVMs who did not require intervention were excluded from the study. Data on clinical profile, endovascular procedure done, supportive therapy given, and immediate outcome were collected and analyzed. Results: Of 1615 children admitted in PICU, 13 had NVM (0.8%), of which five had arteriovenous malformation (AVM), three had vein of Galen arteriovenous malformation (VGAM), one had VGAM with dural AVM, one had acquired carotid-cavernous fistula, two had berry aneurysm, and one had mycotic aneurysm. VGAM presented as hydrocephalus, whereas AVM and aneurysm as intracranial hemorrhage. Endovascular embolization was done using platinum detachable coils, onyx, N-butyl cyanoacrylate glue, and coil assist stents. One child needed decompressive craniectomy and another child needed extraventricular drainage. Four children needed pre-procedure ventilation and seven children needed prolonged post-procedure ventilation. Mortality was 15%; and among the survivors, 72% had an uneventful recovery. One child had seizures and two had hemiparesis at discharge. Conclusion: Endovascular management is an effective intervention for pediatric NVM. Multidisciplinary team approach and good pediatric intensive care are important for successful outcome. Further studies with long-term follow-up are needed to assess the durability of endovascular therapy.

Forbidden Fruit: Some Berry Aneurysms Might Best Be Left Alone.

Forbidden Fruit: Some Berry Aneurysms Might Best Be Left Alone.

Genetics of Intracranial Aneurysms.

Intracranial aneurysms (IAs) are localized dilatations of intracranial arteries that are because of weaknesses of the endothelial layer. These dilations vary in size (small aneurysms, 25 mm) and are classified according to their shapes: either localized sac-like pouches or long dilatations that increase the vessels diameter; these shapes are referred to, respectively, as saccular or berry aneurysms and fusiform aneurysms. Most IAs are saccular and typically occur at the arterial branching sites of the circle of Willis. Common sites of saccular IAs include the anterior communicating artery, the posterior communicating artery, internal carotid artery, the middle cerebral artery, and the basilar artery bifurcation. Although the exact pathogenesis of IA remains to be established, several hypotheses have highlighted the contribution of maladaptive vascular remodeling triggered by hemodynamic stress and inflammatory response1—a chain of events that would ultimately damage blood vessel walls and lead to IA. The worldwide prevalence of IA is estimated to be ≈3.2%.2 Subarachnoid hemorrhage (SAH) accounts for ≈5% of all strokes, and 85% of SAHs are because of aneurysmal ruptures. SAH has an incidence rate of 9 per 10 000 persons per year and a fatality rate ≈50%.3 The incidence of SAH is markedly higher in the Finnish and Japanese populations, but surprisingly, this is not because of the prevalence of IA in these populations.2 The most common clinical symptoms of aneurysmal SAH are a sudden onset of severe headache with stiff neck, vomiting, and photophobia. Unruptured IAs are usually asymptomatic and are identified through the screening of high-risk individuals or as incidental findings of magnetic resonance imaging, particularly magnetic resonance angiogram, or computerized tomographic studies. The diagnosis of IA is made by magnetic resonance angiogram, computerized tomographic angiography, or classical angiography. The diagnosis of …

Post-Partum Reversible Cerebral Vasoconstriction Syndrome Associated with Coronary Vasospasm

Objective: To report the first case of reversible cerebral vasoconstriction syndrome (RCVS) diagnosed when reversible cardiac wall motion akinesia was observed after the administration of atropine in a 28-year-old lady presenting 4 weeks post-partum with a 2-week history of thunderclap headache. Case presentation: We present a case of a 28-year-old lady, who presented to the American University of Beirut Medical Center, with a history of migraine with visual auras and peri-partum pituitary hyperplasia, presenting 4 weeks postpartum with a 2-week history of thunderclap headache. Results: RCVS comprises a group of diseases characterized by reversible focal segmental narrowing of cerebral vessels, usually accompanied by thunderclap headache and sometimes focal neurological deficits. Conclusion: Several case reports and case series have described the association of this disorder with vascular manifestations outside the cerebral vasculature, including dissection of both external and internal branches of the carotid arteries, unruptured saccular berry aneurysms and fibromuscular dysplasia of the extracranial internal carotid artery (ICA). In this short report we describe a patient with reversible cerebral vasoconstriction associated with reversible cardiac wall abnormalities.