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Neuroradiology Case of the Week

Case 178

Uchendu Azodo, MD and Henry Wang, MD, PhD

Clinical Presentation: A 54 year-old man presents with left-sided hemiparesis.

Radiological Findings:

Diagnosis: Multiple cerebral aneurysms

Discussion: It is not clear what leads to the development of a cerebral aneurysm. They are uncommon in patients below 20 years of age but increase with age. In people over 65 years of age, aneurysms can be found in a small percent of the asymptomatic population. It appears that an aneurysm is related to the absence of a muscular layer that makes up part of the blood vessel wall, and that over time an aneurysm will develop due to stretching and thinning at the junction between two vessels.  Smoking appears to be associated with the development of cerebral aneurysms.
     Unruptured aneurysms are generally asymptomatic. If there is rupture, blood extends into the subarachnoid space and this is associated with sudden onset of severe headache and has a high morality rate. Complications of aneurysmal bleeding are vasospasm, hydrocephalus, herniation, death, and posterior communicating artery aneurysm which can cause mass effect even if not ruptured.
     There are two treatment options for a cerebral aneurysm. One is surgical clipping and the other one is endovascular embolization. The traditional treatment is clipping, but endovascular approaches are gaining acceptance because of lower morbidity. Endovascular treatment is done by navigating a small tube or catheter into the aneurysm and then depositing platinum coils into the aneurysm.

References:

1. Piel-Spellman J. Cerebral aneurysms. http://cpmcnet.columbia.edu/dept/cerebro/Aneurysm.htm
2. Liebeskind DS. Cerebral aneurysms. http://www.emedicine.com/NEURO/topic503.htm