Oculomotor Nerve Palsy in a Patient with a Ruptured Middle Cerebral Artery Aneurysm

We describe a case of acute oculomotor nerve palsy caused by a ruptured middle cerebral artery (MCA) aneurysm. A 59-year-old female presenting with headache and nausea was admitted to our hospital. Her consciousness was alert, and had no other neurological deficit without left oculomotor nerve palsy. A computed tomography (CT) showed SAH extending from left sylvian cistern to basal cistern. CT angiography revealed a left MCA aneurysm which protruded toward internal carotid artery. The patient was successfully treated with surgical clipping. The oculomotor nerve palsy resolved immediately after the surgery. Perioperative radiological evaluation revealed that there were no evidence of midbrain hemorrhage or stroke, vessel anomaly of basilar, posterior cerebral or superior cerebellar artery, vasospasm, and uncal herniation. Furthermore, intraoperative findings revealed that the aneurysm was projected toward the affected carotid cistern and oculomotor nerve. From these findings and time course of oculomotor nerve palsy, it is suggested that the jet flow of bleeding from the ruptured MCA aneurysm caused oculomotor nerve palsy in the patient

Symptomatic regrowth of a small intracranial aneurysm that had ruptured and completely thrombosed: a case report

We report a case of small internal carotid–posterior communication artery (IC–PC) aneurysm that was completely thrombosed after initial bleeding, but subsequently became symptomatic, causing a mass effect. A 54-year-old woman initially presented with grade-five subarachnoid hemorrhage from a small right IC–PC aneurysm. The aneurysm was treated conservatively and completely thrombosed within 35 days. The patient slowly recovered and remained well until 4 years later, when she developed right oculomotor nerve palsy. Imaging revealed relapse of the aneurysm, and repair led to symptom resolution. This case offers a reminder that totally thrombosed aneurysms carry a risk of regrowth if left untreated

Partially thrombosed giant aneurysm arising from a distal anterior inferior cerebellar artery–posterior inferior cerebellar artery variant: A case report

Anterior inferior cerebellar artery (AICA)–posterior inferior cerebellar artery (PICA) is a well-known variant in cerebral arteries. However, aneurysms located on the variant are rare and a giant one has not been reported. We report a case of a partially thrombosed giant aneurysm arising from an AICA–PICA variant. The patient was a 42-year-old man who presented with right hearing loss and facial numbness associated with left hemidysesthesia. Magnetic resonance imaging revealed an approximately 3.0-cm mass lesion at the right cerebello-pontine angle (CPA). Angiography showed a partially thrombosed aneurysm arising from the right AICA–PICA. The aneurysm was treated with endovascular trapping and surgical thrombectomy. Although cerebral aneurysm is known to occur at this site, this case provides awareness, that manifestations of aneurysms in the CPA include progressive multiple cranial nerve palsies and sensory disturbance caused by brainstem compression

Is MRA at 3.0 Tesla sufficient for preoperative planning for aneurysmal clipping in patients with contraindicated condition of contrast media?

Background: We evaluated the possibility that 3.0 T MRA was sufficient for unique imaging modality before aneurysmal clipping in patients with contraindication to contrast media. Method: 13 cases (16 aneurysms) were retrospectively evaluated. Ruptured aneurysms were 3 cases (3 aneurysms). 10 cases (12 aneurysms) were operated on after preoperative evaluation using only 3.0 T MRA because of contraindication to contrast media, whereas both 3D-DSA/CTA and 3.0 T MRA were performed in 3 cases (4 aneurysms) before the operation because of each clinical reasons. In these 13 cases, we compared aneurysmal findings between intraoperative views and images of 3D-time of flight MRA with volume rendering at 3.0 T. Results: Compared to operative views, the shape of aneurysm including bleb in MRA tended not to be slightly sharp, but the size of neck and dome of aneurysms did not show significant differences. These discrepancies did not affect the intraoperative procedures. Regarding perforators, posterior communicating artery and anterior choroidal artery were confirmed in the operation as same view with MRA findings. It was difficult to distinguish double anterior communicating artery aneurysm by 3.0 T MRA. In thrombosed case, it was necessary to examine raw data of MRA as pretreatment planning tool in order to evaluate the extent of thrombus in aneurysmal neck. Reviewing the cases operated using only 3.0 T MRA retrospectively, there was no case that showed treatment planning by 3.0 T MRA was insufficient. Conclusions: This paper may suggest that treatment planning of aneurysmal clipping on the basis of 3.0 T MRA is feasible and an effective option for patients with contraindication to contrast media. Keywords: Aneurysm, Clipping, MRA, CTA, DSA, Contrast medi