Evolution from an Infundibulum of the Posterior Communicating Artery to a Saccular Aneurysm.
Summary of "Evolution from an Infundibulum of the Posterior Communicating Artery to a Saccular Aneurysm."
INTRODUCTION:
An infrequent case of a de novo aneurysm formation originating from an infundibulum at the origin of the posterior communicating artery (PcomA) is presented. The aneurysm developed within 7 years in a patient who initially presented with subarachnoid hemorrhage (SAH) from a saccular aneurysm of the vertebral artery. A 43-year-old female patient was admitted to our hospital on 16th June 2000 after an acute onset of massive occipital headache. A computed tomography (CT) scan showed a subarachnoid hemorrhage (SAH) around the brainstem and 4-vessel angiography revealed an aneurysm originating from the V4 segment of the right vertebral artery (VA) as the cause of the SAH. A small aneurysm at the basilar artery (BA)/superior cerebellar artery (SCA) bifurcation was also found. Injection of the left internal carotid artery (ICA) showed a diffuse enlargement at the origin of the left PcomA, which at this time was considered to be a so-called infundibulum. The VA aneurysm was treated by coil occlusion. Follow-up digital subtraction angiography (DSA) in 2005 showed a de novo aneurysm formation at the VA junction, again treated by coil occlusion. The PcomA infundibulum at the left ICA was not examined. Follow-up angiography performed in 2007 revealed a saccular de novo aneurysm of the left ICA arising from the origin of the left PcomA with a maximum diameter of 12 mm. Coil occlusion of the PcomA aneurysm was subsequently carried out.
CONCLUSION:
Infundibular widening of cerebral arteries can develop into true aneurysms. Mid-term and long-term follow-up MRI (e.g., in yearly intervals) is advised for infundibula with a diameter of 3 mm or more. In patients with other aneurysm(s), with a documented de novo aneurysm formation or with a familial occurrence of aneurysms, the risk of evolution of an infundibulum to a saccular aneurysm may be increased and follow-up should be even more stringent.
Affiliation
Klinik für Neuroradiologie, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
Journal Details
This article was published in the following journal.
Name: Clinical neuroradiology
ISSN: 1869-1447
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21140127
- DOI: http://dx.doi.org/10.1007/s00062-010-0038-1
Medical and Biotech [MESH] Definitions
Posterior Cerebral Artery
Artery formed by the bifurcation of the BASILAR ARTERY. Branches of the posterior cerebral artery supply portions of the OCCIPITAL LOBE; PARIETAL LOBE; inferior temporal gyrus, brainstem, and CHOROID PLEXUS.
Circle Of Willis
A polygonal anastomosis at the base of the brain formed by the internal carotid (CAROTID ARTERY, INTERNAL), proximal parts of the anterior, middle, and posterior cerebral arteries (ANTERIOR CEREBRAL ARTERY; MIDDLE CEREBRAL ARTERY; POSTERIOR CEREBRAL ARTERY), the anterior communicating artery and the posterior communicating arteries.
Vertebral Artery Dissection
Splitting of the vessel wall in the VERTEBRAL ARTERY. Interstitial hemorrhage into the media of the vessel wall can lead to occlusion of the vertebral artery, aneurysm formation, or THROMBOEMBOLISM. Vertebral artery dissection is often associated with TRAUMA and injuries to the head-neck region but can occur spontaneously.
Dyslexia, Acquired
A receptive visual aphasia characterized by the loss of a previously possessed ability to comprehend the meaning or significance of handwritten words, despite intact vision. This condition may be associated with posterior cerebral artery infarction (INFARCTION, POSTERIOR CEREBRAL ARTERY) and other BRAIN DISEASES.
Infarction, Posterior Cerebral Artery
NECROSIS induced by ISCHEMIA in the POSTERIOR CEREBRAL ARTERY distribution system which supplies portions of the BRAIN STEM; the THALAMUS; TEMPORAL LOBE, and OCCIPITAL LOBE. Depending on the size and location of infarction, clinical features include OLFACTION DISORDERS and visual problems (AGNOSIA; ALEXIA; HEMIANOPSIA).
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