gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Subarachnoid hemorrhage from rupture of an intracranial aneurysm in a 2-year-old boy: Case report and review of the literature

Meeting Abstract

  • M. Heckelmann - Klinik und Poliklinik für Neurochirurgie, Zentrum für Neurologie und Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main
  • A. Kern - Pädiatrische Intensivmedizin, Zentrum der Kinderheilkunde, Universitätsklinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • W. Schneider - Pädiatrische Intensivmedizin, Zentrum der Kinderheilkunde, Universitätsklinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • E. Güresir - Klinik und Poliklinik für Neurochirurgie, Zentrum für Neurologie und Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main
  • H. Vatter - Klinik und Poliklinik für Neurochirurgie, Zentrum für Neurologie und Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main
  • V. Seifert - Klinik und Poliklinik für Neurochirurgie, Zentrum für Neurologie und Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP13-10

DOI: 10.3205/09dgnc396, URN: urn:nbn:de:0183-09dgnc3964

Published: May 20, 2009

© 2009 Heckelmann et al.
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Outline

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Objective: Subarachnoid hemorrhage (SAH) caused by aneurysm rupture in childhood and adolescence is extremely rare. The prevalence is reported with 0.5% to 4.6%. Association to systemic vascular diseases is more common in this age group.

Methods: Here we report on a boy (210/12 years of age) who presented with SAH (WFNS class V; Fisher grade 3) due to rupture of an aneurysm. The literature is reviewed to give an up-to-date description and understanding of this rare entity.

Results: The boy with no known pre-existing illness presented with a sudden onset of headache, followed by loss of consciousness and repeated generalized tonic-clonic seizures. He was immediately admitted to the intensive care unit of a hospital of tertiary medical care. Here the child was intubated and SAH was diagnosed by cCT scan before it was referred to our neurosurgical department. The angiogram demonstrated a dysmorphic and fusiform broad based aneurysm involving the left ICA at the outlet of the MCA and its proximal M1 segment. There were no endovascular treatment options. The surgical treatment, which was performed promptly, consisted of right ventricular external drainage and operative ligation of the aneurysm by clipping with a micro-clip. Intraoperative angiography confirmed the complete closure of the aneurysm. The boy was admitted to the pediatric intensive care unit. The clinical situation stabilized until a re-bleeding occurred on the 21st postoperative day, which elicited emergency surgery. Intraoperatively, re-clipping of the very dysmorphic newly formed aneurysmatic bulging by tangential clip placement proved to be impossible, and as ultima ratio clipping of the aneurysm together with the thrombosed left MCA was performed keeping the anterior cerebral artery conserved. After stabilization the boy presented reduced muscular tonicity of the right extremities. He responded adequately in verbal communication when discharged to a rehabilitation clinic.

Conclusions: Compared to the devastating initial and consecutive hemorrhages complicated by infarction in the area of the MCA the neurologic deficit remained relatively mild. The dramatic course is very illustrative for this rare entity with respect to aneurysm morphology and site, the tendency to rebleed, and a remarkably fair outcome.