Article
Patient with two SAH from two different aneurysms, one of them a real de novo aneurysm – case report
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Authors
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Alexandros Iordanidis
- Siegen, Deutschland
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Veit Braun
- Siegen, Deutschland
| Published: | June 9, 2017 |
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Outline
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Introduction: We report of a meanwhile 48 years old woman who suffered from a SAH twice during the last 10 years. The first bleeding occurred in 2005 from an AComA aneurysm, the second one in 2015 from a de novo pericallosal aneurysm. Additional risk factors were a hypertension and a nicotine abuse.
Case Report: In 2005 the 1968 born patient suddenly suffered from severe headache and vomiting during skating, subsequently diagnosed as a SAH H & H II / Fischer II. Angiography revealed a 4 mm AComA aneurysm, which was clipped on the same day. 3 weeks later she could be discharged without neurological deficit. No other vascular malformations could be detected nor during her hospitalization, neither at control angiography one year later. At this time, the AComA aneurysm was totally occluded. 10 years later in 2015, the patient suffered from the same symptoms during her own wedding and collapsed. CAT scan revealed a interhemispheric SAH mainly in the corpus callosum area without basal SAH. CTA and DSA demonstrated a left side 3 mm pericallosal aneurysm with a direct contact to the hematoma, furthermore a 10 mm recurrent AComA aneurysm. The AComA aneurysm was occluded by coils, afterwards, the patient was transferred to the OR for open clipping of the pericallosal aneurysm. During surgery, it could be confirmed, that this aneurysm was the origin of the bleeding. 3 weeks later the patient was discharged for rehab in stable neurological conditions (modified Rankin score 2, Barthel index 85 / 100P.) with a slight left hemiparesis, which totally resolved 6 months later. The ultimate control angiography on august 22, 2016 showed a complete occlusion of both aneurysms. We did not find any evidence for a mycotic aneurysm disease.
Discussion: The present case is highly exceptional in several aspects. First, our patient is one of the few cases developing a de novo aneurysm, which subsequently ruptured. Second, a clipped aneurysm can relapse, even if the one year angiographic control does not show any pathology. Third, both ruptured aneurysms were smaller than 5 mm, especially the second bleeding did not originate from the bigger recurrent AComA aneurysm. As in coiled patients we recommend a yearly follow up for at least 10 years after clipping.
