Intracranial Aneurysms and Arteriovenous Malformation in the Right Anterior Cerebral Artery

Introduction It is a rare occurrence for multiple distal anterior cerebral artery aneurysms (DACA) to coexist with an arteriovenous malformation (AVM) on the same vessel in the brain. Here we present a case of an intracranial AVM in the right frontal lobe with multiple aneurysms along right anterior cerebral artery. Methods This case report was prepared in accordance with the CARE (CAse REport) guidelines to ensure clarity and transparency. Patient information was collected through review of medical records, clinical examination, and relevant imaging studies. Result/ Case History A 43‐year‐old woman developed sudden onset severe headaches accompanied by vomiting. CT brain (plain) revealed subarachnoid hemorrhage and CT angiography showed multiple saccular aneurysms along distal anterior cerebral artery (DACA). Digital subtraction angiography (DSA) confirmed multiple aneurysms along right ACA, along with an arteriovenous malformation (AVM). Right A2 ACA aneurysm measured 5.62mm in depth and 5.40mm in width, while the A2‐A3 ACA junction aneurysm was 7.43mm by 4.09mm, with multiple smaller aneurysms along the A3 ACA segment. Repeat DSA four months later showed persistent aneurysms with decreased flow through the AVM. The decreased flow was felt to be due to arterial steal to the contralateral side, secondary to AVM's high resistance shunt. She underwent successful coiling of the A2 ACA and A2‐A3 ACA junction aneurysms and showed no new postoperative neurological deficit. Conclusion DACA aneurysms are usually small and broad‐based. Their concomitant presentation with an AVM is an anatomic rarity, which makes the simultaneous treatment of such lesions particularly challenging. image image