A case of distal accessory ACA ruptured aneurysm treated at 6 years after onset

Seiji Tajiri; Yutaka Ueda; Shu Hasegawa; Masaki Miura; Akitake Mukasa

doi:10.3995/jstroke.10742

December 9, 2019NosotchuOpen Access

A case of distal accessory ACA ruptured aneurysm treated at 6 years after onset

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Key Points

To describe a rare case of a ruptured distal accessory anterior cerebral artery aneurysm that went undetected at initial presentation and was surgically treated six years later.
Reviewed the clinical course, diagnostic imaging, and surgical outcomes of a 77-year-old female who presented with faint interhemispheric subarachnoid hemorrhage of unknown origin.
Conducted long-term outpatient imaging follow-up including magnetic resonance angiography (MRA), followed by craniotomy clipping upon delayed aneurysm detection.
Initial acute evaluations failed to detect the bleeding source due to faint hemorrhage volume, small aneurysm size, cerebral vasospasm, and restricted imaging coverage.
Routine MRA six years post-onset identified a saccular aneurysm in the distal accessory anterior cerebral artery without any interim re-rupture, which was successfully clipped.

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Implication

Case report reports successful clipping of a ruptured distal accessory anterior cerebral artery aneurysm six years post-bleed, highlighting diagnostic challenges in peripheral lesions.

Abstract

要旨：脳動脈瘤破裂後，長期間が経過して出血源の動脈瘤を手術したくも膜下出血例は稀であり，初診時に動脈瘤が見落とされた経緯が教訓的でもあり，報告する．症例は77 歳女性．突然の頭痛で発症し，4 日後に受診．CT で大脳縦裂間に薄いくも膜下出血を認めた．出血源検索を繰り返し施行したが同定できず，出血源不明のくも膜下出血と診断した．その後，外来で定期的に画像フォローをしたが，出血源は確認できなかった．発症6 年後，偶然にもMRA で前大脳動脈末梢部に囊状動脈瘤を指摘した．発症時の画像を再検証し，同部位を出血源と診断し，開頭クリッピング術を施行した．本症例は，SAH の分布が少量で不明瞭，末梢の小さな動脈瘤，脳血管攣縮，画像検査が不十分などから，初回入院時に破裂動脈瘤が見落とされたが，6 年間再破裂なく経過し出血源を処置できた稀な症例である．3DCTA やMRA のみの画像検査では，特にdistal ACA の動脈瘤は見落とされる可能性があり，撮像範囲が限定されていないかにも注意を要する．

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Tajiri et al. (2019) studied this question.

synapsesocial.com/papers/6a96c21576292a5bc0fbb74e https://doi.org/10.3995/jstroke.10742

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A case of distal accessory ACA ruptured aneurysm treated at 6 years after onset

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A case of distal accessory ACA ruptured aneurysm treated at 6 years after onset

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