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Case Reports
. 2015 Feb;21(1):55-60.
doi: 10.15274/inr-2014-10107.

Carotid rete mirabile associated with subarachnoid hemorrhage from intracranial aneurysm: A case report and systematic review

Eric Homero Albuquerque Paschoal  1 , Vitor Nagai Yamaki  2 , Fernando Mendes Paschoal Júnior  2 , Ronie Leo Piske  3 , Manoel Jacobsen Teixeira  4 , Edson Bor-Seng-Shu  4
Affiliations
Case Reports

Carotid rete mirabile associated with subarachnoid hemorrhage from intracranial aneurysm: A case report and systematic review

Eric Homero Albuquerque Paschoal et al. Interv Neuroradiol. 2015 Feb.

Abstract

Carotid rete mirabile (CRM) is a rare physiological vascular network in humans that is most often found in Eastern populations. This paper describes a CRM associated with an aneurysmal subarachnoid hemorrhage (aSAH) and discusses the details of the patient's treatment. A 28-year-old woman was admitted to our service with clinical signs and symptoms of a spontaneous aSAH. Computed tomography revealed a diffuse and extensive SAH (Fisher group IV), while an angiogram showed an abnormal collateral network in the right carotid system and a hypoplastic aspect to the internal carotid artery (ICA) on the same side. In addition, a saccular aneurysm with a diameter of 9.5 mm was present in the ophthalmic segment of the left ICA. This case is extremely uncommon. To avoid rebleeding in the patient, we successfully treated the patient by clipping the aneurysmal lesion. No procedure was performed for the CRM.

Keywords: Cerebrovascular disorders; case report; collateral circulation; subarachnoid hemorrhage.

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Figures

Figure 1.
Figure 1.
A) Vessel angiogram demonstrating external and internal carotid arteries with a rete mirabile-type network compensating for segmental hypogenesis of the epidural horizontal segment of the right internal carotid artery (5th segment), promoting reconstitution of the distal siphon through collateral branches from the maxillary artery. This phase shows an early injection in the angiogram study at the right internal carotid artery. B) Late phase angiogram study demonstrating distal branches from the internal carotid artery.
Figure 2.
Figure 2.
Berry aneurysm located on the left side of the ophthalmic segment of the internal carotid artery over the upper surface of the arterial vessel.
Figure 3.
Figure 3.
Axial view of the skull base with CT demonstrating absence of the right carotid canal.
See this image and copyright information in PMC

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