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Case Reports
. 2018 Jan-Mar;4(1):19-23.
doi: 10.4103/bc.bc_2_18. Epub 2018 Apr 18.

Mid A1 blister aneurysm presenting with subarachnoid hemorrhage: Case report and review

Gary B Rajah  1 , Dylan J Goodrich  1 , Leonardo Rangel-Castilla  2 , Sandra Narayanan  1
Affiliations
Case Reports

Mid A1 blister aneurysm presenting with subarachnoid hemorrhage: Case report and review

Gary B Rajah et al. Brain Circ. 2018 Jan-Mar.

Abstract

Blister aneurysms are uncommon and difficult-to-treat lesions. They are a substantial cause of morbidity and mortality when encountered. Here, we report a blister aneurysm of the mid A1 segment of the anterior cerebral artery presenting with diffuse basal subarachnoid hemorrhage (SAH). The aneurysm was treated by surgical clipping of the parent vessel. Postoperatively, there was no filling of the parent vessel or aneurysm. A treatment algorithm including direct surgical repair and flow diversion for ruptured blister aneurysms is described. A high level of suspicion should be maintained in the setting of angiographic-negative SAH with an asymmetrically diffuse pattern.

Keywords: Angiography; blister aneurysm; subarachnoid hemorrhage.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Presenting computed tomography head demonstrating diffuse subarachnoid hemorrhage eccentric to the left with hydrocephalus. (b) Preoperative anteroposterior angiogram demonstrating seemingly normal vasculature. (c) Magnified left anterior oblique view angiogram demonstrating small mid A1 blister aneurysm
Figure 2
Figure 2
(a) Intraoperative image demonstrating the left internal carotid artery and proximal A1 segment. The hemorrhagic adventitia of the A1 is visible; the blister aneurysm is within the clot on the posterior side of the vessel. During dissection in this area, intraoperative rupture occurred. (b) Intraoperative image with stacked mini permanent clips across the diseased A1 segment. Lateral (c) and anteriorposterior (d) right internatl carotid artery intraoperative runs demonstrating good bilateral flow through anterior cerebral artery territories from R A1, and no residual aneurysm or left A1 filling on left internal carotid artery run (white arrow)
See this image and copyright information in PMC

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