Multiple Aneurysms of the PICA Communicating Artery : A Case Report and Review of the Literature

Abstract

We report a case of multiple aneurysms arising from an abnormal vessel connecting to the bilateral distal posterior inferior cerebellar artery (PICA communicating artery). A 71-year-old man presented with sudden onset of consciousness disturbance and respiratory failure. On admission, his level of consciousness was 200 in JCS, 4 in GCS (E1V1M2). Computed tomography (CT) without contrast material showed a subarachnoid hemorrhage with massive intraventricular hematoma predominantly in the fourth ventricle. Three-dimensional CT angiogram (3D-CTA) revealed 3 aneurysms at the distal PICA. After 2 weeks of management with a respirator, the patient recovered gradually. Sequential 3D-CTA disclosed enlargement of the aneurysms. The patient underwent suboccipital craniotomy. The right PICA was followed distally to identify two aneurysms at the communicating artery and an aneurysm at the cortical segment of the left PICA. The first aneurysm was clipped and the two distal aneurysms were resected. Pathological findings of the aneurysms were compatible with berry aneurysms. Postoperative course was uneventful with gradual improvement without development of hydrocephalus. The patient was transferred to a rehabilitation hospital. There have been only 4 reports on PICA communicating artery aneurysms in the literature. Our case is the 5th such case of a PICA communicating artery aneurysm and the second case involving multiple aneurysms. The occluded left vertebral artery might induce hemodynamic stress to develop this type of aneurysms.