A case of ruptured peripheral dissecting superior cerebellar artery aneurysm for which the source of bleeding was difficult to confirm

Abstract

Objective: We report a case of ruptured peripheral dissecting superior cerebellar artery (SCA) aneurysm as a rare and difficult to confirm source of subarachnoid hemorrhage (SAH).
Case presentation: A 55-year-old male patient was admitted to our hospital with impaired level of consciousness. Although the patient's CT showed SAH, no intra-cranial arterial saccular aneurysm was seen on DSA. However, there was a suspicion of morphological changes in the lateral pontomesencephalic segment of the left SCA. An MRI 4 days after onset showed cerebellar infarction in the left SCA territory. This raised reasonable suspicion that the SAH was caused by a ruptured dissecting SCA. On day 6 after onset, a parent artery occlusion of the left SCA was performed. After the operation a transient right conjugate gaze deviation was observed.
Conclusion: A dissecting SCA may be the possible cause of SAH. We expect that parent artery occlusion can be an effective method of management, as it is in other locations for this type of pathology.