Distal lenticulostriate artery aneurysm in a patient with atherosclerotic intracranial artery occlusion

Abstract

A 65-year-old man was admitted to our hospital with a history of sudden onset of paresis in his upper limb and face on the right side. He had a history of untreated hypertension and dyslipidemia over a long period. Brain CT scan showed acute intracranial hemorrhage 10 mm in diameter in the left frontal subcortical area, and MR angiography showed the left A1 and the distal portion of the left M1 occlusion. Digital subtraction angiography (DSA) revealed severe atherosclerotic change in the intracranial arteries and several small aneurysms in the distal part of the left lenticulostriate artery developed as a collateral artery of the M1 and A1 occlusion. He was diagnosed with intracranial hemorrhage caused by the rupture of a distal cerebral aneurysm and was treated conservatively with strict antihypertensive therapy and rehabilitation. Three months later, he was discharged from our hospital without any neurological deficits. He kept receiving antihypertensive therapy and underwent follow-up DSA after 2 years. Distal cerebral aneurysms disappeared, and the left M1 and A1 remained occluded. This is a rare case of distal lenticulostriate artery aneurysms that disappeared with a conservative therapy in a patient with atherosclerotic intracranial artery occlusion.