Internal carotid aneurysm with multiple variations in the bilateral infraoptic course of the anterior cerebral artery: a case report

Abstract

Objective: A case of an internal carotid-infraoptic (IC-IOA) course of an anterior cerebral artery aneurysm with multiple cerebrovascular variations is reported. Case Presentation: A 37-year-old woman who presented with headache was referred by a local doctor to our institution. Magnetic resonance imaging (MRI) showed a paraclinoid internal carotid artery aneurysm on the right side. The angiography, however, showed small bilateral infraoptic arteries (IOAs) and the right IC-IOA aneurysm with a maximum diameter of 6.7 mm. Several arterial variations also coexisted, such as a plexiform anterior communicating artery complex leading to a bihemispheric anterior cerebral artery (ACA), bilateral ophthalmic arteries exclusively supplied by the external carotid arteries, atypical courses of bilateral vertebral arteries, and the left occipital artery arising from the IC artery. Moreover, her corpus callosum appeared mildly dysplastic on MRI. Stent-assisted coil embolization for the aneurysm with preservation of the vessel was successfully performed. Conclusion: Since this relatively rare aneurysm tends to have many variations, detailed reading of images might be of great importance, particularly prior to treatment.