2021 Volume 6 Issue 3 Pages 127-134
Objective: We report a case of aplastic or twig-like middle cerebral artery (Ap/T-MCA) with a tiny ruptured aneurysm in the collateral network in a patient who presented with intracerebral hemorrhage that was treated using bypass surgery and parent artery occlusion.
Case Presentation: A 51-year-old man presented with a headache. CT revealed intracerebral hemorrhage in the right temporal lobe, and CTA revealed Ap/T-MCA. He received conservative therapy; however, he developed rebleeding on the 10th day of admission. DSA revealed a tiny ruptured aneurysm in the collateral vascular network between the anterior choroidal and anterior temporal arteries. We performed initial bypass surgery, followed by parent artery occlusion using a liquid embolic agent for treatment of the aneurysm.
Conclusion: The treatment strategy should consider the site of hemorrhage, including the collateral network and the patient's hemodynamics in case of Ap/T-MCA hemorrhage.
