Abstract
A 53-year-old man presented with subarachnoid hemorrhage (SAH) in the left sylvian fissure. Preoperative computed tomography angiography revealed symmetrical aneurysms located at the bifurcations of the right and left middle cerebral arteries (MCAs). The left MCA aneurysm responsible for the SAH was clipped. The patient received post-surgical volume expansion treatment that did not induce hypertension. His systolic blood pressure ranged from 170 to 225 mmHg between the day of the first surgery and the 11th postoperative day. The postoperative course was uneventful until the 11th postoperative day when the patient suffered another SAH in the right sylvian fissure. The right MCA aneurysm was responsible for the second SAH and was clipped. The patient had multiple risk factors for rupture of concomitant unruptured aneurysm including a large, multilobed aneurysm, hypertension, smoking, and a family history of aneurysmal SAH. The present case suggests that all aneurysms should be simultaneously treated using endovascular coil embolization or several craniotomies if the patient has multiple risk factors.
