Abstract
A case of a cerebral aneurysm coexisting with an arteriovenous malformation in addition to multiple vascular malformations was reported. A 47-year-old female suddenly developed severe headache and vomiting. Neurological examination revealed slight disorientation, memory disturbance, and positive Kernig's sign. CT scan demonstrated a right temporo-parietal intracerebral hematoma with ventricular rupture in addition to small calcifications at the site of hemorrhage. Right retrograde brachial angiography demonstrated an arteriovenous malformation at the right posterior temporal lobe, a basilar top aneurysm, and a parietal small vascular malformation. Marked dilatation of the right posterior communicating artery and posterior cerebral artery were also demonstrated. Left carotid angiography showed a small vascular malformation at the parietal lobe, symmetrical to the right side. A right frontotemporo-parietal craniotomy bone-flap was raised. With a subtemporal approach, neck clipping of the basilar aneurysm was done and then the nidus of the temporal malformation and liquefied hematoma were totally excised. The two small vascular malformations on both parietal lobes were left. The postoperative course was uneventful and the patient was discharged with mild homonymous hemianopsia on the left side.
In the present case, it is possible to suppose that not only the increased blood flow due to the arteriovenous malformation, but also other congenital factors might have played an important role in the production or development of the saccular aneurysm situated at the artery proximal to the arteriovenous malformation.
