Abstract
A 41-year-old male was admitted with a transient left hemiparesis in 1974. No neurological deficits were noted but his systemic blood pressure was high. Right carotid angiography revealed only right M1 stenosis and no aneurysm was seen. Systemic hypertension has not been controlled. In 1981, this patient was readmitted because of a subarachnoid hemorrhage. Right carotid angiography revealed an anterior communicating artery aneurysm and the same right M1 stenosis as before. Left carotid angiography revealed hypoplasia of left Al segment and the blood flow of bilateral distal anterior cerebral arteries was supplied mainly through the right A1. No aneurysm was seen in the posterior circulation. Right frontotemporal craniotomy was performed and neck clipping of the aneurysm was done, and a ventriculoperitoneal shunt was added because of normal pressure hydrocephalus.
The postoperative course was uneventful. The present case indicates that hemodynamic stress following middle cerebral artery stenosis, as well as systemic hypertension and anomaly of the circle of Willis, might have played a role in the pathogenesis of intracranial arterial aneurysm.
