Abstract
A 33-year-old woman was hospitalized for sudden onset of severe headache. On neurological examination the only abnormalities were mild nuchal rigidity and anisocoria. Angiography revealed an arteriovenous malformation (AVM) in the right temporal tip with aneurysmal shadows in the right middle cerebral, right internal carotid, and contralateral middle cerebral arteries. Through the right frontotemporal approach, the right middle cerebral and internal carotid artery aneurysms were obliterated. The nidus of the AVM was then radically excised. The patient later underwent a second operation for the contralateral aneurysm, without complications. She was discharged without neurological deficits. It has been emphasized that, in cases of intracranial aneurysms associated with an AVM, the aneurysms are located on the feeding arteries or the contributory vessels proximal to the AVM. Hence, some authors have suggested that feeding arteries with increased blood flow are predisposed to the development of aneurysms. However, this patient also had an aneurysm on a vessel that did not feed the AVM. The presence of a “mirror” aneurysm is interpreted as evidence of a congenital anomaly.
