2024 Volume 52 Issue 5 Pages 370-374
A 73-year-old woman presented with severe headache and subsequent gait disturbance and was referred to a nearby emergency hospital three days after onset. Plain head computed tomography (CT) revealed subarachnoid hemorrhages in the bilateral Sylvian fissures, interhemispheric fissures, and lateral ventricles. Three-dimensional CT angiography revealed two small aneurysms in the right anterior cerebral artery; one at the bifurcation of the recurrent artery of Heubner (RAH) and the other at the posterior wall of the A1 segment. The patient was transferred to our hospital for endovascular treatment; however, the aneurysms were extremely small to be safely treated with coil embolization. The patient was conservatively managed for three weeks, and delayed open surgery was planned. Vessel wall magnetic resonance imagining on day 20 illustrated enhancement of the arterial wall in accordance with the RAH bifurcation aneurysm using fusion images with MRA; therefore, ruptured RAH bifurcation aneurysm was definitively diagnosed. Neck clipping surgery was performed successfully on day 22 with wrapping of the A1 posterior wall of the concomitant aneurysm. RAH aneurysms are extremely rare, with only 10 previously reported cases. Particularly, cases of saccular aneurysms arising from the RHA bifurcation remain unclear.
