Abstract
A case of multiple intracranial aneurysms was reported. Their locations were the right pericallosal artery and the left vertebral artery. The patient died from the second attack of subarachnoid hemorrhage.
A 48-year-old male had an attack of subarachnoid hemorrhage on July 21, 1972 and he was admitted to the Toranomon Hospital on July 24, 1972.
Neurological findings: He was drowsy and confused with stiff neck, and showed motor weakness of right upper extremity and left lower extremity. Babinki's was positive on the right side. Fundi oculi showed papilledema and pre-retinal hemorrhage.
Among these neurological findings, we considered that motor weakness of the left lower extremity was worthy mentioning. Then, right carotid angiography was performed, and a small arterial loop was found at the right peripheral pericallosal artery. But, as a results of repeated angiography, it was diagnosed a saccular aneurysm. During 4 vessel study, we found another saccular aneurysm arising from the left vertebral artery at the junction of the posterior inferior cerebellar artery. However, we considered that the initial rupture of aneurysm was that of pericallosal artery, mainly from the neurological findings.
As the level of consciousness was recovering gradually, we were preparing the direct attack to the aneurysm of the pericallosal artery. But he had the second attack of the subarachnoid hemorrhage and rapidly died on September 9, 1972. Autopsy showed the rupture of vertebral aneurysm. No rupture of the pericallosal aneurysm was confirmed.
-Conclusion-
(1) At the acute stage of ruptured intracranial aneurysm, we must evaluate the neurological symptoms, when they exist.
(2) when the location of angiographically detected aneurysm does not explain the neurological symptoms, we must perform a complete 4 vessel study.
