Kissing Distal Anterior Cerebral Artery Aneurysm

by

G.N. Lakshminarayan, M.D.

Mathew Cherian, M.D. (Interventional Radiologist)

S Murugan, M.D. (Radiologist)

This 50 yrs old man was admitted for headache and giddiness of three days duration.  He is a business man by occupation, who developed headache and giddiness suddenly three days ago. He was not sure how sudden. No vomiting or loss of consciousness.  Had three days of fever about a week prior to developing headache which subsided after taking some antibiotics and paracetamol. He was not a diabetic but on ACE+ARB combination drug for his mild hypertension.  Since his CT Scan of the brain (contrast enhanced) showed a right medial frontal small infarct, I did an MR angiography with imaging of the brain.  Diff/Perf imaging confirmed the infarct and the MRA showed two small aneurysms of the distal Anterior Cerebral arteries (kissing each other).  Blood culture and rheumatologic workup was negative. No h/o head injury in the recent past.

Invasive angiograms (DSA) confirmed the two aneurysms (picture). The right ACA aneurysm was coiled first without loss of the artery (picture). Three days later the other aneurysm on the left ACA also was coiled without any deficits. Patient is improving.

The distal segment of the anterior cerebral artery is defined as the distal portion to the anterior communicating artery. DACA aneurysms also called pericallosal or A2 aneurysms, whose low incidence ranged from 2.1 to 9.2%.  This include aneurysms of the pericallosal and calloso-marginal arteries. All reported series of DACA aneurysms have shown a high association with intracranial aneurysms in other locations. In most cases this type of aneurysm distant to the circle of Willis has clinical characteristics that present technical difficulties when treatment is by neck clipping.  The headache in this patient was probably due to a small sentinel bleed which was not picked up by the CT. LP was not done.

 

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November 5, 2006

(c) 2006 M.H. Rivner