Kim Hak Jin, Lee Sang Won, Lee Tae Hong, Kim Young Soo
Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
J Cerebrovasc Endovasc Neurosurg. 2015 Sep;17(3):234-8. doi: 10.7461/jcen.2015.17.3.234. Epub 2015 Sep 30.
We describe a case of a huge intramural hematoma in a thrombosed middle cerebral artery aneurysm. A 47-year-old female patient with liver cirrhosis and thrombocytopenia presented to the neurosurgical unit with a 5-day history of headache and cognitive dysfunction. Magnetic resonance imaging and computed tomography of the brain showed a thrombosed aneurysm located in the right middle cerebral artery with a posteriorly located huge intramural hematoma mimicking an intracerebral hematoma. Imaging studies and cerebrospinal fluid analysis showed no evidence of subarachnoid hemorrhage. Angiography showed a partially thrombosed aneurysm at the origin of the right anterior temporal artery and an incidental aneurysm at the bifurcation of the right middle cerebral artery. Both aneurysms were embolized by coiling. After embolization, the thrombosed aneurysmal sac and intramural hematoma had decreased in size 4 days later and almost completely disappeared 8 months later. This is the first reported case of a nondissecting, nonfusiform aneurysm with a huge intramural hematoma, unlike that of a dissecting aneurysm.
我们描述了一例大脑中动脉血栓性动脉瘤内巨大壁内血肿的病例。一名47岁患有肝硬化和血小板减少症的女性患者因头痛和认知功能障碍病史5天就诊于神经外科。脑部磁共振成像和计算机断层扫描显示，位于右侧大脑中动脉的一个血栓性动脉瘤，其后方有一个巨大的壁内血肿，类似脑内血肿。影像学检查和脑脊液分析未发现蛛网膜下腔出血的证据。血管造影显示右前颞动脉起始处有一个部分血栓形成的动脉瘤，以及右侧大脑中动脉分叉处有一个偶然发现的动脉瘤。两个动脉瘤均通过弹簧圈栓塞治疗。栓塞后，血栓性动脉瘤囊和壁内血肿在4天后体积减小，8个月后几乎完全消失。这是首例报道的非夹层、非梭形动脉瘤伴巨大壁内血肿的病例，与夹层动脉瘤不同。
