Mallett Peter, O'Reilly Sean Thomas, Rennie Ian, Shanmuganathan Mano, Thompson Andrew James
Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK.
Department of Radiology, Royal Victoria Hospital, Belfast, UK.
BMJ Case Rep. 2020 Apr 23;13(4):e233875. doi: 10.1136/bcr-2019-233875.
A previously well, 14-month-old girl presented with acute decreased level of consciousness. There was no history of trauma, systemic upset or significant family history. Blood pressure was within normal range and no focal neurological deficit was elicited on examination. Neuroimaging revealed a subarachnoid haemorrhage secondary to a basilar tip aneurysm. Patient underwent endovascular embolisation with good clinical outcome. Follow-up MRI revealed anterior circulation vasospasm, and although clinically asymptomatic, she was treated with a calcium channel antagonist. She was later discharged home with no neurological deficit. Follow-up MRI 3 months following presentation suggested recurrent formation of the aneurysmal sac. The patient then underwent elective endovascular repair 2 months later and was discharged home on antiplatelet therapy with planned close outpatient clinical and radiological surveillance.
一名此前健康的14个月大女童出现急性意识水平下降。无外伤史、全身不适或重大家族史。血压在正常范围内，检查未引出局灶性神经功能缺损。神经影像学检查显示为基底动脉尖动脉瘤继发蛛网膜下腔出血。患者接受了血管内栓塞治疗，临床效果良好。随访磁共振成像显示前循环血管痉挛，尽管临床上无症状，但她接受了钙通道拮抗剂治疗。她后来出院回家，无神经功能缺损。就诊后3个月的随访磁共振成像提示动脉瘤囊反复形成。该患者随后在2个月后接受了择期血管内修复，并在抗血小板治疗下出院回家，计划进行密切的门诊临床和影像学监测。
