Miyachi Hiroshi, Suzuki Kohei, Nagasaka Shohei, Kitagawa Takehiro, Yamamoto Junkoh
Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
Surg Neurol Int. 2021 Mar 24;12:115. doi: 10.25259/SNI_843_2020. eCollection 2021.
Acute cerebral infarction is a rare complication resulting from an unruptured cerebral aneurysm (UCA). There is presently no consensus on the optimal strategy for the management of UCAs with cerebral infarctions.
A 53-year-old man presented with transient dysarthria and left hemiparesis. Magnetic resonance imaging (MRI) demonstrated the presence of a 7 mm UCA originating from the middle cerebral artery bifurcation, and diffusion-weighted imaging showed no evidence of cerebral infarction. One month later, his transient left hemiparesis recurred, and the patient was admitted to our hospital. Computed tomography angiography showed enlargement of the aneurysm. His left hemiparesis worsened 3 days later. MRI showed cerebral infarction in the area of perforating arteries and further enlargement of the aneurysm with surrounding parenchymal edema. Therefore, the rupture risk was considered to be rarely high and dome clipping was performed immediately. Postoperatively, his neurological status improved without any recurrent brain ischemia.
We report a rare case of a rapidly enlarging aneurysm that presented with cerebral infarction. This is the first report describing aneurysmal sac enlargement that can lead to perforating artery obstruction and brain ischemia. The case illustrates the importance of performing close follow-up examinations to confirm findings that suggest a high rupture risk.
急性脑梗死是未破裂脑动脉瘤（UCA）的一种罕见并发症。目前对于伴有脑梗死的UCA的最佳治疗策略尚无共识。
一名53岁男性出现短暂性构音障碍和左侧偏瘫。磁共振成像（MRI）显示存在一个起源于大脑中动脉分叉处的7毫米UCA，弥散加权成像未显示脑梗死迹象。一个月后，他的短暂性左侧偏瘫复发，患者入住我院。计算机断层血管造影显示动脉瘤增大。3天后他的左侧偏瘫加重。MRI显示穿支动脉区域出现脑梗死，动脉瘤进一步增大并伴有周围实质水肿。因此，认为破裂风险极高，立即进行了瘤顶夹闭术。术后，他的神经功能状态改善，未出现任何复发性脑缺血。
我们报告了一例罕见的伴有脑梗死的快速增大动脉瘤病例。这是第一份描述动脉瘤囊增大可导致穿支动脉阻塞和脑缺血的报告。该病例说明了进行密切随访检查以确认提示高破裂风险的发现的重要性。
