Symmetrical bilateral low-density lesions in the areas of supply by Heubner's arteries after aneurysm surgery.

Three patients with symmetrical bilateral low-density areas which were the perfusion territories of Heubner's arteries are reported. The infarctions were demonstrated on computed tomography after aneurysm surgery. Two of them had an anterior communicating artery aneurysm and the other one had multiple aneurysms of both sides. They were operated upon in the acute stage after subarachnoid haemorrhage. As common factors, a thick and diffuse subarachnoid haemorrhage, an acute-stage operation, temporary clips to bilateral A1 segments or the internal carotid artery and a relatively low systemic blood pressure during operation were found. From these findings we conclude that the pathogenesis of the infarctions was due to occlusive changes affecting Heubner's arteries bilaterally.