title: Ruptured distal accessory anterior cerebral artery aneurysm: case report.
abstract: OBJECTIVE
  Accessory anterior cerebral artery (ACA), which is a type of median artery of anomalous triplicate ACA, is not rare, but aneurysmal formation is extremely rare. We report a rare case with ruptured aneurysm arising from a distal accessory ACA. We discuss the characteristics and causes of this type of aneurysm and classification of this anomaly.
  
  
  METHODS
  A 63-year-old man suddenly developed severe headache and then loss of consciousness and paraplegia. Computed tomography disclosed thick and diffuse subarachnoid hemorrhage and interhemispheric hematoma. Subsequent bleeding occurred 2 hours after the first hemorrhage. Cerebral angiography disclosed a saccular aneurysm arising from the distal accessory ACA.
  
  
  METHODS
  Neck clipping of the aneurysm was performed 22 hours after the second episode, using an interhemispheric approach.
  
  
  CONCLUSIONS
  Although transient paraplegia occurred 8 days after onset, the patient recovered well after surgery without neurological deficit. The characteristics of the aneurysm arising from distal accessory ACA are considered similar to those of distal ACA aneurysm. There is, however, some confusion regarding the terminology of the anterior communicating artery complex anomalies, which we discuss.
authors.affiliation: Department of Neurosurgery, Kumamoto University Medical School, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Morioka
authors.forename: S
authors.initials: S
authors.lastname: Fujioka
authors.forename: Y
authors.initials: Y
authors.lastname: Itoyama
authors.forename: Y
authors.initials: Y
authors.lastname: Ushio
mesh_terms: D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000473:pathology / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed