Progression of a posterior communicating artery infundibulum into an aneurysm in a patient with Alagille syndrome. Case report.
The authors present a case in which a posterior communicating artery (PCoA) infundibulum progressed into an aneurysm in a patient with Alagille syndrome (arteriohepatic dysplasia). The 3-mm PCoA infundibulum had been noted on angiography studies obtained 5 years earlier, prior to clip occlusion of a basilar tip aneurysm. Recently, the patient presented to the emergency department with the sudden onset of headache and decreased mental status. A computerized tomography scan of the head with three-dimensional angiography revealed no gross subarachnoid hemorrhage, but did demonstrate a 5-mm PCoA aneurysm. Lumbar puncture demonstrated xanthochromia and a large quantity of red blood cells. The patient underwent open surgery for aneurysm clip occlusion and obtained a good recovery. This case illustrates the small but growing number of examples of infundibulum progression. It also indicates the need for a close follow up in patients with congenital abnormalities that may pose an increased risk for what has traditionally been considered a benign lesion.
Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0338, USA. jacowan@umich.edu
John A
JA
Cowan
Garni
G
Barkhoudarian
Lynda J S
LJ
Yang
B Gregory
BG
Thompson
D000328:Adult; D016738:Alagille Syndrome / Q000150:complications*; D017542:Aneurysm, Ruptured / Q000209:etiology* / Q000473:pathology; D002339:Carotid Arteries / Q000002:abnormalities*; D002533:Cerebral Angiography; D018450:Disease Progression; D006801:Humans; D002532:Intracranial Aneurysm / Q000209:etiology* / Q000473:pathology; D008297:Male; D013525:Surgical Instruments