A spontaneous giant pseudoaneurysm presenting with chronic headache in adolescent.
BACKGROUND
Intracranial pseudoaneurysms are rare vascular lesions, particularly in children and adolescents, and are characterized by the presence of organizing hematoma and fibrosis outside the true lumen, instead of true vascular elements. Most pseudoaneurysms result from an eminent insult, such as major trauma or grave infectious illness. Development of pseudoaneurysm without antecedent incident is rare. Furthermore, clinical manifestation with only a headache is also unusual in this age group.


METHODS
We now describe one patient who had a giant pseudoaneurysm arising at the distal middle cerebral artery. A 17-year-old boy complained of headache that had become apparent 3 years ago and intractable to medicine 3 months ago. Brain computed tomographic scan and lumbar cerebrospinal spinal fluid study revealed no trace of recent hemorrhage. However, digital subtraction angiography revealed a huge aneurysmal dilatation along the right M2 segment with the features of delayed filling and emptying of contrast agent. Surgical obliteration of the corresponding aneurysm with tandem clipping and aneurysmectomy rendered him free of headache thereafter.


CONCLUSIONS
The actual cause and mechanisms of this case are not certain; nonetheless, we suggest that traumatic cause produced such a lesion, and minor repeated bleeding also elicited headache, albeit no evidence of recent major injury.
Department of Neurosurgery, Hanyang University Medical Center, Haengdang-dong, Sungdong-gu, Seoul, South Korea. hjyi8499@hanyang.ac.kr
Hyeong-Joong
HJ
Yi
Kwang-Myung
KM
Kim
Yong
Y
Ko
Young-Soo
YS
Kim
Suck-Jun
SJ
Oh
Seong-Hoon
SH
Oh
D000293:Adolescent; D017541:Aneurysm, False / Q000150:complications / Q000601:surgery*; D002533:Cerebral Angiography; D002908:Chronic Disease; D006261:Headache / Q000209:etiology* / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D020768:Middle Cerebral Artery / Q000601:surgery*; D016896:Treatment Outcome