Distal lenticulostriate artery aneurysm rupture presenting as intraparenchymal hemorrhage: case report.
OBJECTIVE
Aneurysms involving the distal lenticulostriate artery branches are a rare cause of spontaneous intracerebral hemorrhage. We report a case of ruptured lenticulostriate aneurysm in an otherwise healthy patient and review the literature on this topic.


METHODS
Computed tomography showed a right basal ganglia hemorrhage in a 44-year-old Native American woman with acute left hemiparesis. Cerebral angiography showed a 2-mm aneurysm in a distal lenticulostriate artery branch.


METHODS
A pterional craniotomy was performed on a delayed basis using computed tomographic angiography and frameless stereotactic guidance. The basal ganglia hematoma was evacuated, and the aneurysm was identified and clipped using microsurgical technique. Because the base of the aneurysm involved a portion of the parent vessel wall, it was wrapped with cotton and reinforced with cyanoacrylate glue. The patient did well after surgery and was discharged to home with outpatient rehabilitation on the third postoperative day.


CONCLUSIONS
Although intraparenchymal hemorrhages are fairly common, the underlying vascular abnormality is rarely identified. Most are related to hypertensive vascular degeneration, rupture of a Charcot-Bouchard aneurysm, or both. When intracerebral hemorrhage occurs in young patients, however, aggressive investigation is warranted to rule out a structural vascular abnormality.
Horn
Eric M
EM
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Zabramski
Joseph M
JM
Feiz-Erfan
Iman
I
Lanzino
Guiseppe
G
McDougall
Cameron G
CG
D000328:Adult; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D015901:Angiography, Digital Subtraction; D020144:Basal Ganglia Cerebrovascular Disease / Q000209:etiology* / Q000601:surgery; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D003487:Cyanoacrylates; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D008866:Microsurgery; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed / Q000379:methods; D014656:Vascular Surgical Procedures / Q000379:methods
D003487:Cyanoacrylates