Intracerebral hemorrhage caused by ruptured intracavernous carotid artery aneurysm. Case report.
A 76-year-old woman presented with an enlarged right intracavernous carotid artery aneurysm first identified incidentally when she was hospitalized for thalamic hemorrhage. She was managed conservatively for 1 year, then suffered right total ophthalmoplegia associated with enlargement of the aneurysm. Two months later, she became comatose due to intracerebral hemorrhage in the right temporal lobe. Magnetic resonance imaging demonstrated further enlargement of the aneurysm. Emergency craniotomy found the lateral dural wall of the cavernous sinus was markedly expanded and torn by compression from the aneurysm. Rupture of the aneurysm into the intradural space through this dural defect was confirmed. The aneurysm was trapped after high-flow bypass, but the patient did not recover and died. Symptomatic enlarged intracavernous carotid artery aneurysm is potentially fatal and may indicate prompt surgical management.
Iwaisako
Kousuke
K
Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, Japan. iwaisako_k@yahoo.co.jp
Toyota
Shingo
S
Ishihara
Masahiro
M
Shibano
Katsuhiko
K
Harada
Yu
Y
Iwatsuki
Koichi
K
Yoshimine
Toshiki
T
D000368:Aged; D020215:Carotid Artery, Internal, Dissection / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000473:pathology; D020226:Cavernous Sinus Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D002548:Cerebral Revascularization; D003128:Coma / Q000209:etiology; D003399:Craniotomy; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000473:pathology; D004401:Dysarthria / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D020199:Hematoma, Subdural, Acute / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D013702:Temporal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D013786:Thalamic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure