Spontaneous subarachnoid hemorrhage due to ruptured cavernous internal carotid artery aneurysm after medical prolactinoma treatment.
Aneurysms of the cavernous segment of the internal carotid artery (ICA) are believed to have a low risk of subarachnoid haemorrhage (SAH), given the confines of the dural rings and the anterior clinoid process. The risk may be greater when the bony and dural protection has been eroded. We report a case of spontaneous SAH from rupture of a cavernous ICA aneurysm in a patient whose large prolactinoma had markedly decreased in size as the result of cabergoline treatment. After passing a balloon test occlusion, the patient underwent successful endovascular vessel deconstruction. This case suggests that an eroding skull base lesion may distort normal anterior cranial base anatomy and allow communication between the cavernous ICA and subarachnoid space. The potential for SAH due to cavernous ICA aneurysm rupture should be recognised in patients with previous pituitary or other skull base lesions adjacent to the cavernous sinus.
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Siri Sahib
SS
Khalsa
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Todd C
TC
Hollon
Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
Ravi
R
Shastri
Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan, USA.
Jonathan D
JD
Trobe
Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
Joseph J
JJ
Gemmete
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Aditya S
AS
Pandey
D017542:Aneurysm, Ruptured / Q000150:complications* / Q000175:diagnosis; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000077465:Cabergoline; D002343:Carotid Artery, Internal; D002426:Cavernous Sinus; D002533:Cerebral Angiography; D004873:Ergolines / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015175:Prolactinoma / Q000150:complications* / Q000188:drug therapy; D012422:Rupture, Spontaneous; D019291:Skull Base / Q000033:anatomy & histology; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*
D000970:Antineoplastic Agents; D004873:Ergolines; D000077465:Cabergoline
Aneurysm; Hemorrhage; Stroke; Subarachnoid