title: Rapid de novo aneurysm formation after clipping of a ruptured middle cerebral artery aneurysm in an infant with an MYH11 mutation.
abstract: The authors report the case of a previously healthy 6-month-old girl who presented with right arm and leg stiffening consistent with seizure activity. An initial CT scan of the head demonstrated acute subarachnoid hemorrhage in the basal cisterns extending into the left sylvian fissure. Computed tomography angiography demonstrated a 7 × 6 × 5-mm saccular aneurysm of the inferior M2division of the left middle cerebral artery. The patient underwent left craniotomy and microsurgical clip ligation with wrapping of the aneurysm neck because the vessel appeared circumferentially dysplastic in the region of the aneurysm. Postoperative angiography demonstrated a small remnant, sluggish distal flow, but no significant cerebral vasospasm. Fifty-five days after the initial aneurysm rupture, the patient presented again with an acute intraparenchymal hemorrhage of the left anterior temporal lobe. Angiogram revealed a circumferentially dysplastic superior division of the M2branch, with a new 5 × 4-mm saccular aneurysm distinct from the first, with 2 smaller aneurysms distal to the new ruptured aneurysm. Endovascular parent vessel occlusion with Onyx was performed. Genetic testing revealed a mutation of the MYH11. To the authors' knowledge, this is the first report of rapid de novo aneurysm formation in an infant with an MYH11 mutation. The authors review the patient's clinical presentation and management and comprehensively review the literature on this topic.
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah; and.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Ravindra
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah; and.
authors.forename: Michael
authors.initials: M
authors.lastname: Karsy
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah; and.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Schmidt
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah; and.
authors.forename: Philipp
authors.initials: P
authors.lastname: Taussky
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah; and.
authors.forename: Min S
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah; and.|Division of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Bollo
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging / Q000235:genetics / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000150:complications / Q000235:genetics / Q000601:surgery*; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D009154:Mutation; D018995:Myosin Heavy Chains / Q000235:genetics*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D013525:Surgical Instruments
chemical_list: C509903:MYH11 protein, human; D018995:Myosin Heavy Chains
keywords: CTA = CT angiography; EVD = external ventricular drain; ICU = intensive care unit; MCA = middle cerebral artery; MRA = MR angiography; MYH11; SAH = subarachnoid hemorrhage; TAAD = thoracic aortic aneurysm and dissection; angiogram; muslin gauze; myosin heavy chain 11; pediatric; saccular aneurysm; vascular disorders