title: Middle cerebral artery aneurysm rupture in a neonate with interrupted aortic arch: case report.
abstract: BACKGROUND
  Arterial cerebral aneurysms in the neonatal population are rare, and while the association of interrupted aortic arch and intracranial aneurysm has been reported in the adult and pediatric population (three cases each), to date, it has not been reported in the neonate.
  
  
  METHODS
  We report the case of a 26-day-old girl who presented with a generalized seizure 2 weeks after undergoing congenital heart surgery. Head CT revealed diffuse SAH with a 1.7 × 2.9-cm frontal intra-parenchymal hematoma with subdural extension producing 3 mm of midline shift. CTA evidenced a 2-mm left MCA bifurcation aneurysm, and the patient was taken to the operating room for clipping. Twenty-four-hour post-operative head CT showed ventriculomegaly and an EVD was placed. It was removed 4 days later without the need for permanent CSF diversion, and after this, her hospital stay was uneventful and she was discharged home. At 25 months of age, she was meeting developmental milestones. At this time, she underwent further heart surgery and expired shortly thereafter due to cardiomyopathy.
  
  
  CONCLUSIONS
  Here, we report the successful treatment of a ruptured neonatal aneurysm, and the first known case associated with interrupted aortic arch. Given the time and presentation, this patient likely illustrates the role of hemodynamic factors in the rupture of neonatal aneurysms. In reviewing all of the reported cases of neonatal aneurysms, promptly securing the aneurysm by either open clipping, parent vessel occlusion, or endovascular coiling is strongly preferable to no surgical intervention.
authors.affiliation: Department of Neurological Surgery, University of Mississippi Medical Center, Batson's Children Hospital, 2500 N State St, Jackson, MS, 39216, USA. jhidalgo@umc.edu.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Hidalgo
authors.affiliation: Department of Neurological Surgery, University of Mississippi Medical Center, Batson's Children Hospital, 2500 N State St, Jackson, MS, 39216, USA.
authors.forename: James Charles
authors.initials: JC
authors.lastname: Dickerson
authors.affiliation: Department of Neurological Surgery, University of Mississippi Medical Center, Batson's Children Hospital, 2500 N State St, Jackson, MS, 39216, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Burnsed
authors.affiliation: Department of Neurological Surgery, University of Mississippi Medical Center, Batson's Children Hospital, 2500 N State St, Jackson, MS, 39216, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Luqman
authors.affiliation: Department of Neurological Surgery, University of Mississippi Medical Center, Batson's Children Hospital, 2500 N State St, Jackson, MS, 39216, USA.
authors.forename: James Mason
authors.initials: JM
authors.lastname: Shiflett
mesh_terms: D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000601:surgery; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: 120: aneurysm; 1220: intracranial hemorrhage; 1280: intraventricular hemorrhage; 2070: subarachnoid hemorrhage