Spontaneous resolution of ruptured dissecting superior cerebellar artery aneurysm
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LETTER TO THE EDITOR
Spontaneous resolution of ruptured dissecting superior cerebellar artery aneurysm Badreeddine Alami 1,2,3 & Saïd Boujraf 1,2
&
Mustapha Maaroufi 2,3 & Moulay Youssef Alaoui-Lamrani 2,3
Received: 30 June 2020 / Accepted: 14 October 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Editor, Our patient was a 49-year-old woman presented with 2-day history of dizziness, headache, and posterior neck pain. Past medical history was unremarkable. Neurological examination was normal. An initial unenhanced brain computed tomography (CT) scan (Fig. 1) showed slight subarachnoid hemorrhage in the prepontine cistern with small hematoma in the left cerebellopontine angle. Contrast-enhanced brain CT scan showed a round well-delineated lesion with intense enhancement located in the left cerebellopontine angle suggestive of an aneurysm (Fig. 2). Digital angiography revealed a dissecting left superior cerebellar artery (SCA) with a 10 × 7 × 6 mm aneurysm of the superior branch of left SCA (Fig. 3). Several treatment options were discussed by multidisciplinary team including aneurysm clipping and arterial embolization. The primary decision was to embolize the aneurysm. However, the preoperative evaluation revealed significant arrhythmias which ruled out any possibility of immediate intervention. Therefore,
we considered the recommendation of the anesthesia team consisted of postponing the intervention to a stage of stabilization if noninvasive therapy does not improve the patient. Indeed, the patient improved clinically by the release of symptoms in the meantime. Vertebral angiograms were performed within a 10-day interval and showed complete occlusion of the aneurysm (Fig. 4). Ruptured dissecting superior cerebellar artery aneurysms are very rare (1). The therapeutic management is often aggressive, including surgical clipping, arterial bypass with aneurysm trapping, and endovascular occlusion with detachable coils. We present this case to show that ruptured dissecting aneurysms of the SCA might resolve spontaneously. Therefore, being conservative and a noninvasive treatment should be considered a therapeutic option.
* Saïd Boujraf [email protected] 1
Department of Biophysics and Clinical MRI Methods, Faculty of Medicine and Pharmacy, Sidi Mohamed ben Abdellah University, BP. 893, Km 2.200, Sidi Hrazem Road, 30000 Fez, Morocco
2
Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed ben Abdellah University, Fez, Morocco
3
Department of Radiology and Clinical Imaging, University Hospital of Fez, Fez, Morocco Fig. 1 Unenhanced brain CT scan showing slight subarachnoid hemorrhage in the prepontine cistern with small hematoma in the left cerebellopontine angle
Neurol Sci Fig. 2 Contrast-enhanced brain CT scan showing an aneurysm in the left cerebellopontine angle
Fig. 3 Digital angiography revealed a dissecting left superior cerebellar artery (SCA) with a 10 × 7 × 6 mm aneurysm of the superior branch of left SCA
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