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Related Experiment Videos

Giant aneurysm causing frontal lobe syndrome.

C Bokemeyer1, B Frank, A Brandis

  • 1Department of Neurology, Städtisches Krankenhaus Nordstadt, Hannover, Federal Republik of Germany.

Journal of Neurology
|February 1, 1990
PubMed
Summary

A giant anterior communicating artery aneurysm, completely thrombosed, presented subtly with gait disturbance and frontal lobe syndrome. Advanced imaging like MRI was crucial for diagnosis, confirmed post-mortem.

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Area of Science:

  • Neurology
  • Neuroradiology
  • Neuroscience

Background:

  • Giant aneurysms, particularly of the anterior communicating artery (ACoA), can present with varied and sometimes subtle neurological deficits.
  • Long-standing frontal lobe syndromes may mask or be associated with underlying cerebrovascular pathology.
  • Thrombosed aneurysms pose diagnostic challenges due to altered imaging characteristics compared to patent aneurysms.

Observation:

  • A 67-year-old patient exhibited a disturbance in stance and gait, alongside bilateral grasp reflexes.
  • The patient displayed symptoms consistent with a frontal lobe psychotic syndrome for over a decade.
  • Initial computed tomography (CT) revealed a hyperdense, calcified suprasellar mass.

Findings:

  • Magnetic resonance imaging (MRI) was instrumental in differentiating the thrombosed giant ACoA aneurysm from other suprasellar lesions.

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  • The imaging findings, particularly from MRI, were critical for establishing the correct diagnosis before post-mortem confirmation.
  • The aneurysm was completely thrombosed, contributing to its unusual presentation and imaging appearance.

    • Implications:

    • This case highlights the importance of advanced neuroimaging techniques, such as MRI, in diagnosing complex cerebrovascular diseases.
    • Subtle neurological signs and long-standing psychiatric symptoms should prompt thorough investigation for underlying structural brain abnormalities.
    • Understanding the imaging characteristics of thrombosed giant aneurysms is vital for accurate diagnosis and potential therapeutic planning in similar cases.