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Updated: May 15, 2026
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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Simultaneous presentation of two cerebral aneurysms
Masahiro Yoshida1, Masayuki Ezura, Kazuto Sasaki
1Department of Neurosurgery, Osaki Citizen Hospital, Osaki, Miyagi. m-ysd@ya2.so-net.ne.jp
Neurologia Medico-Chirurgica
|December 28, 2012
Summary
A rare case of multiple brain aneurysms presented with subarachnoid hemorrhage and oculomotor nerve palsy. Prompt treatment of the posterior communicating artery aneurysm led to complete recovery, highlighting the importance of addressing all vascular lesions.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Neurology
Background:
- Subarachnoid hemorrhage (SAH) is a critical condition often caused by ruptured cerebral aneurysms.
- Multiple intracranial aneurysms require careful diagnostic and therapeutic consideration.
- Oculomotor nerve palsy can be a symptom of specific aneurysm locations or complications.
Observation:
- A 48-year-old woman presented with sudden severe headache, diagnosed with SAH and right frontal intracerebral hematoma.
- Digital subtraction angiography identified three aneurysms: anterior communicating artery (AcomA), right posterior communicating artery (PcomA), and right middle cerebral artery.
- Endovascular coiling of the AcomA aneurysm initially worsened oculomotor nerve palsy.
Findings:
- Immediate embolization of the right PcomA aneurysm resulted in complete resolution of oculomotor nerve palsy within 3 months.
- The simultaneous occurrence of multiple aneurysms with distinct clinical manifestations is uncommon.
- Progressive oculomotor nerve palsy is hypothesized to result from aneurysm enlargement or morphological changes due to hemodynamic stress post-SAH.
Implications:
- This case underscores the complexity of managing multiple cerebral aneurysms.
- It highlights the potential for delayed or secondary neurological deficits related to untreated or inadequately treated aneurysms.
- Accurate diagnosis and sequential management of all identified aneurysms are crucial for favorable patient outcomes in complex cerebrovascular cases.
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