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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
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Pediatric Moyamoya Presenting as a Subarachnoid Hemorrhage from a Ruptured Anterior Cerebral Artery Aneurysm

Mohammad Hassan A Noureldine1, Ibrahim Saikali2, Anis Nassif3

  • 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA.

World Neurosurgery
|November 6, 2019
PubMed
Abstract

Insights

Moyamoya disease (MMD)-associated aneurysms are exceptionally rare in children. A ruptured anterior cerebral artery dissecting aneurysm, presenting as subarachnoid hemorrhage, is reported in a child with MMD-like pathology.

Area of Science:

  • Neurology
  • Pediatric Neurosurgery
  • Vascular Neurology

Background:

  • Moyamoya disease (MMD) is a rare cerebrovascular condition.
  • Intracranial aneurysms occur in 3-14% of adult MMD patients.
  • Aneurysms are rarely reported in pediatric MMD cases.

Observation:

  • This report details the first known case of subarachnoid hemorrhage in a child due to a ruptured anterior cerebral artery dissecting aneurysm.
  • The aneurysm was secondary to newly diagnosed, unilateral Moyamoya-like pathology.
  • This presentation highlights a rare complication in pediatric MMD.

Findings:

  • MMD-associated aneurysms are exceedingly rare in the pediatric population.
  • Subarachnoid hemorrhage can be the initial clinical presentation of MMD in children.
  • Ruptured aneurysms in MMD patients face a high risk of rebleeding due to hemodynamic stress.

Implications:

  • Early diagnosis and prompt intervention are crucial for managing ruptured aneurysms in pediatric MMD.
  • Exclusion of the ruptured aneurysm is essential to prevent rebleeding.
  • This case underscores the importance of considering MMD in children presenting with subarachnoid hemorrhage and dissecting aneurysms.
Keywords:
AneurysmAnterior cerebral arteryPediatric MoyamoyaSubarachnoid hemorrhage

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