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Onyx Embolization of a Distal Middle Cerebral Artery Pseudoaneurysm in a Five-Week-Old: A Case Report and Review of
Yasmeen Elsawaf1, Maryam Zeinomar2, Andrea Scherer3
1Neurosurgery, University of Central Florida College of Medicine, Orlando, USA.
Insights
This study reports the youngest infant diagnosed with a traumatic intracranial pseudoaneurysm, a rare condition in newborns. The infant was successfully treated with Onyx embolization, offering insights into managing pediatric pseudoaneurysms.
Area of Science:
- Pediatric Neurology
- Vascular Neurosurgery
- Neuroradiology
Background:
- Intracranial pseudoaneurysms in infants due to birth trauma are rare and challenging to diagnose.
- Standardized management protocols for pediatric pseudoaneurysms are lacking.
- Common treatments include endovascular embolization and surgical clipping.
Observation:
- A 5-week-old female infant presented with focal seizures.
- Brain MRI/MRA revealed a dysplastic aneurysm of the distal left middle cerebral artery (MCA) branch with a left posterior frontal lobe hemorrhage.
- Cerebral angiography confirmed a left distal MCA pseudoaneurysm.
Findings:
- The infant's pseudoaneurysm was treated with Onyx embolization.
- Post-treatment complications included recurrent seizures and hemorrhagic infarction.
- Seizure control was achieved with a combination of antiepileptic medications.
Implications:
- This case represents the youngest infant treated for a distal MCA pseudoaneurysm with Onyx embolization.
- Highlights the diagnostic and therapeutic challenges in managing pediatric intracranial pseudoaneurysms.
- Contributes to understanding pseudoaneurysmal incidence, diagnosis, and management in infants.
Abstract:
Intracranial pseudoaneurysms secondary to traumatic birth are a rare finding in infants. Definitive diagnosis of such findings is challenging, and no standard management is delineated for management of pseudoaneurysms in the pediatric population. Commonly attempted treatments include endovascular embolization or surgical clipping. A 5-week-old female presented with a two day history of right hand focal seizures. The patient was found to have a dysplastic superficial intra-axial aneurysm arising from the distal left middle cerebral artery (MCA) branch in the setting of a left posterior frontal lobe hemorrhage noted on brain magnetic resonance imaging/magnetic resonance angiography (MRI/MRA). The patient underwent diagnostic cerebral angiogram demonstrating a left distal MCA pseudoaneurysm, which was treated with Onyx embolization. Post-embolization period was complicated by recurrent left central localized seizures and a left hemispheric temporoparietal hemorrhagic infarction. The patient was managed on levetiracetam, phenytoin, phenobarbital with stable seizure control. Herein, we highlight the youngest case to date of a 5-week-old infant with a left distal MCA pseudoaneurysm treated with Onyx embolization. Pseudoaneurysmal incidence, diagnosis and accepted management is discussed.
