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Pseudoaneurysm Formation in a Pediatric Patient After Non-Traumatic Middle Cerebral Artery Dissection With a Rapid
Orlando De Jesus1, Fausto Lugo Morales1, Juan C Vicenty1
1Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI.
Insights
Spontaneous cerebral dissections in children can lead to pseudoaneurysms. This case shows a rare instance of a ruptured middle cerebral artery pseudoaneurysm in a child that spontaneously thrombosed and resolved on follow-up imaging.
Area of Science:
- Pediatric Neurology
- Vascular Neurology
- Neuroradiology
Background:
- Spontaneous cerebral artery dissections are uncommon in children and can result in pseudoaneurysm formation.
- Management of pediatric cerebral pseudoaneurysms remains controversial, with surgical and endovascular options.
- Spontaneous thrombosis of pseudoaneurysms is a rare but possible outcome.
Observation:
- A 12-year-old male presented with an intracerebral hematoma due to a ruptured middle cerebral artery pseudoaneurysm.
- The pseudoaneurysm was identified via digital subtraction angiography.
- No pseudoaneurysm was evident on follow-up imaging 5 days and 2 months later.
Findings:
- The ruptured middle cerebral artery pseudoaneurysm demonstrated rapid, complete spontaneous thrombosis.
- Serial neuroimaging confirmed the resolution of the pseudoaneurysm.
- The patient had no history of trauma preceding the event.
Implications:
- This case highlights the possibility of spontaneous resolution of pediatric cerebral pseudoaneurysms.
- Close neuroimaging surveillance is crucial for thrombosed pseudoaneurysms due to potential recanalization.
- Understanding spontaneous thrombosis mechanisms may inform future management strategies for pediatric cerebrovascular diseases.
Abstract:
Spontaneous cerebral dissections in children are rare and can be associated with the formation of pseudoaneurysms. The management of these pseudoaneurysms is controversial as they can be treated either by surgery or endovascular techniques. On rare occasions, they may spontaneously thrombose. We present a 12-year-old male without a history of trauma who developed an intracerebral hematoma secondary to a ruptured pseudoaneurysm of the middle cerebral artery that showed a rapid spontaneous complete thrombosis. Five days after his initial diagnostic cerebral digital subtraction angiogram, a follow-up study showed no evidence of the previously observed pseudoaneurysm. Two months later, a computed tomographic angiography of the brain showed no evidence of the pseudoaneurysm. Thrombosed pseudoaneurysms should be closely followed by neuroimaging studies as they may subsequently recanalize.
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