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Successive development of ischemic malignant strokes in a patient with multiple fusiform aneurysms: A case report
Dae-Seop Shin1, Dong Kyu Yeo2, Eu Jene Choi3
1Department of Neurology, Soonchunhyang University Gumi Hospital, Gumi 39371, South Korea.
Background:
Intracranial fusiform aneurysms are rare, spindle-shaped, and nonsaccular arterial dilatations that may be caused by dissection.
Case Summary:
A 48-year-old man complained of wake-up onset of dysarthria and left-sided weakness. Diffusion-weighted magnetic resonance imaging of the brain revealed an infarction in the territories of the right middle and posterior cerebral arteries. Computed tomography angiography showed fusiform aneurysms in the right vertebral artery and bilateral petrous segments of the internal carotid arteries (ICAs). Despite conservative management, malignant ischemic stroke recurred in the contralateral ICA territory within a day of the onset of the index stroke.
Conclusion:
We report a rare case of successive malignant strokes in a patient with multiple fusiform aneurysms. Herein, we emphasize that clinicians should consider aggressive treatment for patients with ischemic stroke and multiple fusiform aneurysms.
Insights
Multiple fusiform aneurysms can lead to successive malignant strokes. Aggressive treatment is recommended for patients experiencing ischemic stroke with these rare arterial dilatations.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Intracranial fusiform aneurysms are rare, spindle-shaped arterial dilatations, often associated with dissection.
- These nonsaccular dilatations present a diagnostic and therapeutic challenge in neurovascular medicine.
Observation:
- A 48-year-old male presented with acute dysarthria and left-sided weakness, indicative of stroke.
- Brain MRI confirmed infarction in the right middle and posterior cerebral artery territories.
- CT angiography revealed multiple fusiform aneurysms in the vertebral artery and bilateral internal carotid arteries (ICAs).
Findings:
- The patient experienced a recurrent, malignant ischemic stroke in the contralateral ICA territory shortly after initial presentation.
- Conservative management proved insufficient in preventing further ischemic events in this complex case.
Implications:
- This case highlights the critical need for prompt diagnosis and consideration of aggressive treatment strategies for patients with ischemic stroke and multiple fusiform aneurysms.
- Early and decisive intervention may be crucial to prevent catastrophic outcomes in such rare presentations.
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