[Two cases of giant fusiform aneurysm presenting ischemic attacks]

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Giant fusiform aneurysms are typically characterized by a mass effect on surrounding structures.
• Ischemic events secondary to these aneurysms are considered rare clinical presentations.

Observation:

• Two uncommon cases of partially thrombosed giant fusiform aneurysms are presented.
• Case 1 involved a 68-year-old male with a basilar artery aneurysm causing pontine compression and ischemic stroke, leading to locked-in syndrome.
• Case 2 involved a 42-year-old male with a history of meningiomas, also presenting with a giant fusiform aneurysm.

Findings:

• The primary clinical sign of giant fusiform aneurysms is typically mass effect, not ischemic attack.
• Autopsy in Case 1 revealed a large basilar artery aneurysm with laminated thrombosis, causing an old infarction in the pons.

Implications:

• These cases highlight that ischemic complications, though rare, can occur with partially thrombosed giant fusiform aneurysms.
• Rethinking the typical clinical presentation of these aneurysms is warranted.
• Further investigation into the mechanisms of thrombosis and embolism in fusiform aneurysms is needed.