Concomitant Subarachnoid Hemorrhage and Ischemic Stroke Associated With Ruptured Aneurysms: Case Reports

Aneurysmal rupture concomitant with acute ischemic stroke (IS) unrelated to vasospasm has not been reported previously. We describe, for the first time, three cases of simultaneous aneurysmal subarachnoid hemorrhage and acute IS due to vessel occlusion located distally to the aneurysm. Two mechanisms are suggested for this concurrent occurrence of an aneurysm rupture and IS: (1) Occlusion of a blood vessel distal to the aneurysm from a clot originating from the aneurysm, thereby increasing intra-aneurysmal pressure and causing rupture; (2) rupture of a partially thrombosed aneurysm, resulting in the mobilization of a clot that causes vessel occlusion. Observation of such cases may enhance our understanding of the mechanisms involved in aneurysmal rupture.