[Aneurysms of the anterior communicating artery. Diagnostic, clinical and anatomic difficulties]

Aneurysm in the anterior communicating artery always presents diagnostic difficulties of a clinical and sometimes neuropathological nature. The authors describe the anatomic aspects of 21 cases of this type of aneurysm, together with the clinical background: anatomic recognition of clinically undetected aneurysms is not always straightforward. An inferior frontal inter-hemispheric hematoma suggests the diagnosis, but only macroscopic dissection of the whole hematoma and large vessels allows confirmation. Histological examination often reveals a hemorrhagic lesion in the fronto-polar area. Clinical investigation of these cases shows the reasons for certain classic diagnostic errors. Although this exercise reveals no original concepts, it draws attention to some classic facts that are often unexplainably overlooked. An uncommon speech disorder is described in two cases, but the mechanism of development is not clear.