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Posterior inferior cerebellar artery aneurysm in the fourth ventricle
Abstract:
We report a patient with a ruptured aneurysm of the choroidal branch of the right posterior inferior cerebellar artery (PICA), lying in and causing an isolated haemorrhage in the fourth ventricle. MRI on the first day after bleeding revealed an abnormal vessel in the fourth ventricle, which was surrounded by a mass of intermediate signal on T1- and T2-weighted images. The aneurysm was clipped via partial splitting of the lower vermis and opening the inferior medullary velum. A postoperative angiogram confirmed complete obliteration of the aneurysm. With PICA aneurysms the rate of intraventricular haemorrhage is high and in most cases due to reflux of blood. If there is an isolated intraventricular haemorrhage, a peripheral PICA aneurysm, lying in or near the fourth ventricle, may be suspected.
Insights
A ruptured posterior inferior cerebellar artery (PICA) aneurysm caused isolated fourth ventricle bleeding. Surgical clipping successfully treated the aneurysm, highlighting PICA aneurysms as a cause of intraventricular hemorrhage.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Neurology
Background:
- Posterior inferior cerebellar artery (PICA) aneurysms are rare cerebrovascular lesions.
- Intraventricular hemorrhage (IVH) is a known complication, often resulting from blood reflux.
- Isolated IVH necessitates consideration of peripheral PICA aneurysms.
Observation:
- A patient presented with an isolated hemorrhage confined to the fourth ventricle.
- Magnetic Resonance Imaging (MRI) revealed an abnormal vessel within the fourth ventricle.
- The aneurysm appeared as an intermediate signal mass on T1- and T2-weighted images.
Findings:
- The hemorrhage originated from a ruptured choroidal branch aneurysm of the right PICA.
- The aneurysm was surgically clipped through a partial splitting of the lower vermis and inferior medullary velum.
- Postoperative angiography confirmed complete obliteration of the aneurysm.
Implications:
- This case underscores the importance of suspecting peripheral PICA aneurysms in cases of isolated intraventricular hemorrhage.
- Successful surgical management demonstrates the feasibility of treating such aneurysms.
- Understanding the specific location and presentation of PICA aneurysms is crucial for timely diagnosis and intervention.