"Mickey Mouse" aneurysm presenting with cranial bruit: case report

The production of a bruit associated with intracranial aneurysms is very rare. A patient with a bilobed aneurysm of the middle cerebral artery who was otherwise asymptomatic was admitted with both a subjective and an objective bruit. The bruit resolved with elective clipping of the aneurysm. After a thorough review of the literature, a total of 12 cases of proved intracranial aneurysms were found with associated bruit. Five of those were carotid artery aneurysms within the cavernous sinus. Most (67%) of those patients reviewed were admitted with hemorrhage that was present either into the cavernous sinus or in the form of subarachnoid hemorrhage, with the bruit only secondarily noted. A possible explanation for the production of bruits caused by intracranial aneurysms is discussed. We conclude that, although an audible bruit as the presenting symptom of an intracranial aneurysm is quite rare, it deserves serious surgical considerations.