Distal posterior cerebral artery aneurysm associated with multiple aneurysms

Area of Science:

• Neurology
• Vascular Surgery
• Neuroradiology

Background:

• True congenital peripheral aneurysms of cerebral arteries are exceptionally rare.
• These aneurysms may represent a distinct pathological entity requiring specific diagnostic and therapeutic approaches.
• Previous literature lacks reports on associations between multiple peripheral cerebral aneurysms involving different arterial territories.

Observation:

• A 37-year-old male presented with sudden loss of consciousness.
• Cerebral angiography identified multiple nonmycotic peripheral aneurysms: a distal posterior cerebral artery (PCA) aneurysm, aneurysms of the distal middle cerebral artery (MCA), the basilar artery (BA)-superior cerebellar artery (SCA) junction, and the MCA trunk.
• The distal PCA aneurysm was identified as the source of subarachnoid hemorrhage.

Findings:

• Surgical clipping of the distal PCA aneurysm and endovascular treatment of other aneurysms were performed in a single procedure.
• Pathological examination of the PCA aneurysm sac excluded infectious (nonmycotic) etiology.
• This case represents the first reported instance of nonmycotic peripheral aneurysms involving both the MCA and PCA territories simultaneously.

Implications:

• The findings suggest that congenital peripheral aneurysms can present as multiple lesions in diverse cerebral locations.
• This case expands the understanding of rare cerebrovascular anomalies and their potential associations.
• Further research is warranted to elucidate the pathogenesis and clinical significance of such complex aneurysm presentations.