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MRI locates a posterior fossa aneurysm in the fourth ventricle
H J Schelhaas1, P J Brouwers, H E van der Aa
1Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands.
Abstract:
We report a rare case of a ruptured aneurysm of the choroidal branch of the left posterior inferior cerebellar artery (PICA) located in the fourth ventricle. Digital subtraction angiography revealed this PICA aneurysm but the exact location remained unknown. The unique location in the fourth ventricle was subsequently shown by magnetic resonance imaging (MRI). The patient died and the final diagnosis was confirmed by autopsy. To our knowledge, this is one of the few reported cases of a PICA aneurysm in the fourth ventricle and the only one which was confirmed by the combination of MRI and autopsy.
Insights
A rare ruptured aneurysm of the choroidal branch of the posterior inferior cerebellar artery (PICA) was found in the fourth ventricle. This case, confirmed by MRI and autopsy, is one of few reported PICA aneurysms in this location.
Area of Science:
- Neurology
- Vascular Neurosurgery
- Radiology
Background:
- Aneurysms in the posterior circulation, particularly the posterior inferior cerebellar artery (PICA), are uncommon.
- Aneurysms within the fourth ventricle pose unique diagnostic and management challenges due to their location.
Observation:
- A rare case of a ruptured PICA aneurysm presenting within the fourth ventricle is described.
- Initial digital subtraction angiography identified the aneurysm but could not precisely localize it.
- Magnetic resonance imaging (MRI) successfully delineated the unique intraventricular location.
Findings:
- The ruptured PICA aneurysm was uniquely situated in the fourth ventricle.
- The diagnosis was definitively confirmed through post-mortem autopsy.
- This represents one of the few documented instances of a PICA aneurysm in the fourth ventricle.
Implications:
- Highlights the importance of advanced imaging like MRI for precise localization of rare cerebrovascular lesions.
- Emphasizes the rarity and diagnostic difficulty of intraventricular PICA aneurysms.
- Contributes to the limited literature on fourth ventricular aneurysms, aiding future clinical understanding and treatment strategies.