Basilar artery fenestration is infrequent and even rarer in association with a large aneurysm. With proximity to brain stem and vital perforators, endovascular coiling can be considered first. If the large ruptured aneurysm with a wide neck originated from fenestra of the proximal basilar artery and the fenestration loop has branches of posterior circulation, therapeutic consideration should be...

An unruptured aneurysm was incidentally found in the right middle cerebral artery in a 67-year-old woman. During an attempt to turn the temporalis muscle for surgical clipping, systolic blood pressure suddenly increased. After opening the dura mater, we found a subarachnoid hemorrhage and severe brain swelling. We promptly expanded the craniotomy area to reach the aneurysm while pulling part of...

A 22-year-old female patient presented to the Emergency Department of a tertiary care hospital with symptoms of headache and nausea. She has been on a regular follow-up for the preceding three and a half years after being diagnosed as systemic lupus erythematosus (SLE). She had been treated earlier for SLE nephritis in the same institution, and had two relapses of nephrotic syndrome in the last...

A 42-year-old man presented with right hemiparesis. Brain imaging showed acute infarction in the left middle cerebral artery territory and a thrombosed aneurysm (figure). Extracranial carotid artery was normal. EKG and echocardiography were normal. Holter monitoring for 24 hours revealed no cardiac source of embolism. Cerebral infarction is a rare complication of unruptured aneurysm.1 The imagi...

A pure posteriorly posterior communicating artery (PCoA) aneurysm represents a surgical challenge. This is mainly when there need for good exposure of the aneurysmal neck, sac, PCoA, and anterior choroidal arteries. Ruptured directed PCoA imposes significantly extra challenge as surgeon undergoes dissection through tight brain. Even with measures commonly used to attain brain relaxation like lu...

The natural history of unruptured intracranial aneurysms (IAs) is poorly understood. At present, risk factors for aneurysm rupture are limited to demographics and rudimentary anatomic features of the aneurysm. The first sign of aneurysm destabilization and rupture may be subarachnoid hemorrhage, a potentially devastating brain injury with high morbidity and mortality. An emerging body of litera...

We report a case of successful endovascular treatment of bilateral carotid artery occlusion with concurrent basilar apex aneurysm. An elderly female patient with subarachnoid hemorrhage (SAH) onset was admitted to the hospital. Computed tomography (CT) and digital subtraction angiography (DSA) confirmed the presence of bilateral carotid artery occlusion with concurrent basilar apex aneurysm. Br...

A 38-year-old non-smoker man presented with a ruptured aneurysm one month after clipping of a previous aneurysm. He was first admitted because of sudden onset of severe headache. Brain computed tomography showed subarachnoid hemorrhage. Angiography showed an aneurysm of the left anterior choroidal artery which was surgically clipped. Two weeks later, he was discharged without neurological defic...

Inflammatory carotid artery aneurysm is a rare complication of acute paranasal sinusitis. A 50-year-old female presented with a ruptured giant carotid artery aneurysm secondary to infection of the sphenoid sinus and cavernous sinus. She had been healthy until 5 days before admission, when she developed orbital phlegmon and meningitis. She received antibiotic therapy for 10 days. Computed tomogr...

Up to 5% of the population may have an intracranial aneurysm, although many of these people are unaware of its presence. Most intracranial aneurysms remain asymptomatic, but a small proportion of them will rupture and bleed, causing life-threatening complications. Once diagnosed, treatment of aneurysms may include surgery or a minimally invasive endovascular coiling technique. As technologies i...