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Intracranial pseudoaneurysm due to rupture of a saccular aneurysm mimicking a large partially thrombosed aneurysm (“ghost aneurysm”)

Radiological findings and therapeutic implications in two cases

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Abstract

Intracranial pseudoaneurysm formation due to ruptured non-traumatic saccular aneurysm is extremely rare. We experienced two cases of large pseudoaneurysm formation due to rupture of a saccular aneurysm. The neuroradiological ghost-like appearance of the aneurysms led to misdiagnoses as large partially thrombosed aneurysm. Two cases of large intracranial pseudoaneurysm formation due to rupture of a saccular aneurysm occurred in a 77-year-old comatose woman with an aneurysm on the anterior wall of the internal carotid artery and a 73-year-old comatose woman with an anterior cerebral artery (azygos) aneurysm. Both patients suffered subarachnoid hemorrhage associated with intracerebral and intraventricular hematomas. Angiography showed peculiar “ghost-like” appearance of the aneurysm including delayed filling, changing shape, retention of the contrast material after the venous phase, and unclear location of neck. Neck clipping surgeries were performed, but were difficult because of the preoperative misdiagnosis as large partially thrombosed aneurysm. The entity of “ghost aneurysm” caused by rupture of a saccular aneurysm should be considered in the clinical diagnosis.

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Acknowledgement

We thank Mrs Mie Ohnuma for helping with the preparation of the manuscript and figures.

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Authors and Affiliations

  1. Department of Neurosurgery, Izunagaoka Hospital, Juntendo University, 1129 Nagaoka, Izunagaoka-cho, Tagata-gun, Shizuoka 410-2295, Japan

    Kentaro Mori, Chinatsu Kasuga, Yasuaki Nakao, Takuji Yamamoto & Minoru Maeda

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  1. Kentaro Mori
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  2. Chinatsu Kasuga
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  3. Yasuaki Nakao
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  4. Takuji Yamamoto
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  5. Minoru Maeda
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Correspondence to Kentaro Mori.

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Mori, K., Kasuga, C., Nakao, Y. et al. Intracranial pseudoaneurysm due to rupture of a saccular aneurysm mimicking a large partially thrombosed aneurysm (“ghost aneurysm”). Neurosurg Rev 27, 289–293 (2004). https://doi.org/10.1007/s10143-004-0336-7

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  • DOI: https://doi.org/10.1007/s10143-004-0336-7

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