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Neurosurgical Review

, Volume 39, Issue 4, pp 711–716 | Cite as

A 54-year-old man with 12 intracranial aneurysms and familial subarachnoid hemorrhage: case report

  • Sayied Abdol Mohieb HosaineyEmail author
  • Torstein R. Meling
Case Report

Abstract

Unruptured intracranial aneurysms occur in 1–3 % of the general population, and the risk of rupture is generally considered to be low. However, patients with multiple aneurysms and familial predisposition carry a particular risk of subarachnoid hemorrhage (SAH). A 54-year-old hypertensive man underwent screening with a head CT angiography (CTA) because of his comorbidities. CTA revealed multiple bilateral aneurysms around the circle of Willis. At first surgery, seven aneurysms were clipped (BA, ACOM, ICA ×2, and MCA ×3), two of which were detected intraoperatively only. During the second surgery, another three aneurysms were surgically clipped (PCOM and MCA ×2), one of which was detected intraoperatively. Follow-up angiography revealed another two aneurysms. A PCOM aneurysm was treated by coil embolization and a VA aneurysm clipped surgically during a third admission. The patient made an uneventful recovery. However, 4 months after his second surgery, his daughter underwent surgical clipping of a right-sided ICA aneurysm. This case report highlights both the importance of screening of high risk patients with family history of SAH, as well as its limitations, as our patient developed two de novo aneurysms during 6-month follow-up and CTA preoperatively missed three small aneurysms.

Keywords

Endovascular coil embolization Familial subarachnoid hemorrhage Unruptured intracranial aneurysm Multiple aneurysms Subarachnoid hemorrhage Surgical clipping 

Abbreviations

ACA

Anterior cerebral artery

ACOM

Anterior communicating artery

AChoA

Anterior choroidal artery

BA

Basilar artery

FIA

Familial intracranial aneurysm

ICA

Internal carotid artery

IA

Intracranial aneurysm

ISUIA

International Study of Unruptured Intracranial Aneurysms

MCA

Middle cerebral artery

OR

Odds ratio

PCOM

Posterior communicating artery

SAH

Subarachnoid hemorrhage

VA

Vertebral artery

Notes

Compliance with ethical standards

Written informed consent was obtained from the patient.

Financial disclosure

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Sayied Abdol Mohieb Hosainey
    • 1
    Email author
  • Torstein R. Meling
    • 1
  1. 1.Department of NeurosurgeryOslo University HospitalOsloNorway

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