Abstract
Background
Concomitant intracranial and visceral artery aneurysms are a rare occurrence. We report the case of a patient who underwent surgical repair of a ruptured intracranial aneurysm but subsequently experienced a ruptured hepatic artery aneurysm in the immediate postoperative period.
Methods
A 59-year-old woman presented with a ruptured posterior communicating artery aneurysm and was treated with coil occlusion. On postoperative day 3, she became hypotensive with a rigid abdomen and was found to have a ruptured hepatic artery aneurysm.
Rapid transfusion of packed red blood cells was begun, and the patient was taken to the angiography suite where the hepatic artery aneurysm was identified and successfully occluded using detachable coils to prevent further hemorrhage.
Results
Recovery was complicated by an ileus and mild pulmonary edema. Over several weeks, neurological status and third nerve paresis improved, with eventual discharge to a subacute rehabilitation center. Subsequent follow-up is notable for recurrence of the intracranial aneurysm, and multiple strictures of right intrahepatic arteries and hepatic ducts. The patient is currently being evaluated for liver transplant, but continues to improve neurologically.
Conclusion
Prior to this report, there have only been 2 documented cases of concomitant intracranial and visceral artery aneurysms. These reports serve to remind the clinician that intracranial aneurysms may be only part of a systemic pathology, which should be taken into account when unexpected complications arise postoperatively.
Similar content being viewed by others
References
Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med. 2006;355:928–39.
Carr SC, Pearce WH, Vogelzang RL, McCarthy WJ, Nemcek AA Jr, Yao JS. Current management of visceral artery aneurysms. Surgery. 1996;120:627–34.
DiLuna ML, Bydon M, Gunel M, Johnson MH. Neurological picture. Complications from cervical intra-arterial heroin injection. J Neurol Neurosurg Psychiatry. 2007;78:1198.
Diringer MN. Management of aneurysmal subarachnoid hemorrhage. Crit Care Med. 2009;37:432–40.
Eames PJ, Blake MJ, Dawson SL, Panerai RB, Potter JF. Dynamic cerebral autoregulation and beat to beat blood pressure control are impaired in acute ischemic stroke. J Neurol Neurosurg Psychiatry. 2002;72:467–72.
Eng CW, Venkatesh SK. Clinics in diagnostic imaging (131). Multiple visceral mycotic aneurysms. Singap Med J. 2010;51:824–9. quiz 830.
Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6:1–9.
Fuse T, Takagi T, Yamada K, Fukushima T. Systemic multiple aneurysms of the intracranial arteries and visceral arteries: case report. Surg Neurol. 1996;46:258–62.
Graham J, McCollum C, DeBakey M. Aneurysms of the splanchnic arteries. Am J Surg. 1980;140:797–801.
Kubo S, Nakagawa H, Imaoka S. Systemic multiple aneurysms of the extracranial internal carotid artery, intracranial vertebral artery, and visceral arteries: case report. Neurosurgery. 1992;30:600–2.
Messina LM, Shanley CJ. Visceral artery aneurysms. Surg Clin North Am. 1997;77:425–42.
Neil-Dwyer G, Bartlett JR, Nicholls AC, Narcisi P, Pope FM. Collagen deficiency and ruptured cerebral aneurysms. A clinical and biochemical study. J Neurosurg. 1983;59:16–20.
O’Driscoll D, Olliff SP, Olliff JF. Hepatic artery aneurysm. Br J Radiol. 1999;72:1018–25.
Ostergaard JR, Oxlund H. Collagen type III deficiency in patients with rupture of intracranial saccular aneurysms. J Neurosurg. 1987;67:690–6.
Pope FM, Nicholls AC, Narcisi P, Bartlett J, Neil-Dwyer G, Doshi B. Some patients with cerebral aneurysms are deficient in type III collagen. Lancet. 1981;1:973–5.
Rassias AJ, Harbaugh RE, Corwin HL. Intra-abdominal hemorrhage complicating hypertensive therapy for cerebral vasospasm. Crit Care Med. 1995;23:775–7.
Conflicts of interest
The authors report no conflicts of interest concerning the materials or methods used in this study or findings specified in this paper.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Stetler, W.R., Pandey, A.S. & Mashour, G.A. Intracranial Aneurysm with Concomitant Rupture of an Undiagnosed Visceral Artery Aneurysm. Neurocrit Care 16, 154–157 (2012). https://doi.org/10.1007/s12028-011-9590-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12028-011-9590-z