Intracranial pseudoaneurysms are rare, particularly in children and adolescents. They are characterized by the presence of organizing hematoma and fibrosis without true vascular elements. Most pseudoaneurysms result from events such as major trauma or infectious illness, and the development of pseudoaneurysm without a preceding incident is rare. We here describe a patient with a large pseudoaneurysm arising in the distal middle cerebral artery. A 10-year-old boy experienced a sudden onset of headache, nausea, and vomiting followed by loss of consciousness and was referred to our medical center. Brain computed tomography showed massive subcortical hemorrhage in the left temporal lobe. Digital cerebral angiography revealed a huge aneurysmal dilatation of the distal left M1 segment of the middle cerebral artery, with delayed filling and emptying of contrast media. Surgical resection of the aneurysm with evacuation of the hematoma yielded restoration of consciousness. Although the cause of aneurysm in this case is uncertain, this type of patient is seldom encountered; its etiology and mechanisms of onset are discussed with reference to the literature.

Keywords:
Intracranial aneurysm, Pseudoaneurysm
1.
Buckingham MJ, Crone KR, Ball WS, Tomsick TA, Berger TS, Tew JM Jr: Traumatic intracranial aneurysms in childhood: two cases and review of the literature. Neurosurgery 1988;22:398–408.
2.
Heiskanen O: Ruptured intracranial arterial aneurysms of children and adolescents. Surgical and total management results. Childs Nerv Syst 1989;5:66–70.
3.
Uzan M, Cantasdemir M, Seckin MS, Hanci M, Kocer N, Sarioglu AC, Islak C: Traumatic intracranial carotid tree aneurysms. Clinical study. Neurosurgery 1988;43:1314–1322.
4.
Ventureyra EC, Higgins MJ: Traumatic intracranial aneurysms in childhood and adolescence. Case reports and review of the literature. Childs Nerv Syst 1994;10:361–379.
5.
Yi HJ, Kim KM, Ko Y, Kim YS, Oh SJ, Oh SH: Giant pseudoaneurysm in adolescent. Childs Nerv Syst 2006;22:8–12.
6.
Piatt JH Jr, Clunie DA: Intracranial arterial aneurysm due to birth trauma. Case report. J Neurosurg 1992;77:799–803.
7.
Wojtacha M, Bazowski P, Mandera M, Krawczyk I, Rudnik A: Cerebral aneurysms in childhood. Childs Nerv Syst 2001;17:37–41.
8.
Senegor M: Traumatic pericallosal aneurysm in a patient with no major trauma. Case report. J Neurosurg 1991;75:475–477.
9.
Ostergaard JR: Aetiology of intracranial saccular aneurysms in childhood. Br J Neurosurg 1991;5:575–580.
10.
Piepgras DG, McGrail KM, Tazelaar HD: Intracranial dissection of the distal middle cerebral artery as an uncommon cause of distal cerebral artery aneurysm. Case report. J Neurosurg 1994;80:909–913.
11.
Proust F, Toussaint P, Garnieri J, Hannequin D, Legars D, Houtteville JP, Freger P: Pediatric cerebral aneurysms. J Neurosurg 2001; 94:733–739.
12.
Nishio A, Sakaguchi M, Murata K, Egashira M, Yamada T, Izuo M, Nakanishi N: Anterior communicating artery aneurysm in early childhood. Report of a case. Surg Neurol 1991;35:224–229.
13.
Meyer FB, Sundt TM Jr, Fode NC, Morgan MK, Forbes GS, Mellinger JF: Cerebral aneurysms in childhood and adolescence. J Neurosurg 1989;70:420–425.
14.
Chedid MK, Vender JR, Harrison SJ, McDonnell DE: Delayed appearance of a traumatic intracranial aneurysm. Case report and review of the literature. J Neurosurg 2001;94:637–641.
15.
Raju BS, Purohit AK, Murthy SR, Sundaram C, Sanjay T: Traumatic distal anterior cerebral artery aneurysm in a child: a case report. Neurol India 2001;49:295–298.
16.
Tamaki M, Ohno K, Matsushima Y, Kuroiwa T: Coexistence of cerebral aneurysm and angiographically occult AVM in the occipital lobe: a case report. No Shinkei Geka 1992;20:267–271.
17.
Nakashima S, Shimokawa S, Nakagawa S, Tomokiyo M, Furukawa Y, Anegawa S, Hayashi T: A case of aneurysm of the peripheral middle cerebral artery undetectable on preoperative angiogram. No Shinkei Geka 2001;29:545–549.
© 2008 S. Karger AG, Basel
2008
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.