Subscribe to RSS
DOI: 10.1055/s-0042-1750712
Spontaneous Obliteration of a Dissecting Aneurysm of Recurrent Artery of Heubner Monitored by Serial Magnetic Resonance Vessel Wall Imaging
Funding None.Abstract
Aneurysms of the recurrent artery of Heubner (RAH) are known to be one of the uncommon cerebral aneurysms, predominantly presenting with bleeding symptoms. Previously, nine cases of the RAH aneurysms have been reported, all of which were treated surgically or endovascularly and most cases developed postoperative cerebral infarct in the ipsilateral caudate nucleus. Herein, we report a man presenting with transient ischemic attack due to diffuse cerebral vasospasm from a minor non-disabling subarachnoid hemorrhage (SAH) from an RAH aneurysm. He visited our hospital 7 days after the first experience of a thunderclap headache complaining with transient unilateral motor weakness and thin SAH in the right sylvian fissure. Diagnostic catheter angiography revealed a dissecting fusiform aneurysm (8 mm in size) originating from the left RAH contralateral to the thin SAH. Contrast-enhanced magnetic resonance vessel wall imaging (MR-VWI) helped to identify the ruptured nature of the RAH aneurysm. Owing to his delayed ischemic condition after minor SAH, he was conservatively treated with serial MR-VWI monitoring. The aneurysm was spontaneously obliterated with an asymptomatic lacunar infarct in the ipsilateral caudate nucleus in a month. Together, this case was considered as the dissecting aneurysm of RAH with a favorable outcome after the conservative management. Although long-term follow-up is mandatory because the disappearance of the vessel wall enhancement does not necessarily secure the permanent cure of the lesion, serial MR-VWI is helpful to diagnose the ruptured nature and monitor its chronological change in combination with conventional radiological imaging techniques.
Note
This paper was presented at Mt. Fuji workshop on CVD held at Sendai, Japan, on August 28, 2021.
Publication History
Article published online:
25 August 2022
© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Wanibuchi M, Kurokawa Y, Ishiguro M, Fujishige M, Inaba K. Characteristics of aneurysms arising from the horizontal portion of the anterior cerebral artery. Surg Neurol 2001; 55 (03) 148-154 , discussion 154–155
- 2 Vellore Y, Madan A, Hwang PYK. Recurrent artery of Heubner aneurysm. Asian J Neurosurg 2014; 9 (04) 244
- 3 Hong CE, Chung Y, Won YS, Chung P-W, Rho MH. Ruptured aneurysm of recurrent artery of Heubner: a case report. Nerve 2019; 5: 94-96
- 4 Bechan RS, van Rooij WJ. Endovascular treatment of a ruptured flow aneurysm of the heubner artery as part of a moyamoya collateral network in a young patient with an occluded middle cerebral artery. Interv Neuroradiol 2014; 20 (06) 791-795
- 5 Mansfield K, Rahme R. Dissecting aneurysm of the recurrent artery of Heubner in a patient with osteogenesis imperfecta. Can J Neurol Sci 2015; 42 (06) 461-465
- 6 Khoo J, Khoo B, Alalade AF, Webster J. Case of recurrent artery of Heubner aneurysm masquerading as partially thrombosed A1 aneurysm radiologically. World Neurosurg 2019; 130: 444-449
- 7 Ogata A, Sakata S, Okamoto H, Abe T. Ruptured dissecting aneurysm of the recurrent artery of Heubner: consideration of pathological findings. Neurol India 2017; 65 (03) 623-625
- 8 Omodaka S, Endo H, Niizuma K. et al. Quantitative assessment of circumferential enhancement along the wall of cerebral aneurysms using MR imaging. AJNR Am J Neuroradiol 2016; 37 (07) 1262-1266