Teaching NeuroImages Neurology Resident and Fellow Section 2018 American Academy of Neurology Giordan et al Giordan et al 47 yearold male with history of smoking and hypertension ID: 715033
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Rupture and spontaneous resolution of a P1 perforator pseudoaneurysm
Teaching NeuroImages Neurology Resident and Fellow Section
© 2018 American Academy of Neurology
Giordan et al.Slide2
Giordan et al.
47
year-old male
with history of smoking and hypertension
Sudden onset of headache
Admission Head CT showed subarachnoid hemorrhage with epicenter in the interpeduncular cistern
Develops progressive
ophthalmoplegia and brain MRI documented bilateral thalamic infarctsAdmission catheter angiography showed no vascular lesions Repeat catheter angiography four days later showed a 2 mm dissecting pseudoaneurysm of a thalamoperforator artery The pseudoaneurysm was managed conservatively and a follow-up catheter angiogram six weeks later demonstrated spontaneous obliteration
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© 2018 American Academy of NeurologySlide3
Giordan et al.
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© 2018 American Academy of NeurologySlide4
Rupture and spontaneous resolution of a P1 perforator pseudoaneurysm
Dissecting pseudoaneurysms of perforating posterior circulation vessels can present with a pattern suggestive of perimesencephalic SAH.
Presence of neurological deficits should increase the level of suspicion.
Spontaneous resolution
can occur without invasive treatment [1].
Giordan
et al.
© 2018 American Academy of Neurology