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NEUROIMAGES
Year : 2018  |  Volume : 66  |  Issue : 3  |  Page : 884-886

Large serpentine aneurysm of the anterior cerebral artery


1 Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Neuroradiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication15-May-2018

Correspondence Address:
Dr. Manoj K Goyal
Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.232329

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How to cite this article:
Kumar AS, Sachdeva J, Balaini N, Shree R, Goyal MK, Lal V, Ahuja C. Large serpentine aneurysm of the anterior cerebral artery. Neurol India 2018;66:884-6

How to cite this URL:
Kumar AS, Sachdeva J, Balaini N, Shree R, Goyal MK, Lal V, Ahuja C. Large serpentine aneurysm of the anterior cerebral artery. Neurol India [serial online] 2018 [cited 2018 Aug 20];66:884-6. Available from: http://www.neurologyindia.com/text.asp?2018/66/3/884/232329




Sir,

A 45-year old woman presented with headache of 15 years duration with sudden worsening, associated with weakness of right upper-lower limb and right upper motor neuron (UMN) facial palsy in 2012. She was managed at a local hospital but no neuroimaging was performed. She had recurrence of similar symptoms in 2016 when she visited our institute and was evaluated. Computed tomography (CT) scan of the head, with and without contrast, showed a large hyperdense lesion at the basal paramedian frontal lobe at the point of distribution of the left anterior cerebral artery (ACA). Calcification was noted in the peripheral portion of the mass [Figure 1]a. Magnetic resonance (MR) images revealed the presence of a giant, partially thrombosed aneurysm with residual flow through a serpiginous lumen within its thrombosed portion [Figure 1]b and [Figure 1]c. Cerebral CT angiography and digital subtraction angiography demonstrated a partially thrombosed giant aneurysm arising from the left ACA [Figure 1]d. The serpiginous lumen filled slowly and supplied blood to two distal left ACA branches arising directly from the lateral aspect of the giant aneurysm. These findings were consistent with a giant serpentine aneurysm arising at the left ACA.
Figure 1: (a) Noncontrast CT scan of head, (b and c) axial T2-weighted and fluid attenuated inversion recovery MR image of the brain, (d) digital subtraction angiography showing thrombosed and calcified giant serpiginous aneurysm of left anterior cerebral artery

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Large serpentine aneurysm was first described by Segal and McLaurin in 1977.[1] It has been defined as a partially thrombosed aneurysm (>25 mm in diameter), with tortuous vascular channels that have separate entry and exit pathways. It is frequently seen in the middle cerebral artery,[2] and its occurrence in the ACA is extremely rare.[3] If unrecognized, it can easily be mistaken for a neoplasm, particularly because it often presents with progressive and recurrent neurologic deficits, with computed tomographic (CT) and magnetic resonance (MR) imaging frequently associated with adjacent edema and mass effect. Cerebral angiography can establish the presence of a giant serpentine aneurysm and provide the anatomic detail necessary for its treatment. [Table 1][3],[8] details serpentine aneurysms reported in the world literature. Parent artery occlusion (PAO) by one of the endovascular techniques is the preferred line of management.
Table 1: Literature review

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Segal HD, McLaurin RL. Giant serpentine aneurysm. Report of two cases. J Neurosurg 1977;46:115-20.  Back to cited text no. 1
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2.
Christiano LD, Gupta G, Prestigiacomo CJ, Gandhi CD. Giant serpentine aneurysms. Neurosurg Focus 2009;26:E5.  Back to cited text no. 2
    
3.
Kim ST, Jeong YG, Jeong HW. Treatment of a giant serpentine aneurysm in the anterior cerebral artery. J Cerebrovasc Endovasc Neurosurg 2016;18:141-6.  Back to cited text no. 3
[PUBMED]    
4.
Biondi A, Jean B, Vivas E, Le Jean L, Boch AL, Chiras J, et al. Giant and large peripheral cerebral aneurysms: Etiopathologic considerations, endovascular treatment, and long-term follow-up. AJNR Am J Neuroradiol 2006;27:1685-92.  Back to cited text no. 4
[PUBMED]    
5.
Amin-Hanjani S, Chen PR, Chang SW, Spetzler RF. Long-term follow-up of giant serpentine MCA aneurysm treated with EC-IC bypass and proximal occlusion. Acta Neurochir (Wien) 2006;148:227-8.  Back to cited text no. 5
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6.
van Rooij WJ, Sluzewski M, Beute GN. Endovascular treatment of giant serpentine aneurysms. AJNR Am J Neuroradiol 2008;29:1418-9.  Back to cited text no. 6
[PUBMED]    
7.
Mahadevan A, Tagore R, Siddappa NB, Santosh V, Yasha TC, Ranga U, et al. Giant serpentine aneurysm of vertebrobasilar artery mimicking dolichoectasia--an unusual complication of pediatric AIDS. Report of a case with review of the literature. Clin Neuropathol 2008;27:37-52.  Back to cited text no. 7
[PUBMED]    
8.
Hsu YW, Kao HW, Lin GY, Lai CH, Lee JT. Giant serpentine aneurysm of the posterior cerebral artery: A rare clinical entity and technical challenge in diagnosis and treatment. Neurol India 2017;65:917-8.  Back to cited text no. 8
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