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|Year : 2018 | Volume
| Issue : 3 | Page : 884-886
Large serpentine aneurysm of the anterior cerebral artery
Amith S Kumar1, Julie Sachdeva1, Neeraj Balaini1, Ritu Shree1, Manoj K Goyal1, Vivek Lal1, Chirag Ahuja2
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 Publication||15-May-2018|
Dr. Manoj K Goyal
Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|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
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. 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, and its occurrence in the ACA is extremely rare. 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], details serpentine aneurysms reported in the world literature. Parent artery occlusion (PAO) by one of the endovascular techniques is the preferred line of management.
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