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LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 1  |  Page : 75-76

Mickey Mouse aneurysms: A rare case of bilateral superior cerebellar artery origin aneurysms


Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission21-Nov-2013
Date of Decision27-Nov-2013
Date of Acceptance02-Feb-2014
Date of Web Publication7-Mar-2014

Correspondence Address:
Vivek Joseph
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.128331

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How to cite this article:
Gupta A, Nair BR, Joseph V. Mickey Mouse aneurysms: A rare case of bilateral superior cerebellar artery origin aneurysms. Neurol India 2014;62:75-6

How to cite this URL:
Gupta A, Nair BR, Joseph V. Mickey Mouse aneurysms: A rare case of bilateral superior cerebellar artery origin aneurysms. Neurol India [serial online] 2014 [cited 2022 Aug 7];62:75-6. Available from: https://www.neurologyindia.com/text.asp?2014/62/1/75/128331


Sir,

Superior cerebellar artery (SCA) aneurysms are rare, accounting for 0.2-1.7% of all intracranial aneurysms. [1],[2] They can generally occur at the junction of the basilar artery and the SCA (laterobasilar aneurysm), and distally in the SCA (hemipheric aneurysm). Proximal SCA aneurysms are more common than the distal variety. [2] Endovascular stenting as well as surgical clipping are both equally effective methods of treatment for these aneurysms. [3],[4] Literature review could reveal only one case report of a bilateral distal (hemispheric) SCA aneurysm. To the best of our knowledge, aneurysms arising bilaterally at the SCA origin have not been reported in the literature until date, hence this case report.

A 57-year-old male patient presented with two episodes of loss of consciousness associated with severe headache and multiple episodes of vomiting, but no neurological deficits. Magnetic resonance imaging brain showed subarachnoid hemorrhage, predominantly in the superior cerebellar cistern. Cerebral four vessel angiography showed a Mickey Mouse appearance with two wide necked, lobulated saccular aneurysms at the origins of SCAs bilaterally [Figure 1]. The patient underwent a Guglielmi detachable coil coiling of the right sided aneurysm and was being followed-up for the left sided aneurysm.
Figure 1: Anteroposterior view of left vertebral artery injection, showing bilateral saccular aneurysms at the origins of the superior cerebellar arteries

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The etiopathogenesis of multiple intracranial aneurysms has not been clearly understood. The possible implicated risk factors include age, female sex, hypertension, smoking, alcohol, postmenopausal state or a family history of cerebrovascular disease. [5] However, the presence of these risk factors alone may not predispose an individual to the formation of mirror aneurysms. Hence, we propose a two-hit theory as a possible mechanism for the formation of symmetrical aneurysms, analogous to the two-hit theory applicable to genetic mutations and phenotypic variations. The first hit is a congenital defect in the intracranial vasculature or a defect in the embryogenesis of the vessels themselves. An example of a congenital defect would be an absence of the muscularis media at certain sites within the intracranial vasculature, particularly at the bifurcating apex of an artery which has been termed as "medial defect of Forbus". [6] These defects predispose an individual to the formation of multiple intracranial aneurysms, but not until the "second hit" has been delivered, which could be either of the risk factors mentioned (hypertension, smoking) or the biomechanical hemodynamics of blood flow in particular regions of the intracranial vasculature. The cumulative effect of these genetic and acquired factors produces degenerative changes within the elastic lamina in the deficient areas, which could predispose to aneurysm formation.

 
  References Top

1.Senveli ME, Aciduman A, Belen D. Giant distal superior cerebellar artery aneurysm: Case report and review of the literature. Turk Neurosurg 2008;18:177-82.  Back to cited text no. 1
    
2.Peluso JP, van Rooij WJ, Sluzewski M, Beute GN. Superior cerebellar artery aneurysms: Incidence, clinical presentation and midterm outcome of endovascular treatment. Neuroradiology 2007;49:747-51.  Back to cited text no. 2
    
3.Haw C, Willinsky R, Agid R, TerBrugge K. The endovascular management of superior cerebellar artery aneurysms. Can J Neurol Sci 2004;31:53-7.  Back to cited text no. 3
    
4.Gács G, Viñuela F, Fox AJ, Drake CG. Peripheral aneurysms of the cerebellar arteries. Review of 16 cases. J Neurosurg 1983;58:63-8.  Back to cited text no. 4
    
5.Ellamushi HE, Grieve JP, Jäger HR, Kitchen ND. Risk factors for the formation of multiple intracranial aneurysms. J Neurosurg 2001;94:728-32.  Back to cited text no. 5
    
6.Sekhar LN, Heros RC. Origin, growth, and rupture of saccular aneurysms: A review. Neurosurgery 1981;8:248-60.  Back to cited text no. 6
    


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