Atormac
briv
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 3026  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (912 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed138    
    Printed0    
    Emailed0    
    PDF Downloaded8    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 1109-1110

Large Ophthalmic Artery Aneurysm Presented as Isolated Basifrontal Hematoma without Subarachnoid Hemorrhage: A Rare Imaging Finding


Neurointervention Surgery, Department of Neurosciences, Medanta, The Medicity, Gurgaon, Haryana, India

Date of Submission24-Feb-2018
Date of Decision16-Apr-2018
Date of Acceptance12-Dec-2019
Date of Web Publication2-Sep-2021

Correspondence Address:
Gaurav Goel
Neurointervention Surgery, Department of Neurosciences, Medanta, The Medicity, Gurgaon, Haryana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.325328

Rights and Permissions



How to cite this article:
Mahajan A, Goel G, Das B, Narang KS. Large Ophthalmic Artery Aneurysm Presented as Isolated Basifrontal Hematoma without Subarachnoid Hemorrhage: A Rare Imaging Finding. Neurol India 2021;69:1109-10

How to cite this URL:
Mahajan A, Goel G, Das B, Narang KS. Large Ophthalmic Artery Aneurysm Presented as Isolated Basifrontal Hematoma without Subarachnoid Hemorrhage: A Rare Imaging Finding. Neurol India [serial online] 2021 [cited 2021 Sep 27];69:1109-10. Available from: https://www.neurologyindia.com/text.asp?2021/69/4/1109/325328




A 38-year-old female, known hypertensive and hypothyroid, presented with a 1-day history of sudden severe headache followed by vomiting. She had a history of gradual diminution of vision on the left side for six months. Non-contrast computed tomography (NCCT) head was done which showed an isodense lesion in left basifrontal region with surrounding hematoma and associated edema [Figure 1]a and [Figure 1]b. There was no evidence of subarachnoid hemorrhage (SAH) on NCCT head. Cerebral angiography was performed which revealed a large left ophthalmic artery aneurysm measuring 19 × 9 mm with neck measuring 4.6 mm. It was projecting superiorly on the frontal and lateral projection of angiogram [Figure 1]c and [Figure 1]d. Ophthalmic artery was arising from the neck of the aneurysm. We performed successful balloon-assisted coiling with preservation of origin of the ophthalmic artery [Figure 1]e. The patient was discharged after seven days without any neurological deficit. Patient came for follow-up angiography after 6 months which showed significant recanalization of the aneurysm with compaction of coil mass [Figure 1]f. The recanalization of the aneurysm was anticipated in our case owing to the large size of the aneurysm. We planned endovascular flow diverter treatment for the recanalized aneurysm. Surpass flow diverter (Stryker Neurovascular, Fremont, CA, USA) 4 × 30 mm was successfully deployed across the neck of the aneurysm from the ophthalmic segment to cavernous segment proximally [Figure 1]g and [Figure 1]h. The patient was advised clinical and angiographic follow-up after three months.
Figure 1: Cranial CT head showed isodense lesion (yellow arrow) in left basifrontal region with surrounding hematoma (red arrow) associated edema (a and b). Cerebral angiography showed a large left ophthalmic artery aneurysm (red arrow) with ophthalmic artery (yellow arrow) origin at the aneurysm neck (c and d). Balloon-assisted coiling was successfully performed with preservation of the origin of ophthalmic artery (yellow arrow) (e). Follow-up 6 months angiography showed significant recanalization (red arrow) of the aneurysm (f). Flow diverter (arrow) was deployed across the neck of the aneurysm (g and h)

Click here to view


There are few reported cases of ruptured aneurysm presented with isolated intracerebral hemorrhage (ICH) in the literature which mainly includes the aneurysm located in distal cerebral arteries.[1] Ruptured aneurysm at the main trunk of the circle of Willis presented with isolated ICH were also reported by other authors.[2],[3],[4] Our literature review yielded 23 cases of isolated intracerebral hematoma due to aneurysm rupture.[1],[2],[3],[4],[5],[6],[7],[8] Multifactorial causes of isolated intracerebral hematoma due to ruptured aneurysm have been documented in the literature.[2],[5] The sensitivity of the NCCT decreases with the delay in the interval time between the symptom onset and imaging which can lead to false-negative imaging result of SAH. There was no significant delay (approximately 9 h) in NCCT head acquisition and time of ictus in our case. Sometimes, the density of brain parenchyma increases due to mass effect of ICH and the blood component in subarachnoid space might be diluted due to squeezing out of ICH. Furthermore, this leads to the superposition effect of aneurysmal ICH causing difficulty in diagnosing underlying minimal SAH. The dome of aneurysm buried into the cerebral parenchyma has also been proposed as another cause. In our case, there was also a large ophthalmic artery aneurysm projecting superiorly and that might be buried into the subpial basifrontal lobe. In addition, the linear relationship between the hematocrit and hemoglobin and the appearance of hyperdensity which is a reflection of electron density on noncontrast head has been described in the literature[6] however, in our case hemoglobin and hematocrit values were normal.[5] To our knowledge, this is the first case report of ruptured large ophthalmic artery aneurysm with isolated intracerebral hemorrhage without any evidence of SAH on NCCT head.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ahn JY, Cho JH, Lee JW. Distal lenticulostriate artery aneurysm in deep intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 2007;78:1401-3.  Back to cited text no. 1
    
2.
Thai QA, Raza SM, Pradilla G, Tamargo RJ. Aneurysmal rupture without subarachnoid hemorrhage: Case series and literature review. Neurosurgery 2005;57:225-9.  Back to cited text no. 2
    
3.
Takeuchi S, Takasato Y, Masaoka H, Hayakawa T, Otani N, Yoshino Y, et al. Case of ruptured middle cerebral artery bifurcation aneurysm presenting as putaminal hemorrhage without subarachnoid hemorrhage. Brain Nerve 2009;61:1171-5.  Back to cited text no. 3
    
4.
Yamamoto N, Terakawa Y, Okada Y, Mitsuhashi Y, Nishio A, Shimotake K, et al. Ruptured internal carotid artery bifurcation aneurysm presenting with only intracerebral hemorrhage without subarachnoid hemorrhage-case report. Neurol Med Chir (Tokyo) 2011;51:117-9.  Back to cited text no. 4
    
5.
Li G, Zhu X, Zhang Y, Zhao J, Gao X, Hou K. Aneurysmal isolated intracerebral hemorrhage and/or intraventricular hemorrhage without subarachnoid hemorrhage: A rare and perplexing scenario in neurosurgical practice. Chin Neurosurg J 2016;2:23.  Back to cited text no. 5
    
6.
Matano F, Murai Y, Nakagawa S, Kato T, Kitamura T, Sekine T, et al. Atypical radiological and intraoperative findings of acute cerebralhemorrhage caused by ruptured cerebral aneurysm in a patient with severe chronic anemia. J Nippon Med Sch 2014;81:264-8.  Back to cited text no. 6
    
7.
Da Costa LB, Valiante T, Terbrugge K, Tymianski M. Anterior ethmoidal artery aneurysm and intracerebral hemorrhage. AJNR Am J Neuroradiol 2006;27:1672-4.  Back to cited text no. 7
    
8.
Scott BA, Weinstein Z, Pulliam MW. Computed tomographic diagnosis of ruptured giant posterior cerebral artery aneurysms. Neurosurgery 1988;22:553-8.  Back to cited text no. 8
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow