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NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1481-1482

An Unusual Association of Hemihypertrophy with Extracranial and Intracranial Aneurysms


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

Date of Submission16-Aug-2018
Date of Decision15-Dec-2019
Date of Acceptance19-Jul-2020
Date of Web Publication30-Oct-2021

Correspondence Address:
Gaurav Goel
Department of Neurosciences, Medanta, The Medicity, Gurgaon, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.329600

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How to cite this article:
Mahajan A, Goel G, Banga V, Das B. An Unusual Association of Hemihypertrophy with Extracranial and Intracranial Aneurysms. Neurol India 2021;69:1481-2

How to cite this URL:
Mahajan A, Goel G, Banga V, Das B. An Unusual Association of Hemihypertrophy with Extracranial and Intracranial Aneurysms. Neurol India [serial online] 2021 [cited 2021 Dec 3];69:1481-2. Available from: https://www.neurologyindia.com/text.asp?2021/69/5/1481/329600




A 13-year-old male presented to the neurointervention surgery clinic with complaints of overgrowth of the right side of the face and right lower limb. He also had pulsatile cord-like swelling in the right temporal region [Figure 1]a,[Figure 1]b,[Figure 1]c. Magnetic resonance imaging (MRI) brain was done, which showed incidental nonspecific focal white matter hyperintensities on fluid-attenuated inversion recovery (FLAIR) sequence and T2-weighted imaging in right centrum semiovale [Figure 1]d. No extracranial abnormality was detected on MRI. In addition, there was oval-shaped flow void in the right sylvian fissure likely suggestive of intracranial aneurysm. Two-dimensional echocardiography and ultrasound abdomen were unremarkable. Digital subtraction angiography of cerebral vessels was performed, which showed right middle cerebral artery trifurcation dissecting fusi-saccular aneurysm incorporating the M2 segment branches origin [Figure 1]e,[Figure 1]f,[Figure 1]g and another dissecting fusiform aneurysm in the V4 segment of right vertebral artery [Figure 1]h. There was also an aneurysm in right distal superficial temporal artery [Figure 1]i corresponding to the swelling in right temporal region on local examination. Patient was advised endovascular treatment, but the patient was lost to follow up. There are many overgrowth syndromes with complex vascular anomalies described in literature.[1],[2],[3],[4],[5] The association of hemihypertrophy with cerebrovascular abnormalities has rarely been described in literature.[3],[4] This is an unusual case of hemihypertrophy of right face and lower limb with nonspecific white matter hyperintensities on MRI brain associated with intracranial and extracranial aneurysm that, to the best of the authors' knowledge, this association has not been reported in the literature. The present case also emphasizes the importance of cerebral vascular imaging in patient presented with hemihypertrophy of face and limb.
Figure 1: Hemihypertrophy of right face and right lower limb (a and b). Cord-like swelling over the right temporal region (c). MRI shows white matter focal hyperintensities on FLAIR sequence (d). Large fusisaccular dissecting MCA trifurcation aneurysm incorporating the M2 segment branches origin (e-g). Dissecting fusiform aneurysm in the V4 segment of right vertebral artery (h). Right external carotid artery injection shows a contrast filled outpouching from the distal superficial temporal artery (i)

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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.
Gucev ZS, Tasic V, Jancevska A, Konstantinova MK, Pop Jordanova N, Trajkovski Z, et al. Congenital lipomatous overgrowth, vascular malformations, and epidermal nevi (CLOVE) syndrome: CNS malformations and seizures may be a component of this disorder. Am J Med Genet A 2008;146:2688-90.  Back to cited text no. 1
    
2.
Alomari AI, Chaudry G, Rodesch G, Burrows PE, Mulliken JB, Smith ER, et al. Complex spinal paraspinal fast flow lesions in CLOVES syndrome: Analysis of clinical and imaging findings in 6 patients. AJNR Am J Neuroradiol 2011;32:1812-7.  Back to cited text no. 2
    
3.
Fischer EG, Strand RD, Shapiro F. Congenital hemihypertrophy and abnormalities of the cerebral vasculature. Report of two case. J Neurosurg 1984;61:163-8.  Back to cited text no. 3
    
4.
Kim YW, Kim N, Hwang JM, Choung HK, Khwarg S. Teaching NeuroImages: Multiple giant intracranial aneurysms in Klippel-Trenaunay syndrome. Neurology 2013;81:17-8.  Back to cited text no. 4
    
5.
Baldauf J, Kiwit J, Synowitz M. Cerebral aneurysms associated with von Recklinghausen's neurofibromatosis: Report of a case and review of the literature. Neurol India 2005;53:213-5.  Back to cited text no. 5
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