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A CASE OF AN ANEURYSM ARISING IN ABNORMAL INTRACRANIAL VASCULAR NETWORKS Akira Kamisasa 1 , Hideo Hiratsuka 1 , Yutaka Inaba 1 1Department of Neurosurgery, Tokyo Medical and Dental University, School of Medicine pp.463-468
Published Date 1972/4/1
DOI https://doi.org/10.11477/mf.1406203098
  • Abstract
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A case of an aneurysm arising in abnormal vas-cular networks at the base of the brain is reported.

The 34 year old man has been hemiplegic on the left since the first attack of subarachnoid hemorrhage (SAH) 15 years ago. He had second attack of SAH in Nov. 1970, and he was admitted to ourdepartment 3 weeks later.

On admittion, physical examination was normal except for Wernicke-Mann's posture of the left. Meningeal signs were absent, and cerebrospinal fluid was clear.

Cerebral angiographic findings are as follows :

1) Cervical internal carotid arteires are slendererthan normal, and they are narrowed just above anddistally from the beginning of posterior communi-cating arteries (Fig. 1,2 and 4).

2) Left middle cerebral artery is normal in itscourse except for its narrowing in Mi (Fig. 1,2and 3). Right middle cerebral artery is not visible(Fig. 1 and 4).

3) Ai portion of anterior cerebral artery isopacified bilaterally (Fig. 1), but right pericallosalartery is visualized via rete mirabile anastomosisand engorged anterior and posterior ethmoidalarteries (Fig. 4).

4) Posterior circulation is normal, and anasto-mosis via dorsal percallosal artery is abundant(Fig. 5).

5) Abnormally dilated perforating arteries arederived from A1 (right), A1 and M1 (left), posteriorcommunicating arteries and posterior cerebral art-eries.

6) An ball-shaped aneurysm is found in thebasal vascular networks i. e. probably in the vici-nity of the left basal ganglia (Fig 1,2 and 3).

7) Cerebral angiographies just after the secondSAH revealed moderate vasospasm of the vesselsaround the aneurysm (Fig. 6 and 7).

The authors discussed the genesis of and thecorrelation between the abnormal vascular net-works and the aneurysm. We concluded that theaneurysm arose from one of the dilated perforatingarteries of the abnormal basal vascular networksbecause of its fragility. It is surmised that thefirst SAH was due to the fragility of the vascularnetworks and the second to the ruptured aneurysm.


Copyright © 1972, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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