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Japanese

A CASE REPORT OF RUPTURED LENTICULOSTRIATE ARTERY ANEURYSM WITH ARTERIOVENOUS MALFORMATION Hidenori Ohta 1 , Zentaro Ito 1 , Kenji Nakajima 1 , Hitoshi Fukasawa 2 , Kazuo Uemura 3 1Department of Surgical Neurology Research Institute for Brain and Blood Vessels-Akita 2Department of Pathology, Research Institute for Brain and Blood Vessels-Akita 3Department of Radiology, Research Institute for Brain and Blood Vessels-Akita pp.839-846
Published Date 1980/8/1
DOI https://doi.org/10.11477/mf.1406204632
  • Abstract
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It is well known that the perforating arteries harbor the microaneurysms which cause the hyper-tensive intracerebral hemorrhage. But, aneurysms of these perforating arteries are rarely visualized by the routine cerebral angiography. We experi-enced the ruptured aneurysm (φ6 mm) of enlarged lenticulostriate artery (LSA, φ1 mm) which was one of the feeders of accompaning arteriovenous malformation (AVM). This aneurysm is not only rare in its incidence but also interesting in the mechanism of growth.

A normotensive 26-year-old man was admitted to our hospital in comatose state. He had the history of surgical evacuation of intracerebral hematoma (about 30 ml) three years before under the diagnosis of spontaneous subcortical hematoma situated at the posterior part of basal ganglia on the right side. Angiographycally, there had been no evidence of aneurysm or AVM, but the early venous filling which drained via medullary vein to internal cerebral vein had been clearly visualized.

Neuroradiological examinations after the admis-sion to our hospital were as follows. CT scan showed the massive intracerebral hematoma at the right basal ganglionic region with ventricular rup-ture. Right carotid angiography revealed a newly developed aneurysm of LSA with extravasation and AVM at the right posterior part of operculum. Draining vein, only faintly visualized, was the enlarged medullary vein.

Immediately after the examinations, emergency evacuation of hematoma (120 ml) was done, aneu-rysm and its parent artery (LSA) were resected for the histological examination. Microscopic examina-tion confirmed this as a true saccular aneurysm of LSA. Compared with preperative angiogram, the draining vein are visualized more clearly by the postoperative follow-up angiogram.

There have been many reports concerning the pathogenesis of saccular aneurysms which are sum-med up as congenital, acquired and combined theory. In recent years, many researchers commonly sup-port the combined theory, which the congenital medial defects of vessel-walls plus acquired factors such as the hemodynamic stress will cause the saccular aneurysms.

We concluded that this rare LSA aneurysm had been developed by the hemodynamic stress derived from the accompaning AVM in addition to the congenital abnormalities of vessel-walls such as the medial defect.


Copyright © 1980, 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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