Controversy in the Management of Lenticulostriate Artery Dissecting Aneurysm: A Case Report and Review of the Literature

Lama, Sanju; Dolati, Parviz; Sutherland, Garnette R.

doi:10.1016/j.wneu.2012.12.006

Cited by 21 publications

(18 citation statements)

References 22 publications

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“…Although these modalities offer good sensitiv ity, 29 LSA aneurysms are nonetheless difficult to detect. Of the 46 cases reported in the literature, there were 8 CTA studies 4,7,8,16,19,22,39,43 of which 3 were negative 4,8,19 and 3 MRA studies 17,25,32 of which 1 was negative. 32 All 3 of our patients underwent MRI with an angiographic se quence during the acute phase of the hematoma, but only in 1 case was there evidence of a suspected aneurysm, which was later confirmed on angiography.…”

Section: Discussionmentioning

confidence: 99%

“…22 The natural history of LSA aneurysm rupture and, in particular, the risk of hemorrhage recurrence are poorly understood. Several cases of spontaneous involution free of hemorrhage recurrence have been described in the lit erature.…”

Section: ©Aans 2014mentioning

confidence: 99%

“…Several cases of spontaneous involution free of hemorrhage recurrence have been described in the lit erature. 12,13,22 The surgical or endovascular treatment of these aneurysms is possible but is difficult and risky be cause the lesions are located deep in the brain and close to sensitive cerebral tissues. 11,43 There is thus no clear con sensus on the best therapeutic strategy for the treatment of ruptured LSA aneurysms, and a conservative approach remains an option.…”

Section: ©Aans 2014mentioning

confidence: 99%

“…11,43 There is thus no clear con sensus on the best therapeutic strategy for the treatment of ruptured LSA aneurysms, and a conservative approach remains an option. 12,15,22 We report on 3 cases of ruptured LSA aneurysms resulting in deep intraparenchymal he matomas. One of these patients presented with a very uncommon bilateral hematoma.…”

Section: ©Aans 2014mentioning

confidence: 99%

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Rupture of lenticulostriate artery aneurysms

Heck¹,

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Lacour

et al. 2014

JNS

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The authors report on 3 rare cases of ruptured lenticulostriate artery (LSA) aneurysms that were heralded by deep cerebral hematomas. The hematomas were unilateral in 2 cases and bilateral in 1; in the bilateral case, only a single LSA aneurysm could be identified on the right side of the brain. Because of their small size (≤ 2 mm), fusiform aspect, and deep location within the brain, all of the aneurysms were treated conservatively. There was no hemorrhage recurrence, and followup angiography demonstrated spontaneous thrombosis in 2 of the 3 cases. The clinical course was favorable in 2 of the 3 patients. The course in the patient with the bilateral hematoma was marked by an ischemic event after the initial episode, resulting in an aggravation of deficits. The cause of this second event was uncertain.Because our knowledge about the natural history of LSA aneurysms is incomplete, there is no consensus con cerning a therapeutic strategy. The authors' experience in 3 reported cases leads them to think that a conservative ap proach involving close angiographic monitoring may be proposed as first-line treatment. If the monitored aneurysm then persists or grows in size, its occlusion should be considered. Nonetheless, other studies are needed to further strengthen the legitimacy of this strategy. (http://thejns.org/doi/abs/10.3171/2013.8.JNS13608) key WOrDs • lenticulostriate artery • aneurysm • cerebral hemorrhage • intracerebral hematoma • stroke • vascular disorders Abbreviations used in this paper: AVM = arteriovenous malfor mation; CTA = CT angiography; IVH = intraventricular hemor rhage; LSA = lenticulostriate artery; MRA = MR angiography; mRS = modified Rankin Scale; SAH = subarachnoid hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Section: ©Aans 2014mentioning

confidence: 99%

Section: ©Aans 2014mentioning

confidence: 99%

Section: ©Aans 2014mentioning

confidence: 99%

See 2 more Smart Citations

Rupture of lenticulostriate artery aneurysms

Heck¹,

Anxionnat

Lacour

et al. 2014

JNS

View full text Add to dashboard Cite

show abstract

“…AChA aneurysms comprise 2–5% of the intracranial aneurysms,12 13 and fewer than 60 cases of true LSA aneurysms have been reported 14 15. Owing to the small number of angiographically detected LSA aneurysms, the natural history of these aneurysms is unclear 16–18…”

Section: Discussionmentioning

confidence: 99%