Giant intracavernous internal carotid artery aneurysm with fatal epistaxis

Haffajee, M.R.; Naidoo, Saloshni

doi:10.1002/ca.10127

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…In adults, this pathology has been described by some authors 3,6,7,[14][15][16][17][18][19][20] . Because of its rarity in adults, and despite what is known from these studies, there is still insufficient information about this disease during adult age 13 .…”

Section: Discussionmentioning

confidence: 99%

Vein of Galen aneurysm in an adult: case report

Lobão

Sassaki

et al. 2006

Arq. Neuro-Psiquiatr.

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-Vein of Galen aneurysm is a rare pathology, representing less than 1% of intracranial vascular malformations. We report on a 65 years-old man who experienced a generalized tonic-clonic seizure. Brain imaging showed a large calcified expanding mass in the pineal region, confirming the diagnosis of a vein of Galen aneurysm. Because of the spontaneous thrombosis of the malformation, there was no need for microsurgical or endovascular treatment and he is been regularly followed since that.KEY WORDS: vein of Galen aneurysm, vein of Galen malformation, cerebral vein, congenital vascular malformation. Aneurisma da veia de Galeno em adulto: relato de casoRESUMO -Aneurisma da veia de Galeno é patologia rara, representando menos de 1% das malformações vasculares intracranianas. Apresentamos o caso de um homem de 65 anos que teve episódio de crise convulsiva tônico-clônica generalizada. Exames de imagem evidenciaram grande processo expansivo calcificado na região pineal, confirmando o diagnóstico de aneurisma trombosado de veia de Galeno. Devido à trombose espontânea da malformação, foi excluída a possibilidade de tratamento endovascular bem como microcirúrgico, mantendo-se o acompanhamento clínico. PALAVRAS-CHAVE: aneurisma da veia de Galeno, mal-formação da veia de Galeno, veias cerebrais, malformação vascular congênita.Vein of Galen aneurysm (VGA) is a rare vascular malformation representing less than 1% of vascular intracranial abnormalities. It is a congenital process frequently detected between the 6 th and 11 th months of gestational age 1 , during early childhood or neonatal period 2 . This finding in adult age is very rare, presenting or not symptoms throughout childhood 3 . Clinical manifestations can present at any age in the form of heart failure, delayed neuropsychomotor development, hydrocephalus and seizures 4 .We describe a case of VGA reporting clinical symptoms, radiological findings and management relating to current published literature. CASEA 65 year-old man was brought to the emergency room at the University Hospital of the Pontifical Catholic University of Paraná, Brazil because of generalized tonic-clonic seizures. On admission, he was treated with anticonvulsant therapy for status epilepticus. Past medical history was significant for treated high blood pressure and heart failure diagnosed late in life. Also significant for an episode of ischemic cerebrovascular disease two years before, resulting in left hemiparesis. During childhood and adult life there was no neuropsycomotor development delay, no signs of cardiopathy, no neurological signs or symptoms as well as no history of epilepsy.CT scan showed a calcified expanding process in the pineal region (Fig 1). MRI showed a heterogenic roundshaped mass localized in the supra-vermian cistern with dimensions of 35x32x30 mm showing high signal in T2-weight imaging (Fig 2). The MRI images were suggestive of a thrombosed VGA. Cerebral angiography showed a thrombosed VGA also (Fig 3).Considering the fact that the aneurysm was already thrombosed ...

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Section: Discussionmentioning

confidence: 99%

Vein of Galen aneurysm in an adult: case report

Lobão

Sassaki

et al. 2006

Arq. Neuro-Psiquiatr.

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“…Detection of a vein of Galen aneurysm in an adult person is a rare event (Abe et al, 1996;Shin et al, 2000;Cordonnier et al, 2002;Haffajee and Naidoo, 2003). Intracranial hemorrhage is the most frequent presentation, mainly due to bleeding of a vessel distal to the venous ectasia rather than to laceration of the vein of Galen itself (Lasjaunias et al, 1987).…”

Section: Discussionmentioning

confidence: 99%

Vein of Galen aneurysm: Anatomical study of an adult autopsy case

et al. 2004

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We present a case of vein of Galen aneurysmal malformation in an adult, the rupture of which caused a fatal hemorrhage. Macroscopic examination, together with plastination of specimen with S10, and microscopic examination showed connection of the aneurysm with the right thalamoperforating artery and, bilaterally, with the posterior choroidal and mesencephalic arteries. Histology also showed thinning of the aneurysmal wall, due to marked reduction of the muscular media at the point of rupture, and its connection with an arteriovenous malformation of the left thalamus. A review of the anatomy of the Galenic system shows that the medullary veins curve at an acute angle to form the paired internal cerebral veins, with a sudden change in flow and that, from late fetal life, the vein of Galen curves around the splenium to enter the straight sinus at an angle opposing its flow. Based on anatomical study and a review of the literature, we suggest that aneurysmatic dilatation of the vein of Galen may result from a combination of pathological and predisposing anatomical factors. The anatomical characteristics of the origin of the internal cerebral veins and of the entry of the vein of Galen into the straight sinus make particularly susceptible to the hemodynamic effects of arteriovenous shunts the vein of Galen itself, which is situated in the cisterna ambiens, an anatomical space that does not impede its enlargement.

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“…15) Traumatic intracavernous ICA aneurysms causing fatal epistaxis are sometimes encountered. 5) However, massive epistaxis from a nontraumatic ICA aneurysm is rare. 2,4,6,7,10,12,13,15,[18][19][20]22) Patients with nontraumatic intracavernous ICA aneurysm usually present with symptoms of a space-occupying lesion.…”

Section: Introductionmentioning

confidence: 99%

Massive Epistaxis From a Thrombosed Intracavernous Internal Carotid Artery Aneurysm 2 Years After the Initial Diagnosis -Case Report-

Nomura

Shima

Sugihara

et al. 2010

Neurol. Med. Chir.(Tokyo)

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A 77-year-old woman presented with a rare case of nontraumatic intracavernous internal carotid artery (ICA) aneurysm causing epistaxis. The thrombosed aneurysm was discovered incidentally, and was not treated. However, she suffered massive nasal bleeding 22 months after the initial diagnosis. The lesion was successfully treated by endovascular coil embolization. The present case shows that thrombosed intracavernous ICA aneurysm may still carry the risk of rupture. Radiological evidence of erosion of the sphenoid sinus wall and repeated minor bleeding may be important predicting signs for massive nasal bleeding. Parent artery occlusion including the aneurysm may be the best treatment for intracavernous ICA aneurysms if sufficient collateral blood flow to the territory of the affected ICA is expected.

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Giant intracavernous internal carotid artery aneurysm with fatal epistaxis

Cited by 7 publications

References 19 publications

Vein of Galen aneurysm in an adult: case report

Vein of Galen aneurysm in an adult: case report

Vein of Galen aneurysm: Anatomical study of an adult autopsy case

Massive Epistaxis From a Thrombosed Intracavernous Internal Carotid Artery Aneurysm 2 Years After the Initial Diagnosis -Case Report-

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