Intraparenchymal brain hemorrhage due to rupture of aneurysm in infants: report of two cases

Abstract

Background Cerebral or brain hemorrhage due to the rupture of intracranial aneurysms is extremely rare in pediatric population. The aim of our work is to describe two cases in children and to review the existent bibliography about this issue. Case presentation Both of our patients presented with nonspecific symptoms and subsequent neurological deficit. The brain imaging test revealed intraparenchymal hemorrhage. In both cases, the aneurysm was located at the distal portion of the middle cerebral artery. Surgical intervention was needed, clipping the aneurysm due to the impossibility of intravascular embolization. After the surgery, one patient presented with persistent hydrocephalus secondary to intraventricular hemorrhage, requiring the placement of a cerebrospinal fluid shunt. Over time, the child presented with refractory epilepsy compatible with West syndrome. The second patient did not present postoperative complications but died suddenly 2 months after. Conclusions Our two patients presented with a middle cerebral artery aneurysm at the distal level, which seems to be the most frequent location according to literature. The correct diagnosis can be delayed because of the nonspecific initial symptoms, as occurred in one of our patients with a delay of 3 days from the onset of symptoms. In both patients, surgical treatment was preferred over endovascular treatment, due to the anatomical characteristics of the aneurysm and the patient’s age. Torpid evolution is also described, with one of our patients dying at 2 months, probably due to rebleeding, and the other suffering right hemiparesis and epilepsy compatible with West syndrome.