Onyx embolization of distal middle cerebral artery aneurysm in a patient with nontraumatic subdural hematoma

Abstract

Distal cortical middle cerebral artery (MCA) aneurysm is a rare entity. Despite the challenging procedure, the role of endovascular treatment is emerging due to its safety and efficacy in obliterating the microaneurysm. We report a 25-year-old male, who presented with a history of dizziness and headache for almost 2 weeks. Computed tomography scan showed a right front parietal subdural hematoma (SDH). We could not identify any underlying defining etiology of SDH neither head injury nor coagulopathy disorder. Therefore, diagnostic cerebral angiogram was performed, which showed a microaneurysm in the distal right MCA cortical branch. Hence, complete obliteration of this microaneurysm was performed using Onyx for endovascular embolization. Therefore, this case report demonstrates the efficacy of this modality in the treatment of microaneurysms with SDH.

Infracallosal Aneurysm Rupture Revealed by Chronic Subdural Hematoma: A Case Report

“…Chronic subdural hematoma associated to rupture of aneurysm is an emergency and can be treated by endovascular treatment safely [13] and in our case we treated efficacely by microsurgical technic. In some cases, the chronic subdural bleeding is associated with aneurysm in an arachnoid cystic cavity [3] and the frequent location are the middle cerebral artery aneurysm [4] [5] [10]. The infracallosal aneurysm association is very rare and we didn't find in the literature.…”

Ruptured giant aneurysm of a cortical middle cerebral artery: A case report

“…In our review of the literature, we identified a total of 15 cases including the present case. [ 4 - 8 , 10 , 11 , 16 , 21 ] The mean age was 44 years with 80% ( n = 12) males. Headache and altered mental status were the most common presentations, followed by ICH and subdural hematoma.…”

“…This distinction is prognostically significant given the higher risk of rupture associated with mycotic aneurysms. [ 3 , 8 , 10 , 11 , 14 , 15 ]…”

“…However, the distal location of the aneurysms and the tortuosity of the parent vessel can increase the risk of complications for endovascular interventions. [ 8 ]…”