Rapid de novo aneurysm formation after clipping of a ruptured middle cerebral artery aneurysm in an infant with an MYH11 mutation

Abstract

<jats:p>The authors report the case of a previously healthy 6-month-old girl who presented with right arm and leg stiffening consistent with seizure activity. An initial CT scan of the head demonstrated acute subarachnoid hemorrhage in the basal cisterns extending into the left sylvian fissure. Computed tomography angiography demonstrated a 7 × 6 × 5–mm saccular aneurysm of the inferior M<jats:sub>2</jats:sub> division of the left middle cerebral artery. The patient underwent left craniotomy and microsurgical clip ligation with wrapping of the aneurysm neck because the vessel appeared circumferentially dysplastic in the region of the aneurysm. Postoperative angiography demonstrated a small remnant, sluggish distal flow, but no significant cerebral vasospasm. Fifty-five days after the initial aneurysm rupture, the patient presented again with an acute intraparenchymal hemorrhage of the left anterior temporal lobe. Angiogram revealed a circumferentially dysplastic superior division of the M<jats:sub>2</jats:sub> branch, with a new 5 × 4–mm saccular aneurysm distinct from the first, with 2 smaller aneurysms distal to the new ruptured aneurysm. Endovascular parent vessel occlusion with Onyx was performed. Genetic testing revealed a mutation of the <jats:italic>MYH11</jats:italic>. To the authors' knowledge, this is the first report of rapid de novo aneurysm formation in an infant with an <jats:italic>MYH11</jats:italic> mutation. The authors review the patient's clinical presentation and management and comprehensively review the literature on this topic.</jats:p>

Rescue endovascular treatment for rapid regrowth of aneurysm remnant on middle cerebral artery trunk after unsuccessful surgical clipping in patients with a ruptured cerebral aneurysm: A report of two cases

“…D E www.the-jcen.org ally thought to be due to arterial wall weakening and/or the influence of hemodynamics stress. [11][12][13][14] Similarly, our hypothesis is that a change of focal hemodynamic stress by microsurgical clipping may be one of the main factors that leads to decreasing resistibility and structural fra- unsuccessful clipping are associated with aneurysms located at the anterior communicating artery complex or posterior circulation. 6-9)12) However, MCA trunk aneurysms are located either on the main trunk, at the origin of an early frontal or temporal branch, or at the origin of the lateral LSA.…”

Identification of key genes, transcription factors and microRNAs involved in intracranial aneurysm

“…In the present study, the MCM4 TF was shown to be at a high degree in the integrated network and was predicted to regulate the expression of MYH11 . Additionally, mutation of myosin heavy chain 11 ( MYH11 ) was inversely correlated with RIA ( 35 ), which suggested that the MCM4 TF regulates MYH11 for participating in the development of IA.…”

Bioinformatics analysis of potential common molecular pathogenesis assumed by intracranial aneurysm, aortic aneurysm and aortic dissection

“…SMTN family are composed of SMTN-a, SMTN-band SMTNL1.SMTN was expressed in tunica media SMCs of normal arteries , but unexpressed in the media SMCs of saccular intracranial aneurysm (sIA); Meanwhile, sIA SMCs showed signi cant decrease of MYH11 expression 25 . It's reported that MYH11 mutation correlated with thoracic aortic aneurysms, dissections and de novo intracranial aneurysm formation 26 .TAGLN is an actin binding enzyme of the calponin family, performing actin binding and actin bundling activities. Loss of TAGLN promotes thoracic aortic aneurysm and aortic dissection progression in vivo 27 .…”