Ruptured aneurysm at the fenestration of the middle cerebral artery detected by magnetic resonance angiography in a patient with systemic lupus erythematosus and renal failure: a case report

Abstract

IntroductionA cerebral aneurysm arising at the fenestration of the middle cerebral artery is extremely rare, with one report describing subarachnoid hemorrhage due to this type of lesion. There have been no reports of this type of lesion occurring in a patient with systemic lupus erythematosus.Case presentationA 47-year-old Japanese woman with 23 years’ history of systemic lupus erythematosus and chronic renal failure had sudden onset of subarachnoid hemorrhage. We avoided using contrast medium due to her chronic renal failure. Magnetic resonance angiography showed her ruptured aneurysm arising at the site of fenestration of her middle cerebral artery. Successful clipping, perioperative management avoiding the cerebral vasospasm, renal dialysis initiated after the acute phase and placement of a ventriculoperitoneal shunt were performed, and she was discharged home with no complications.ConclusionsThis is the first report of ruptured aneurysm associated with middle cerebral artery fenestration in a patient with systemic lupus erythematosus as detected by magnetic resonance angiography. The presence and anatomical relationship of fenestration accompanied by aneurysm could be noninvasively and accurately evaluated preoperatively using three-dimensional time-of-flight magnetic resonance angiography with the volume rendering method in a case in which contrast medium was contraindicated.

Endovascular treatment of unruptured aneurysm arising from duplicate origin of the middle cerebral artery – A case report and literature review

“…Our extensive review found 11 reported cases of DOMAassociated aneurysms, including ours. [3,5,7,[9][10][11][12][18][19][20] e paucity may be, in part, due to the general lack of awareness of this variation. Actually, out of the 11 patients, five were reported as fenestration in MCA and three as MCA duplication.…”

“…So far as we know, there are 11 reported patients, including ours, eight women and three men, with an aneurysm arising from DOMA [Table 1]. [3,5,7,[9][10][11][12][18][19][20] e age ranged from 42 to 81 years old with a mean of 54.8 ± 13.4 (Standard deviation [SD]) years. Our patient is the youngest.…”

“…[7] MCA fenestration 75/F Rt. Rennert J, 2013 [9] MCA duplication 52/F Lt. Tabuchi S, 2014 [12] MCA fenestration Xue X, 2019 [19] MCA fenestration 43/F Rt. Iwata M, 2020 [5] DOMA 59/M Rt.…”

The Clinical Characteristics and Treatment Considerations for Intracranial Aneurysms Associated With Middle Cerebral Artery Anomalies: A Systematic Review

“…Twelve studies reporting of 12 patients were identified, aging from 14 to 81 (49.3 ± 13.1) years old ( Table 3) (2,(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58). The male to female ratio was 1:1.…”

The clinical characteristics and treatment considerations for intracranial aneurysms associated with middle cerebral artery anomalies: a systematic review

“…Twelve studies reporting of 12 patients were identi ed, aging from 14 to 81 (49.3 ± 13.1) years old (Table 3) [2,[48][49][50][51][52][53][54][55][56][57][58]. The male to female ratio was 1:1.…”