Unruptured distal anterior cerebral artery mirror aneurysms associated with ruptured middle cerebral artery aneurysm: Case report

Abstract

Introduction. Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal aneurysms are rare, while aneurysms in mirror position are extremely rare. These aneurysms have high tendency for rupture (PHASES score is always > 4). In more than a half of the patients with the DACA aneurysm rupture, imaging reveals intracerebral hematoma which is a predictor of poor outcome. Case report. A 49year-old female patient was treated endovascularly in other institution, due to middle cerebral artery aneurysm (MCA) rupture, when the two small bilateral aneurysms at the distal segments of anterior cerebral artery (ACA) were revealed, left one measuring 4.5 mm and the right one measuring 6 mm in size, with the aneurysmal neck width of 3 mm and 4 mm, respectively. The decision was made by the interventional neuroradiologist only to treat the bleeding MCA aneurysm immediately. The patient was referred to our department six