Occlusion of ruptured dissecting distal anterior inferior cerebellar artery aneurysm following pharmacological blood pressure control: A case report

Abstract

Background: Intracranial dissecting aneurysms cause subarachnoid hemorrhage (SAH). These pathologies located in the distal portion of the intracranial posterior circulation are rare, and appropriate treatments are still controversial. We present a patient with progressive occlusion of ruptured dissecting distal anterior inferior cerebellar artery (AICA) aneurysm located at the meatal and postmeatal segments following pharmacological blood pressure control. Case description: A 71-year-old woman presenting with deep coma was admitted. Head computed tomography (CT) findings revealed diffuse SAH. Left vertebral injection revealed a fusiform aneurysm at the meatal segment of the left AICA-posterior inferior cerebellar artery (PICA) variant, suggesting a dissecting aneurysm. Considering severe neurological status, surgical trapping of the aneurysm with occipital artery-AICA anastomosis was not attempted. Endovascular trapping of dissecting segment was also precluded due to the risk of pontine and cerebellar infarction. She was managed conservatively under strict blood pressure control between 100 and 120 mmHg (systolic). Follow-up angiogram obtained at 2.5 months after onset of SAH demonstrated progressive occlusion of the aneurysm and proximal AICA without newly developed ischemic lesion. The patient was discharged with modified Rankin scale score 3 and has been uneventful for 8 months after the onset. Conclusions: Observation of strict blood pressure control may be an optional treatment for ruptured distal AICA dissection, if the patient is considered intolerant for surgical or endovascular treatment.

Keywords

• Anterior inferior cerebellar artery
• Dissecting aneurysm
• Spontaneous occlusion