Available online 12 December 2012
Publication year: 2012
Source:World Neurosurgery
Background Intracranial arterial dissection is an uncommon but well-recognized entity. Treatment remains variable, ranging from observation to intervention using either surgical or endovascular techniques. Aneurysms along the lenticulostriate artery have been reported in only 41 patients. The current case study illustrates the effectiveness of observation in the context of a dissecting lenticulostriate aneurysm, and discusses other approaches that have been used in the treatment of this particular entity. Clinical Summary An Accomplished Mountain Climber presented, following coitus, with acute headache, mild facial weakness, and forgetfulness. Vascular imaging studies revealed a right putaminal hemorrhage secondary to a 3 mm lenticulostriate artery dissecting aneurysm. Clinically, the patient did well, with marked improvement in presenting symptoms enabling his return to mountain climbing. Follow up angiography showed spontaneous resolution of the arterial dissecting aneurysm. Among the 41 reported cases, 19 were idiopathic, 5 associated with hypertension, and 17 related to various conditions such as moyamoya disease, arteriovenous malformation, systemic vasculitis, intraventricular tumor or substance abuse. Of the 42 cases, including the present case, 28 were surgically or endovascularly managed and 12 observed. Only one of the reported cases, a 33 year old male with moyamoya disease, who was managed conservatively, died of rebleeding. CONCLUSION There is no common consensus in literature on a single treatment strategy for a lenticulostriate artery aneurysm. The present case illustrates that observation and follow up vascular imaging can be an important treatment strategy allowing healing of the vessel wall and disappearance of the dissecting aneurysm.
Júlio Leonardo B. Pereira
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