A giant basilar artery perforator aneurysm

Abstract

Basilar artery perforator aneurysms (BAPA's) are a rare entity. Their natural history and treatment are unclear. We describe the largest BAPA reported thus far in literature in a 64-year-old Caucasian woman. This patient did not present with subarachnoid hemorrhage, but with left hemiparesis due to pontine ischemia. The aneurysm was initially misdiagnosed as a tumoral mass in a referring center. Angiography confirmed the presence of a BAPA and a flow diverter was successfully placed. This case shows us that a BAPA can mimic a tumoral mass and can cause ischemia due to mass effect without having ruptured. Both conservative and flow diverter placement seems viable treatment options. Individual patient characteristics and preferences should be considered in decision-making for treatment.

Keywords: Intracranial Aneurysm; Stents; Subarachnoid Hemorrhage.

Conflict of interest statement

The manuscript has not been submitted elsewhere nor published elsewhere in whole or in part. None of the authors has potential conflicts of interest related to this manuscript.

© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.

Figures

Fig. 1

Different imaging modalities showing the basilar artery perforator aneurysm. (A) A prepontine mass on CT after 2 weeks of presentation; (B) CT with contrast did not show enhancement; (C) on T1 sequence MRI the aneurysm appeared iso-intens; (D) on T2 sequence MRI the aneurysm showed mixed intensities but mainly hypo-intens; (E) angiography showed a partially thrombosed aneurysm; (D) 3D reconstruction of the aneurysm on angiography.