Ruptured lenticulostriate artery aneurysm: a report of a case treated with endovascular embolisation

Abstract

A 65-year-old woman presented to the emergency department with sudden onset of left-sided weakness, headache and vomiting. A cerebral CT showed an acute intracerebral haemorrhage involving the right caudate nucleus and lentiform nucleus with mild midline shift and intraventricular extension. CT angiography did not reveal aneurysm or other vascular anomaly. Conventional cerebral angiography demonstrated a 3 mm right medial lenticulostriate branch aneurysm, arising from the right anterior cerebral artery (ACA). Endovascular treatment was performed from the left internal carotid via the anterior communicating artery into the right ACA. Complete occlusion was achieved with injection of N-butyl-2-cyanoacrylate. The patient had neurological rehabilitation during hospitalisation followed by outpatient physical therapy. Two years later, clinical follow-up demonstrated excellent recovery.

Keywords: interventional radiology; neuroimaging.

Conflict of interest statement

Competing interests: None declared.

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Figures

Figure 1

(A) Unenhanced CT demonstrates intraparenchymal haematoma at the level of the basal ganglia in association with intraventricular haemorrhage. (B) Angiography demonstrates a 3 mm aneurysm (black arrow) along a right medial lenticulostriate branch arising from the anterior cerebral artery. (C) Pre-embolisation superselective microcatheter injection of the lenticulostriate branch harbouring the aneurysm from ipsilateral carotid, demonstrating recurrent origin of the target vessel. (D) Endovascular embolisation with NBCA performed from controlateral internal carotid through the anterior communicating artery. (E) Post-treatment unenhanced CT demonstrates NBCA cast (black arrow) and (F) post-treatment angiographic control demonstrates complete occlusion of the aneurysm. NBCA, N-butyl-2-cyanoacrylate.