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-Digital subtraction angiogram (DSA) of right and left carotid arteries done through right femoral artery percutaneous access under local anesthesia using 4F sheath wire. Angiogram in lateral projection, and 3D reconstruction of the right internal carotid artery (A, B) showing wide neck aneurysm (white & black arrows) located within the supra clinoid segment of the right internal carotid artery, pointing in cranio-lateral direction ant measuring 6 mm in diameter. Angiogram in lateral projection, as well as 3D reconstructed images (C-E) of left internal carotid artery showed wide neck, lobulated aneurysm (white & black arrows) located within the para ophthalmic segment of the left internal carotid artery. It was pointing in a cranio-medial direction and measuring 8 mm in diameter.
Source publication
Unruptured supra-clinoid carotid aneurysms are rare aneurysmal dilatation of the supra-clinoid segment of internal carotid artery. Most cases are asymptomatic and discovered incidentally, while others may present with compressive symptoms on cranial nerve II, the optic nerve. We present a case of a 44-year-old female who presented with chronic head...
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Citations
Intracranial aneurysms are common conditions that are usually asymptomatic and found incidentally, yet they can rupture and lead to subarachnoid hemorrhage, in addition to causing mass effects, especially with larger aneurysms. Bilateral supraclinoid aneurysms are extremely rare and were reported in only two instances. These aneurysms can cause a range of symptoms and require careful management. We present the case of a 42-year-old man with no concomitant medical conditions who presented with a persistent headache and deteriorating visual acuity over time. Neurological examination was unremarkable. Connective tissue diseases were ruled out by clinical and laboratory testing. Bilateral large, partly thrombosed supraclinoid segment fusiform aneurysms of the internal carotid artery that are causing midbrain compression and obstructive hydrocephalus were shown by brain CT, CT angiography, MRI, and MR angiography (MRA). Both surgery and endovascular treatment were denied by the patient. However, a ventriculoperitoneal shunt was placed in an outside center and relieved the patient's symptoms. The patient is being followed up. In conclusion, bilateral giant aneurysms of the internal carotid artery present unique challenges and can lead to various clinical manifestations and effects on surrounding structures. In this case, we reported the first instance of obstructed hydrocephalus caused by the largest bilateral supraclinoid carotid aneurysms.
