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NEUROLOGY 2009;73:e63
© 2009 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImages: Artery-to-artery embolism from a thrombosed cerebral aneurysm

S. -Y. Ha, MD, K. -Y. Park, MD, Y. C. Youn, MD, PhD, H. -J. Seo, MD and O. -S. Kwon, MD, PhD

From the Department of Neurology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, South Korea.

Address correspondence and reprint requests to Dr. Kwang-Yeol Park, Department of Neurology, Chung-Ang University College of Medicine, 224-1, Heukseok-dong, Dongjak-gu, Seoul 156-755, South Korea kwangyeol.park{at}gmail.com

A 42-year-old man presented with right hemiparesis. Brain imaging showed acute infarction in the left middle cerebral artery territory and a thrombosed aneurysm (figure). Extracranial carotid artery was normal. EKG and echocardiography were normal. Holter monitoring for 24 hours revealed no cardiac source of embolism.


Figure 116
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  		Figure Thrombosed aneurysm causing cerebral infarction

Brain CT 3 years prior showed unruptured aneurysm without thrombus (A). Current CT demonstrates a thrombus (B, arrow). CT angiography revealed residual lumen from which the divisions of MCA take off (C, arrow). The thrombus formed a layer (D: T2, E: T1). Acute infarction was found on diffusion-weighted imaging (F).

 

Cerebral infarction is a rare complication of unruptured aneurysm.1 The imaging changes over time strongly suggest artery-to-artery embolism due to thrombosed unruptured aneurysm.

Supported by a Chung-Ang University Research Grant.

Disclosure: Dr. Ha reports no disclosures. Dr. Park and Dr. Youn receive institutional research support from Chung-Ang University. Dr. Seo and Dr. Kwon report no disclosures.


   REFERENCE
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 REFERENCE
 

  1. Qureshi AI, Mohammad Y, Yahia AM, et al. Ischemic events associated with unruptured intracranial aneurysms: multicenter clinical study and review of the literature. Neurosurgery 2000;46:282–289.[Medline]




This Article
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Right arrow Articles by Kwon, O. -S.
PubMed
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Right arrow Articles by Ha, S. -Y.
Right arrow Articles by Kwon, O. -S.
Related Collections
Right arrow Stroke in young adults
Right arrow Embolism
Right arrow Infarction

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