Basilar artery perforator aneurysm
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Perimesencephalic SAHsubarachnoid haemorrhage.
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Cerebral angiogram (DSA) shows hints ofsuggests a basilar artery perforator aneurysm, easily overlooked! 3D Angiogram isangiogram reconstructions are really helpful in detecting these small aneurysms.
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BasilarSmall basilar artery perforator Aneurysmaneurysm, just indenting the pons. SWI shows capping. Very subtle finding inon TOF angiogram.
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The 4-week follow-up MRI shows persistent haemosiderin capping inon SWI, there is T1. T1W hyperintensity in the saccular aneurysm related to blood products, but no real flow sign in TOF angiography where the saccular signal is rather duedue instead to T1 shine through effect. However an angiogram is needed to confirm aneurysm occlusion or persistence.
Further there is a subacute ischaemia of the pons with no diffusion restriction anymore. The patient was asymptomatic for this, it is very probably anlikely ischaemia related to spontaneous occlusion of the aneurysm bearing basilar perforator aneurysm.
Direct angiogram is still required to assess aneurysm occlusion or persistence.
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Follow-up cerebral angiogram provesconfirms spontaneous occlusion of the basilar artery perforator aneurysm.
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Basilar artery perforator aneurysms (BAPA) are a rare entitygroup of intracranial aneurysms. While infor many cases of perimesencephalic subarachnoid haemorrhagehaemorrhages no cause is found, BAPA are a possible overlooked cause and are easily overseen even with extensive diagnostic workup including CT, MRI, MRA and DSA. They are one of the reasons why in apparently angio-negative SAH, a second DSA and performing 3D angiograms are recommended.
Endovascular treatment options are available including Coilcoil occlusion or flow diverter stent implantation. In the literature some cases of larger BAPA have been treated surgically. In small aneurysms there arecan be technical difficulties for endovascular and surgical approaches (small neck, proximity of BAbasilar perforators or branches andat risk of ischaemia).
The natural cause of BAPA seems rather benign and therefore conservative treatment often is a viable option (and frequently the only option anyways).
Case imaging courtesy of Prof. R. Chapot and PD Dr. P. Mosimann (Alfried Krupp Krankenhaus Essen, Germany).
-<p>Basilar artery perforator aneurysms (BAPA) are a rare entity of intracranial aneurysms. While in many cases of perimesencephalic subarachnoid haemorrhage no cause is found, BAPA are a possible cause and are easily overseen even with extensive diagnostic workup including CT, MRI, MRA and DSA. They are one of the reasons why in apparently angio-negative SAH a second DSA and performing 3D angiograms are recommended.</p><p>Endovascular treatment options are available including Coil occlusion or flow diverter stent implantation. In the literature some cases of larger BAPA have been treated surgically. In small aneurysms there are technical difficulties for endovascular and surgical approaches (small neck, proximity of BA perforators or branches and risk of ischaemia).</p><p>The natural cause of BAPA seems rather benign and therefore conservative treatment often is a viable option (and frequently the only option anyways).</p><p>Case imaging courtesy of Prof. R. Chapot and PD Dr. P. Mosimann (Alfried Krupp Krankenhaus Essen, Germany).</p>- +<p>Basilar artery perforator aneurysms (BAPA) are a rare group of intracranial aneurysms. While for many perimesencephalic subarachnoid haemorrhages no cause is found, BAPA are a possible overlooked cause even with extensive diagnostic workup including CT, MRI, MRA and DSA. They are one of the reasons why in apparently angio-negative SAH, a second DSA and performing 3D angiograms are recommended.</p><p>Endovascular treatment options are available including coil occlusion or flow diverter stent implantation. In the literature some cases of larger BAPA have been treated surgically. In small aneurysms there can be technical difficulties for endovascular and surgical approaches (small neck, proximity of basilar perforators or branches at risk of ischaemia).</p><p>The natural cause of BAPA seems rather benign and therefore conservative treatment often is a viable option (and frequently the only option anyways).</p><p>Case imaging courtesy of Prof. R. Chapot and PD Dr. P. Mosimann (Alfried Krupp Krankenhaus Essen, Germany).</p>