Giant serpentine middle cerebral artery aneurysm

Case contributed by Peter Mitchell , 16 Feb 2015
Diagnosis certain
Changed by Henry Knipe, 26 Aug 2015

Updates to Case Attributes

Title was changed:
Giant serpentine MCAmiddle cerebral artery aneurysm

Updates to Study Attributes

Findings was changed:

CEREBRAL ANGIOGRAM

There is large, irregular fusiform aneurysm arising off an early branch of the left MCA.

There is stenotic portion at the proximal portion of the aneurysm with post-stenotic dilatation measuring 8mm (this is the greatest diameter of the patent segment of the aneurysm).

The aneurysm extends posterior and lateral for at least 8cm and then terminates in a left parietal branch.No other aneurysms are noted or vascular malformations are noted.

Updates to Study Attributes

Findings was changed:

MRI/MRA Brain

A thrombosed mixed fusiform/saccular giant aneurysm, measuring up to 4 x 5.2 cm, is centred within the left Sylvian fissure, splaying the major left MCA branches.

The inferior irregular non-thrombosed portion of the aneurysm, measuring 10 mm diameter, arises from a posterior branch of the left MCA M2 segment.

This communicates directly with a 5 mm diameter serpiginous channel, which winds through the thrombosed body of the aneurysm to terminate at the dome's superomedial margin, apparently in direct communication with a tiny left parietal branch.

Despite the aneurysm's size, there is only mild to moderate mass effect and surrounding vasogenic oedema, adjacent sulcal effacement and up to 4-5 mm midline shift to the right.

Multiple T2 hyperintense lesions are scattered elsewhere through the frontoparietal white matter of both cerebral hemispheres.

Appearances are in keeping with chronic small vessel ischaemic change, relatively excessive for age.

Images Changes:

Image MRI (T2) ( update )

Perspective changed from Ax T2 FSE S to Axial.

Image MRI (Echo planar) ( update )

Perspective changed from EPI to Axial.

Image MRI (T1) ( update )

Perspective changed from Ax T1 SE C- to Axial.

Image MRI (T1 C+) ( update )

Perspective changed from Ax T1 SE C+ to Axial.

Image MRI (MRA) ( update )

Perspective changed from PJN to Axial.

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