MCA aneurysm rupture in an infant

Case contributed by Joseph Scheller
Diagnosis almost certain

Presentation

Abrupt episode of unresponsiveness, GCS 3. Previous episode of respiratory arrest 4 months prior.

Patient Data

Age: 6 months
Gender: Male

Acute hemorrhage in the right sylvian fissure, with additional subarachnoid and intraventricular hemorrhage. Thin acute subdural hematoma along the falx and tentorium. Possible left retinal hemorrhage. Possible cerebral edema.

Case Discussion

This child had a first episode of respiratory arrest at age 2 months. At that time a routine head CT was unremarkable, a lumbar puncture revealed 17 RBC and 5 WBC with normal protein and glucose.

This child died shortly after admission to the hospital. Autopsy demonstrated cerebral edema, subarachnoid and subdural hemorrhages as well as retinal hemorrhage. Examination of the circle of Willis did not demonstrate an aneurysm.

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