Aneurysm of lenticulostriate artery in a patient presenting with hemorrhage in the caudate nucleus and lateral ventricle-delayed appearance and spontaneous resolution
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan
- Department of Neurology, Kanto Rosai Hospital, Kawasaki, Japan
Department of Neurology, Kanto Rosai Hospital, Kawasaki, Japan
DOI:10.4103/sni.sni_126_18Copyright: © 2018 Surgical Neurology International This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
How to cite this article: Motohiro Nomura, Eiichi Baba, Kazutaka Shirokane, Atsushi Tsuchiya. Aneurysm of lenticulostriate artery in a patient presenting with hemorrhage in the caudate nucleus and lateral ventricle-delayed appearance and spontaneous resolution. 21-Sep-2018;9:192
How to cite this URL: Motohiro Nomura, Eiichi Baba, Kazutaka Shirokane, Atsushi Tsuchiya. Aneurysm of lenticulostriate artery in a patient presenting with hemorrhage in the caudate nucleus and lateral ventricle-delayed appearance and spontaneous resolution. 21-Sep-2018;9:192. Available from: http://surgicalneurologyint.com/surgicalint-articles/9017/
Background:An aneurysm of distal lenticulostriate artery is very rare. The natural course and management of this rare aneurysm are not clear.
Case Description:An 81-year-old woman developed consciousness disturbance. Computed tomography revealed hemorrhage in the right caudate nucleus and lateral ventricles. Three-dimensional computed tomographic angiography demonstrated only an aneurysm at the basilar artery. On angiography, on the sixth day, an aneurysm at the right lenticulostriate artery was demonstrated. Then, the aneurysm disappeared on three-dimensional computed tomographic angiography on the 15th day. Subsequent radiological examinations revealed no vascular anomaly in the right lenticulostriate artery.
Conclusion:An aneurysm at this location can show dynamic changes based on radiological findings. Close radiological observation is necessary.
Keywords: Cerebral aneurysm, delayed appearance, lenticulostriate artery, ruptured, spontaneous obstruction
An aneurysm originating from the distal lenticulostriate artery is very rare, and it is difficult to treat by direct surgery or endovascular embolization due to its location.[
An 81-year-old woman suddenly developed consciousness disturbance. She was brought to our hospital by ambulance. Computed tomography (CT) revealed hemorrhage in the right caudate nucleus and ventricles, and hydrocephalus [
(a) Computed tomography demonstrating hemorrhage in the right caudate nucleus with ventricular rupture. (b) Three-dimensional computed tomographic angiography demonstrating an aneurysm only on basilar artery (arrow). (c) A raw image of three-dimensional computed tomographic angiography on admission showing no abnormal enhancement adjacent to the hematoma. A small low-density area is observed in the hematoma (arrow)
(a) Angiography performed on the sixth day showing an aneurysm originating from the right lenticulostriate artery (arrow). (b) Computed tomography after angiography showing an enhanced lesion in the hematoma (arrow). This portion appears identical to the low-density area indicated in Figure
Three-dimensional computed tomographic angiography on the 15th (a) and angiography on the 23rd (b) day showing no aneurysm on the right lenticulostriate artery. (c) Three-dimensional computed tomographic angiography on the 42nd day also showing no lenticulostriate artery aneurysm. (d) Three-dimensional computed tomographic angiography at the 9th month showing no aneurysm on the right lenticulostriate artery
An aneurysm arising from the distal lenticulostriate artery is very rare. The natural course and management of an aneurysm on the distal lenticulostriate artery have not been fully clarified. To our knowledge, 62 cases have been reported in the literature.[
Regarding the natural course of the aneurysm on the distal lenticulostriate artery, there have been several reports describing the spontaneous disappearance of the lesion. Nearly half of the reported cases showed obstruction in their natural courses. Seventeen cases showed spontaneous disappearance or near disappearance in 20 cases of lenticulostriate artery aneurysms which were not radically treated [
This aneurysm may be a dissection or pseudoaneurysm rather than a saccular aneurysm on a main artery in other locations.[
If the aneurysm is not obstructed, the lesion is still associated with a risk of rerupture. In such a case, radical treatment should be considered. As for radical treatment, clipping, trapping, or resection was performed in 22 cases, and endovascular embolization in 6. For 1 case, stereotactic radiosurgery was performed, and the lesion disappeared.[
In our case, initial radiological examination as 3D-CTA on admission failed to demonstrate the lenticulostriate artery aneurysm. Angiography might not be commonly performed for cases with simple hemorrhage in the caudate nucleus, or intraventricular hemorrhage. We performed angiography for the purpose of evaluating a coincidentally developing BA aneurysm. As a result, the lenticulostriate artery aneurysm was unexpectedly identified. There is a possibility that a distal artery aneurysm such as a lenticulostriate artery aneurysm exists in cases of hemorrhage around the lateral ventricles. In fact, raw images of 3D-CTA obtained on admission showed a small low-density area in the hematoma. It was not clear whether this low-density area represented the obstructed aneurysm. Tan et al.[
An aneurysm originating from the lenticulostriate artery is rare. This aneurysm may show a delayed appearance and spontaneous resolution. Therefore, serial radiological examinations are mandatory. Also, radiological examinations focusing on a lenticulostriate artery aneurysm are necessary in cases with hemorrhage around the lateral ventricles, although the incidence is low, even though the hemorrhage is considered to be simple.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
This study was supported by research funds to promote the hospital functions of Japan Organization of Occupational Health and Safety.
Conflicts of interest
There are no conflicts of interest.
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