기저 동맥 거대 동맥류 혈전증의 뇌간 압박으로 추정되는 사망 1례
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Background & significance: The basilar aneurysm represents only 3~5% of all the intracranial aneurysms. Fifteen percent of the giant aneurysm lesions occur at the basilar artery. Thrombosis and ischemic stoke due to blood clot formation within the aneurysm and distant embolus, occur in 2~5% of patients with giant aneurysm. Case: A 60-year-old women presented with new-onset right-sided eyelid ptosis for two months. Her medical history was unremarkable except for borderline hypertention. Neurologic examination revealed a right dilated pupil with sluggish reflex to the light. Brain-imaging studies(CT, MRI) showed a basilar aneurysm with 3.2~3.4 cm in diameter. Initial angiogram showed a partially thombused giant aneurysm. She refused intervention and was discharged against medical advice. At the time of seven months after symptom onset, she was taken to the emergency room where she was drowsy, dysarthria, nystagmus, and right-sided hemiparesis. Brain CT revealed an unruptured almost totally thrombosed giant basilar aneurysm without contrast filling. Two days later, Her respiration was arrested and she became comatose and showed no brainstem reflex. She expired, 6 days later. Conclusion: We report a fatal case who deteriorated from compression effect of the total thrombus or hematoma mass followed by a chronic unruptured giant basilar artery intra-aneurysmal thrombosis. Prevention of subarachnoid hemorrhage intracranial aneurysm is most important nowadays and a long-term step of preventive methods for compression effect of thrombosis for giant aneurysms is also necessary.
Abstract
Background & significance: The basilar aneurysm represents only 3~5% of all the intracranial aneurysms. Fifteen percent of the giant aneurysm lesions occur at the basilar artery. Thrombosis and ischemic stoke due to blood clot formation within the aneurysm and distant embolus, occur in 2~5% of patients with giant aneurysm. Case: A 60-year-old women presented with new-onset right-sided eyelid ptosis for two months. Her medical history was unremarkable except for borderline hypertention. Neurologic examination revealed a right dilated pupil with sluggish reflex to the light. Brain-imaging studies(CT, MRI) showed a basilar aneurysm with 3.2~3.4 cm in diameter. Initial angiogram showed a partially thombused giant aneurysm. She refused intervention and was discharged against medical advice. At the time of seven months after symptom onset, she was taken to the emergency room where she was drowsy, dysarthria, nystagmus, and right-sided hemiparesis. Brain CT revealed an unruptured almost totally thrombosed giant basilar aneurysm without contrast filling. Two days later, Her respiration was arrested and she became comatose and showed no brainstem reflex. She expired, 6 days later. Conclusion: We report a fatal case who deteriorated from compression effect of the total thrombus or hematoma mass followed by a chronic unruptured giant basilar artery intra-aneurysmal thrombosis. Prevention of subarachnoid hemorrhage intracranial aneurysm is most important nowadays and a long-term step of preventive methods for compression effect of thrombosis for giant aneurysms is also necessary.