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Medical Science Monitor Basic Research


Rupture of De Novo Middle Cerebral Artery Aneurysm 8 Years After the Clipping of Ruptured M1 Middle Cerebral Artery Aneurysm

Unknown ethiology, Unusual clinical course, Mistake in diagnosis, Unusual or unexpected effect of treatment, Rare disease, Congenital defects / diseases, Educational Purpose (only if useful for a systematic review or synthesis), Rare co-existance of disease or pathology

Ahmad F. Tamimi, Nosaiba T. Al Ryalat, Malik E. Juweid, Rahma M. Doudeen, Qutada Al-Soub, Tareq M.A. Kanaan, Iskandar A. Tamimi

Jordan Department of Neurosurgery, Faculty of Medicine, University of Jordan, Amman, Jordan

Am J Case Rep 2021; 22:e929194

DOI: 10.12659/AJCR.929194

Available online: 2020-12-24

Published: 2021-02-08


BACKGROUND: Development and rupture of a de novo intracranial aneurysm is rare. Little is known regarding its etiology and the appropriate timing of follow-up angiograms after surgical clipping or coiling.
CASE REPORT: We present a case report of a 39-year-old male smoker with history of hypertension who developed a de novo aneurysm 8 years after surgical clipping of an aneurysm in the middle cerebral artery in the same segment. He presented with neck rigidity and drowsiness. Laboratory analysis did not show blood dyscrasia. Brain computerized tomography showed right temporal lobe hematoma and 4-vessel angiogram demonstrated de novo aneurysm in the same segment of the M1 middle cerebral artery, which was confirmed by intraoperative microsurgical findings. We review the literature on such cases and discuss the pathophysiology, diagnosis, and treatment of this condition. De novo aneurysm, although rare, can develop within days to as long as 10 years after surgical clipping or coiling.
CONCLUSIONS: This rare case of de novo aneurysm supports follow-up imaging of patients after initial surgical clipping for up to 10 years.

Keywords: Angiography, intracranial aneurysm, Subarachnoid Hemorrhage