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AJNR - American Journal of Neuroradiology

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Giant Serpentine Aneurysm with Acute Spontaneous Complete Thrombosis

A. Sari^a, S. Kandemir^a, K. Kuzeyli^b and H. Dinc^a

^a Department of Radiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
^b Department of Neurosurgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey

View larger version (100K): [in a new window]   Fig 1. Postgadolinium T1-weighted (A) and T2-weighted (B) MR images show a large, partially thrombosed aneurysm. The aneurysm contains a persistent vascular channel, which causes a ghost artifact and enhances on the postgadolinium T1-weighted image (arrows). The vascular channel is surrounded by thrombus. Note the associated mass effect on the left lateral ventricle and midline shift.

View larger version (148K): [in a new window]   Fig 2. Left internal carotid artery angiogram. Early arterial phase oblique projection (A) shows filling of vascular channel serpentine aneurysm arising from upper trunk of the left middle cerebral artery (MCA). Midarterial phase Towne projection (B) and late-arterial-phase oblique projection (C) show the whole tortuous vascular channel of the serpentine aneurysm. Note the extremely slow flow and the filling of normal cortical branches of distal parietal arteries. Schematic drawing (D) illustrates the giant serpentine aneurysm (GSA) that corresponds to the angiograms.

View larger version (140K): [in a new window]   Fig 3. Repeat angiogram 13 days after the first diagnostic angiography shows the complete obliteration of the aneurysm lumen. There is also superior and medial displacement in internal carotid artery and middle cerebral artery (MCA).

View larger version (108K): [in a new window]   Fig 4. A, Sixteen months later, T2-weighted axial image shows a large thrombosed aneurysm in the left frontotemporal region. B, Three years later, unenhanced axial CT image shows the large mass in the left frontotemporal region, with central and peripheral calcification.

View larger version (142K): [in a new window]   Fig 5. Three years later, final angiogram shows no abnormal vascular channel.