AneurysmPerianeurysm edema with second-generation bioactive coils
Introduction
Perianeurysm edema is a rare complication of intracranial aneurysms. It generally presents as an acute increase in mass effect. Most reports have associated it with sudden thrombosis of a giant aneurysm. It has been described, using either deconstructive or constructive approaches, to occur both spontaneously as well as after surgery and endovascular treatment [1], [3], [4], [5], [7], [9], [10], [11], [14], [15], [17], [18]. We present the first report of a nongiant saccular aneurysm embolized primarily with Matrix2 coils that developed marked perianeurysm edema. We also propose a new mechanism and its implications for management.
Section snippets
Case report
A 27-year-old woman presented with episodic headaches and vertigo over the course of a week. She had no other medical conditions and denied any personal or family history suggestive of aneurysm rupture. Magnetic resonance imaging and angiography was performed, revealing a left carotid terminus aneurysm without evidence for prior intracranial hemorrhage (Fig. 1A).
Catheter angiography demonstrated a 6 × 6 × 8 mm saccular aneurysm arising from the carotid artery terminus (Fig. 1B). No other
Discussion
Acute, perianeurysmal edema is a rarely reported and poorly understood syndrome. The diagnosis should be considered when signs and symptoms suggestive of local mass effect of an aneurysm develop, either with or without treatment. Typical presentations include hemiparesis [7], [9], visual deficits [11], aphasia [9], or seizures [15], [18]. Massive cerebral edema rarely occurs and may cause alteration in mental status, papilledema, Parinaud sign, herniation, or even death [9], [14]. Other
Conclusions
Perianeurysm edema is an uncommon complication of intracranial aneurysms. It has been reported predominantly in giant aneurysms and attributed to sudden thrombosis with or without treatment. We describe a rare case of an unruptured, nongiant, saccular aneurysm that developed marked, asymmetric perianeurysm edema after embolization with Matrix2 coils. We suspect that in this case the associated edema was due to a delayed microperforation or breakdown of the aneurysm wall and an intense tissue
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Perianeurysmal edema: Prevalence, risk factors and clinical significance
2017, Journal of NeuroradiologyCitation Excerpt :In the 9 patients with pre-existing PAE, we observed different evolution after EVT, in line with the proposed pathogenesis. PAE clinical significance appears varied with some detected incidentally as well as some displaying neurological symptoms [12–14,16–27]. In our series, five patients with PAE (25.0%) were symptomatic.
A ruptured basilar tip aneurysm showing repeated perianeurysmal edema after endovascular coil embolization: Case report
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