Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Other Publications
    • ajnr

User menu

  • Subscribe
  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

  • Subscribe
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds
OtherPEDIATRICS

Spontaneous Partial Thrombosis of a Basilar Artery Giant Aneurysm in a Child

Elisa F. M. Ciceri, Alison L. Lawhead, Tiziana De Simone, Luca Valvassori and Edoardo Boccardi
American Journal of Neuroradiology January 2005, 26 (1) 56-57;
Elisa F. M. Ciceri
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alison L. Lawhead
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tiziana De Simone
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Luca Valvassori
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Edoardo Boccardi
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
Loading

Abstract

Summary: We report the complete, spontaneous obliteration of a partially thrombosed dissecting giant aneurysm in the basilar artery by occlusion of both the lumen of the aneurysm and the parent artery in a 15-year-old girl.

Giant dissecting aneurysms of the posterior intracranial circulation are a rare finding in the pediatric population. We report a partially thrombosed, giant dissecting basilar artery (BA) aneurysm in a young female patient that spontaneously and asymptomatically resolved by complete thrombosis of both the giant aneurysm and the BA. We briefly review the pathophysiology, clinical presentation and MR imaging and angiographic findings associated with partially and completely thrombosed dissecting giant aneurysms.

Case Report

A 15-year-old female patient was admitted to our hospital for angiographic follow-up and possible treatment of a partially thrombosed BA aneurysm extending from the midbasilar portion to the origin of the superior cerebellar arteries (SCAs) that had been discovered at another hospital 11 days before. The patient originally complained of sudden nuchal headaches 1 week before her first hospitalization. During the following week, headaches became intermittent and disappeared without any treatment. Headaches were sometimes associated with nausea, vomiting, and visual changes. No history of previous trauma was reported. Findings of the physical and neurologic examinations performed during the patient’s hospital admissions were within normal limits. A cerebral CT scan obtained during the first hospital admission showed an aneurysmal dilatation of the BA with no sign of bleeding. Four-vessel cerebral digital subtraction angiography (DSA) performed 11 days after the CT scan confirmed the presence of the BA aneurysmal dilatation measuring 5 mm in its patent portion with an extension of 2 cm in length (Fig 1). Stenosis of the BA was recognizable proximal and distal to the aneurysm. Both SCAs were injected from the BA. MR imaging performed 1 day later visualized the dissecting basilar aneurysm and small ischemic areas at the left lower part of the pons and in the left cerebral peduncle (Fig 2). The patient was discharged on antiplatelet therapy (ticlopidine 250 mg/dL) to prevent further thrombotic events.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Left vertebral artery angiogram, obtained 11 days after the initial symptoms, demonstrates the presence of the BA aneurysm. At both edges of the aneurysm, stenosis of the BA is recognizable (arrows).

Fig 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 2.

MR image, obtained concurrently with the DSA image, demonstrates the thrombotic component located peripherally (arrowheads). The patent lumen is indicated (arrow). Small ischemic areas on the left side of the pons are also visible.

The stenosis at the distal edge of the BA aneurysm had slightly progressed at the 2-month follow-up cerebral MR imaging with MR angiography (MRA), with an irregular T1 hyperintense bulging consistent with a newly formed clot at the cranial portion of the aneurysm. The antiplatelet therapy was maintained. The 4-month follow-up MR imaging with MRA showed further progression of the BA stenosis. Finally, the follow-up angiogram (Fig 3) obtained 11 months after the initial symptoms demonstrated complete obliteration of the BA at the level of the dissection without any evidence of filling of the aneurysmal pouch and adequate collateral flow to the posterior communicating arteries and SCAs provided by the internal carotid artery via the posterior communicating arteries. MR imaging performed at the same time demonstrated shrinkage of the aneurysm without new lesions. At the present time, the patient remains clinically stable and neurologically intact. The 19-month follow-up MR imaging ruled out the presence of new ischemic areas.

Fig 3.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 3.

Follow-up angiogram, obtained 11 months after the onset of symptoms, shows complete obliteration of the BA at the level of the dissection, without any evidence of residual filling of the aneurysm.

Discussion

Intracranial aneurysms in children account for 0.5–4.6% of all aneurysms (1). In this population, 20% are giant aneurysms. Aneurysms located in the posterior circulation are more numerous in children than in adults (1, 2). Dissecting giant aneurysms of the vertebral and basilar intracranial arteries are relatively rare in the pediatric population. They do, however, carry a severe morbidity and mortality rate because of the tendency to cause distal thromboembolism (3). The mechanisms determining the behavior of partially thrombosed giant aneurysms are not completely understood. These aneurysms probably grow by intramural hemorrhage, as seen on their MR images, which typically show concentric layers of blood in different stages with varying signal intensities (4, 5). Regardless of age or location, the percentage of reported spontaneous total thrombosis of giant aneurysms ranges from 13–20% (6). It has been proposed that thrombosis is not the usual final stage of the aneurysm evolution, but rather an ongoing dynamic process that has potential for further growth and mass effect. Aneurysmal growth may be due to accumulation of thrombotic materials, recurrent intramural hemorrhage, or development of intrathrombotic capillary channels, which may, in turn, thrombose or bleed. Among children, trauma represents the most common predisposing factor for vertebrobasilar (VB) dissecting aneurysms (3). Strokes are quite frequent in children with VB dissecting aneurysms because of secondarily reduced distal flow or embolic phenomena. The angiographic signs of a dissection are not always evident in the acute phase (5); for this reason, when a dissection is suspected, repeat angiography is mandatory, also in light of the frequency of delayed aneurysm formation. The natural history of most untreated giant aneurysms is extremely dismal. The literature contains very few cases of complete spontaneous occlusion of partially thrombosed giant BA aneurysms (1, 7, 8).

In the two cases described in the pediatric population in which spontaneous occlusion occurred, a few similarities with our patient were recognizable (1, 8). First, none of the patients experienced subarachnoid hemorrhage. Second, all of them remained clinically stable or improved during the follow-up period. Third, the aneurysms were located at the same level of the BA, between the midbasilar portion and the origin of the SCAs. Finally, at the diagnostic DSA, tapered narrowing of the parent artery close to the neck of the aneurysm was demonstrated in all three patients. In our opinion, this condition may have altered the dynamic of the jet stream of blood, promoting the progression of the thrombosis of both the aneurysm and the parent artery.

References

  1. ↵
    Kanaan I, Lasjaunias P, Coates R. The spectrum of intracranial aneurysms in pediatrics. Minim Invasive Neurosurg 1995;38:1–9
    PubMed
  2. ↵
    Allison JW, Davis PC, Sato Y, et al. Intracranial aneurysms in infants and children. Pediatr Radiol 1998;28:223–229
    CrossRefPubMed
  3. ↵
    Massimi L, Moret J, Tamburrini G, Di Rocco C. Dissecting giant vertebro-basilar aneurysms. Childs Nerv Syst 2003;19:204–210
    PubMed
  4. ↵
    Artmann H, Vonofakos D, Muller H, Grau H. Neuroradiologic and neuropathologic findings with growing giant intracranial aneurysm. Surg Neurol 1984;21:391–401
    CrossRefPubMed
  5. ↵
    Schubiger O, Valavanis A, Wichmann W. Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging. Neuroradiology 1987;29:266–271
    PubMed
  6. ↵
    Schubiger O, Valavanis A, Hayek J. Computer tomography in cerebral aneurysms with special emphasis on giant intracranial aneurysms. J Comput Assist Tomogr 1980;4:24–32
    PubMed
  7. ↵
    Maeda K, Usui M, Tsutsumi K, Iijima A. Spontaneous occlusion of a giant basilar tip aneurysm and a basilar artery due to the dissection of both structures: case report. Surg Neurol 1997;48:606–609
    PubMed
  8. ↵
    Loevner LA, Ting TY, Hurst RW, et al. Spontaneous thrombosis of a basilar artery traumatic aneurysm in a child. AJNR Am J Neuroradiol 1998;19:386–388
    Abstract
  • Received February 10, 2004.
  • Accepted after revision April 16, 2004.
  • Copyright © American Society of Neuroradiology
View Abstract
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 26 (1)
American Journal of Neuroradiology
Vol. 26, Issue 1
1 Jan 2005
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Spontaneous Partial Thrombosis of a Basilar Artery Giant Aneurysm in a Child
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Spontaneous Partial Thrombosis of a Basilar Artery Giant Aneurysm in a Child
Elisa F. M. Ciceri, Alison L. Lawhead, Tiziana De Simone, Luca Valvassori, Edoardo Boccardi
American Journal of Neuroradiology Jan 2005, 26 (1) 56-57;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Spontaneous Partial Thrombosis of a Basilar Artery Giant Aneurysm in a Child
Elisa F. M. Ciceri, Alison L. Lawhead, Tiziana De Simone, Luca Valvassori, Edoardo Boccardi
American Journal of Neuroradiology Jan 2005, 26 (1) 56-57;
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Case Report
    • Discussion
    • References
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Republished: Spontaneous thrombosis of a basilar tip aneurysm after ventriculoperitoneal shunting
  • Spontaneous thrombosis of a basilar tip aneurysm after ventriculoperitoneal shunting
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Neuroimaging Features of Biotinidase Deficiency
  • Medullary Tegmental Cap Dysplasia: Fetal and Postnatal Presentations of a Unique Brainstem Malformation
  • Diagnostic Utility of 3D Gradient-Echo MR Imaging Sequences through the Filum Compared with Spin-Echo T1 in Children with Concern for Tethered Cord
Show more Pediatrics

Similar Articles

Advertisement

News and Updates

  • Lucien Levy Best Research Article Award
  • Thanks to our 2022 Distinguished Reviewers
  • Press Releases

Resources

  • Evidence-Based Medicine Level Guide
  • How to Participate in a Tweet Chat
  • AJNR Podcast Archive
  • Ideas for Publicizing Your Research
  • Librarian Resources
  • Terms and Conditions

Opportunities

  • Share Your Art in Perspectives
  • Get Peer Review Credit from Publons
  • Moderate a Tweet Chat

American Society of Neuroradiology

  • Neurographics
  • ASNR Annual Meeting
  • Fellowship Portal
  • Position Statements

© 2023 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire