1011. A Rare Case of Multiple Posterior Circulation Aneurysms in a Child

Authors: Karoline Schereck Kreitmeyer; Paulo Ricardo Soares; Eduardo Palhares; Marcelo de Lima (Sao Paulo, Brazil)

Introduction: Intracranial aneurysms in children are rare, being more common in the bifurcation of the internal carotid and middle cerebral arteries (72.8%), rarely occurring in the posterior circulation (9.1%), yet they represent twice that found in adults. Aneurysms of the distal posterior cerebral artery in the circle of Willis are the most common aneurysms of posterior circulation in children. The pediatric population presents in 62% of the cases with syncope, meningeal signs, irritability, lethargy and vomiting. Methods: Bibliographic review of scientific articles searched in PubMed, Medline, Embase, Science Direct, The Cochrane Database. Results: J.G.D.S, male, 9 years old, with sudden extremely severe headache, followed by temporary loss of consciousness. Clinical findings: Hunt Hess II, eye opening to speech, no appendicular deficits, nuchal rigidity present, preserved cranial nerves. Head CT: Fisher IV subarachnoid hemorrhage. Arteriography: 2 PICA aneurysms, one 8 x 7 mm bilobed, with 2 mm neck, and the second most distal 4 x 3 mm without definite neck. The embolization of the two aneurysms was unsuccessful and the surgical approach with definitive clipping of the aneurysms was chosen. Patient evolves postoperatively in good condition. Conclusion: Endovascular embolization vs surgical clipping in treatment of cerebral aneurysms present the same rate of postoperative cerebral hemorrhage and ischemia in children. A rare case of multiple aneurysms in children is described showing the need of early radiological investigation to identify the cause of the hemorrhage followed of the best approach to the case: surgical vs. endovascular, according to radiological findings and local availability.