1195. Rare Occurrence and Spontaneous Rupture of Cerebral Pseudoaneurysm in a Patient With no Known Risk Factors

Authors: Neethu Gopal; Mohamed S Muneer; George Vilanilam; Mohamed Badi; Lauren K Ng Tucker; Rabih Tawk; William Freeman; Benjamin L Brown (jacksonville, FL)

Introduction:
 
Intracranial pseudoaneurysms (IPAs) constitutes <1% of all intracranial aneurysms and are due to transmural vessel pathology. IPAs involving the distal branches of the posterior cerebral artery (PCA) are the least to occur compared to the anterior circulation IPAs. While the majority of IPAs are secondary to trauma, infections, iatrogenic injury and vasculitis, spontaneous IPAs are rare.Here we report a rare case of incidental right posterior cerebral artery pseudoaneurysm in a patient with spontaneous intracerebral hemorrhage treated with Onyx embolization

Methods:

Case Report 

Results:

A 54-year-old left-handed gentleman with prior history of tension headaches, hypertension, coronary artery disease, hyperlipidemia, type-2 diabetes, and atrial fibrillation treated with clopidogrel and apixaban, presented with sudden onset of progressive, severe headache. Additional history revealed sudden onset behavioral change and gait imbalance. On examination patient’s NIH stroke scale (NIHSS) was ‘2’, with left homonymous hemianopia. Diagnostic workup was negative for inflammatory markers, and infections including infective endocarditis. Emergent CT revealed right parietal intracerebral hemorrhage. Brain MRI revealed an underlying vascular lesion that was questionable for an arteriovenous malformation or a cavernoma. The intracerebral hemorrhage was managed conservatively using Andexxa, to reverse the effects of Apixaban.  Cerebral angiography revealed a pseudoaneurysm of the right parietal cortical branch of the posterior cerebral artery measuring 3.3 mm in maximal diameter. The IPA was successfully embolized with Onyx and follow-up imaging confirmed complete obliteration.

Conclusion:
This case demonstrates successful endovascular obliteration of incidental IPA of distal branch of PCA in spontaneous intracerebral hemorrhage. Further research is needed investigating the etiology and pathogenesis of incidental IPAs.