[Intraventricular hemorrhage due to the rupture of atherosclerotic dissecting aneurysm of the middle cerebral artery].

BACKGROUND

We present a case of fusiform intracranial aneurysm where, apart from the unusual site, we draw attention to the form of clinical presentation, namely intraventricular haemorrhage. Clinical case. A 68 year-old-man with a history of smoking, hyperuricemia with seizures of gout treated with colchicine and allopurinol, and hypertension treated with captopril. Nine years previously he had a right capsulothalamic haematoma and presented (as a sequela of this) a left sensomotor deficit, with a good functional level. In December 1998 he was admitted for sudden onset of headache and deterioration of consciousness. He had right limb movements which were typical of decerebration and made intubation and mechanical ventilation necessary. Cerebral CT, with angiographic sequences, showed blood in the lateral ventricles and III ventricle, with ventricular dilation and a fusiform aneurysm of the left middle cerebral artery. In view of the neurological state of the patient, treatment of the aneurysm was postponed. After initial improvement, which permitted extubation, tetraparesia (predominantly right) and a pseudobulbar syndrome were seen. The patient had repeated respiratory infections and died from sepsis caused by Pseudomona aeruginosa (of respiratory origin) three months after admission.

CONCLUSIONS

Fusiform intracranial aneurysms form 9% of all aneurysms. Localization to the middle cerebral artery is infrequent, the basilar trunk and internal carotid artery are commoner sites. In our case angio-CT was a useful non-invasive neuro-radiological technique.