A 64-year-old female with an incidental aneurysms

A 64-year-old female with an incidental aneurysms

Rupture and spontaneous resolution of a P1 perforator pseudoaneurysm Teaching NeuroImages Neurology Resident and Fellow Section 2018 American Academy of Neurology Giordan et al. Vignette 47 year-old male with history of smoking and hypertension Sudden onset of headache Admission Head CT showed subarachnoid hemorrhage with epicenter in the interpeduncular cistern

Develops progressive ophthalmoplegia and brain MRI documented bilateral thalamic infarcts Admission catheter angiography showed no vascular lesions Repeat catheter angiography four days later showed a 2 mm dissecting pseudoaneurysm of a thalamoperforator artery The pseudoaneurysm was managed conservatively and a follow-up catheter angiogram six weeks later demonstrated spontaneous obliteration 2018 American Academy of Neurology Giordan et al.

Images A B C E F G F A D 2018 American Academy of Neurology Giordan et al. Rupture and spontaneous resolution of a P1 perforator pseudoaneurysm

Dissecting pseudoaneurysms of perforating posterior circulation vessels can present with a pattern suggestive of perimesencephalic SAH. Presence of neurological deficits should increase the level of suspicion. Spontaneous resolution can occur without invasive treatment [1]. 2018 American Academy of Neurology Giordan et al.

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