Pseudoaneurysms occur at the rupture site of true aneurysms and appear as irregularly shaped and partially thrombosed outpouchings of the main sac. Recanalization of thrombi inside pseudoaneurysmal sac is one of the putative mechanisms of rebleeding of unsecured aneurysms and of coil migration after endovascular treatment. We document “real time” pseudoaneurysm formation after rerupture of an anterior communicating artery aneurysm.
A 55-year-old man with aneurysmal subarachnoid hemorrhage from an anterior communicating aneurysm underwent catheter angiography. After the diagnostic angiogram while awaiting for the anesthesia team to proceed with endotracheal general anesthesia, a seizure occurred. Rebleeding was suspected and confirmed by a dynamic CT in the angio suite. A repeat angiogram showed a pseudoaneurysm arising from the previously ruptured aneurysm which had not been present on the original angiogram a few minutes earlier. Uneventful coiling of the aneurysm was undertaken and the patient was discharged home a week later.
We document angiographic formation of a “pseudoaneurysm” at the site of rupture of an anterior communicating artery aneurysm. “Pseudoaneurysm” formation occurs after rupture of an intracranial aneurysm. They represent a weak spot in the aneurysm sac at the site of rupture and probably the result of persistent flow within the clot forming at the site of rupture. Presence of a pseudoaneurysm with characteristic angiographic features like the one herein described represents an unstable area within the aneurysm. This case also highlights the observation that, in patient harboring unsecured ruptured aneurysms, seizures or seizures-like phenomena are the clinical expression of rebleeding unless proven otherwise.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Ide M, Kobayashi T, Tamano Y, Hagiwara S, Tanaka N, Kawamura H. Pseudoaneurysm formation at the rupture site of a middle cerebral artery aneurysm—case report. Neurol Med Chir (Tokyo). 2003;43:443–6.
Mori K, Kasuga C, Nakao Y, Yamamoto T, Maeda M. Intracranial pseudoaneurysm due to rupture of a saccular aneurysm mimicking a large partially thrombosed aneurysm (“ghost aneurysm”): radiological findings and therapeutic implications in two cases. Neurosurg Rev. 2004;27:289–93.
Nomura M, Kida S, Uchiyama N, et al. Ruptured irregularly shaped aneurysms: pseudoaneurysm formation in a thrombus located at the rupture site. J Neurosurg. 2000;93:998–1002.
Ohta M, Matsuno H. Proximal M2 false aneurysm after head trauma—case report. Neurol Med Chir (Tokyo). 2001;41:131–4.
Molyneux AJ, Kerr RS, Yu LM, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366:809–17.
Conflict of interest
Authors have no affiliations or financial involvement with any organization or entity with a financial interest in the subject matter discussed in this manuscript.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
D’Urso, P.I., Loumiotis, I., Milligan, B.D. et al. “Real time” Angiographic Evidence of “Pseudoaneurysm” Formation After Aneurysm Rebleeding. Neurocrit Care 14, 459–462 (2011) doi:10.1007/s12028-011-9522-y
- Aneurysmal subarachnoid hemorrhage