Posterior Communicating Artery Aneurysm: Multiple Aneurysms, Diagnosed in Mother and Daughter, the Increased Rupture Risk, Consequences for Diagnostic Protocols, and Treatment Decisions

  • Muhammad AlMatterEmail author
  • Marta Aguilar Pérez
  • Hans Henkes
Living reference work entry


An incidental cerebral aneurysm of the left internal carotid artery (ICA) at the origin of the posterior communicating artery (PcomA) was diagnosed on a screening MRI, which was performed due to the diagnosis of multiple cerebral aneurysms in the patient’s mother. The diagnostic angiography revealed an additional small incidental left middle cerebral artery (MCA) aneurysm. The left PcomA aneurysm ruptured prior to the scheduled treatment, resulting in a subarachnoid hemorrhage (SAH). The clinical condition of the patient was graded at Hunt and Hess III, and the ruptured aneurysm was immediately treated by coiling with subtotal occlusion. The left MCA aneurysm was subsequently treated by microsurgical clipping. Due to progressive reperfusion of the ruptured PcomA aneurysm, the treatment was completed by putting a flow diverter (FD) in place, which led to the complete exclusion of the aneurysm remnant while preserving the flow into the covered PcomA. The issue of familial aneurysms is the main topic of this chapter.


Familial aneurysm Subarachnoid hemorrhage Flow diverter Coil occlusion Microsurgical clipping 


  1. Bourcier R, Le Scouarnec S, Bonnaud S, Karakachoff M, Bourcereau E, Heurtebise-Chrétien S, Menguy C, Dina C, Simonet F, Moles A, Lenoble C, Lindenbaum P, Chatel S, Isidor B, Génin E, Deleuze JF, Schott JJ, Le Marec H, ICAN Study Group, Loirand G, Desal H, Redon R. Rare coding variants in ANGPTL6 are associated with familial forms of intracranial aneurysm. Am J Hum Genet. 2018;102(1):133–41. Scholar
  2. Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med. 2006;355(9):928–39. Scholar
  3. Broderick JP, Brown RD Jr, Sauerbeck L, Hornung R, Huston J 3rd, Woo D, Anderson C, Rouleau G, Kleindorfer D, Flaherty ML, Meissner I, Foroud T, Moomaw EC, Connolly ES, FIA Study Investigators. Greater rupture risk for familial as compared to sporadic unruptured intracranial aneurysms. Stroke. 2009;40(6):1952–7. Scholar
  4. Bromberg JE, Rinkel GJ, Algra A, Greebe P, van Duyn CM, Hasan D, Limburg M, ter Berg HW, Wijdicks EF, van Gijn J. Subarachnoid haemorrhage in first and second degree relatives of patients with subarachnoid haemorrhage. BMJ. 1995;311(7000):288–9. Scholar
  5. Jabbarli R, Dinger TF, Darkwah Oppong M, Pierscianek D, Dammann P, Wrede KH, Kaier K, Köhrmann M, Forsting M, Kleinschnitz C, Sure U. Risk factors for and clinical consequences of multiple intracranial aneurysms: a systematic review and meta-analysis. Stroke. 2018;49(4):848–55. Scholar
  6. Mensing LA, Rinkel GJE, Vlak MHM, van der Schaaf IC, Ruigrok YM. Difference in aneurysm characteristics between patients with familial and sporadic aneurysmal subarachnoid haemorrhage. PLoS One. 2016;11(4):e0154281. Scholar
  7. Rahman M, Ogilvy CS, Zipfel GJ, Derdeyn CP, Siddiqui AH, Bulsara KR, Kim LJ, Riina HA, Mocco J, Hoh BL. Unruptured cerebral aneurysms do not shrink when they rupture: multicenter collaborative aneurysm study group. Neurosurgery. 2011;68(1):155–60 , discussion 160–1. Scholar
  8. Rinkel GJ, Djibuti M, Algra A, van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke. 1998 Jan;29(1):251–6. Scholar
  9. Ruigrok YM, Rinkel GJ, Algra A, Raaymakers TW, Van Gijn J. Characteristics of intracranial aneurysms in patients with familial subarachnoid hemorrhage. Neurology. 2004;62(6):891–4. Scholar
  10. Sánchez van Kammen M, Moomaw CJ, van der Schaaf IC, Brown RD Jr, Woo D, Broderick JP, Mackey JS, GJE R, Huston J 3rd, Ruigrok YM. Heritability of circle of Willis variations in families with intracranial aneurysms. PLoS One. 2018;13(1):e0191974. Scholar
  11. ter Berg HW, Dippel DW, Limburg M, Schievink WI, van Gijn J. Familial intracranial aneurysms. A review. Stroke. 1992;23(7):1024–30. Scholar
  12. van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet. 2007;369(9558):306–18. Scholar
  13. Wiebers DO, Whisnant JP, Sundt TM Jr, O'Fallon WM. The significance of unruptured intracranial saccular aneurysms. J Neurosurg. 1987;66(1):23–9. Scholar
  14. Wu Y, Li Z, Shi Y, Chen L, Tan H, Wang Z, Yin C, Liu L, Hu J. Exome sequencing identifies LOXL2 mutation as a cause of familial intracranial aneurysm. World Neurosurg. 2018;109:e812–8. Scholar
  15. Zhou S, Gan-Or Z, Ambalavanan A, Lai D, Xie P, Bourassa CV, Strong S, Ross JP, Dionne-Laporte A, Spiegelman D, Dupré N, Foroud TM, Xiong L, Dion PA, Rouleau GA. Genome-wide association analysis identifies new candidate risk loci for familial intracranial aneurysm in the French-Canadian population. Sci Rep. 2018;8(1):4356. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Muhammad AlMatter
    • 1
    Email author
  • Marta Aguilar Pérez
    • 1
  • Hans Henkes
    • 1
  1. 1.Neuroradiologische KlinikKlinikum StuttgartStuttgartGermany

Personalised recommendations