What’s the diagnosis?
- In patients with intracranial aneurysms and an acute neurological decline, subarachnoid hemorrhage due to aneurysmal rupture must be considered. In this case, a non-contrast CT head scan on presentation did not show any subarachnoid hemorrhage or intra-parenchymal blood products to suggest aneurysmal rupture as the cause of the patient’s symptoms.
- Giant intracranial aneurysms are defined as having a diameter of at least 25 mm.
- Patients with giant intracranial aneurysms commonly present with subarachnoid hemorrhage or local mass effect, but thromboemboli from these aneurysms or other large aneurysms can cause transient ischemic attacks or strokes.
- The Law of LaPlace states that wall tension increases with aneurysm diameter and in general, larger aneurysms carry a higher risk of rupture than smaller ones.
- In the case of an acute large vessel occlusion, the potential benefits of endovascular thrombectomy must be weighed against the treatment risks. In this case, the risk of attempting endovascular thrombectomy is higher than normal because the aneurysm will need to be traversed in order to access the clot, and rupture of the aneurysm due to manipulation would be a catastrophic event.