Elderly adult PMHx remote TBI with incidentally identified giant left MCA partially-thrombosed fusiform aneurysm. Now acute stroke syndrome including aphasia, dysarthria, and right hemiparesis
What’s the diagnosis?
Giant, acutely partially-thrombosed left superior M2 division MCA aneurysm that is symptomatic
Cerebral aneurysms larger than 25 mm are termed giant aneurysms.
Giant saccular and fusiform intracranial aneurysms commonly have spontaneous, intraluminal thrombotic events.
These aneurysms are considered to be unstable. It is unpredictable when they will undergo partial or complete thrombosis and when thrombosis does occur thrombus may become dislodged and embolize distally to downstream vessels and cause ischemic stroke.
What's your treatment plan?
Microsurgical clip reconstruction, with or without resection of the aneurysmal thrombosed components to reduce mass effect.
Endovascular flow diversion, with or without concomitant coil embolization of the non-thrombosed portion of the aneurysm.
In this case although the giant aneurysm had mass effect on the inferior M2 branch it was not flow limiting. The concern was for further distal thromboembolic events.
In this case coil embolization of the non-thrombosed portion of the giant left MCA aneurysm was performed. Subsequently, a Pipeline embolization device was placed across the neck of the aneurysm.