Ruptured Distal Anterior Choroidal Artery Aneurysm Presenting as Isolated Intraventricular Hemorrhage: Case Report and Comprehensive Review of the Literature.

Distal anterior choroidal artery (AChA) aneurysms are infrequent. We discuss the case of a 59-year-old patient who presented with an isolated intraventricular hemorrhage (IVH) secondary to a ruptured distal AChA aneurysm. Initial noninvasive cerebral computed tomography angiography revealed no evidence of an underlying vascular pathology. The patient underwent further digital subtraction cerebral angiography, which revealed an aneurysm arising from the distal AChA segment. The aneurysm was successfully treated with surgical clip ligation. The current study highlights the importance of considering a ruptured distal AChA aneurysm as a potential source of isolated IVH.

Ruptured True Anterior Choroidal Artery Aneurysm in Cisternal Segment.

BACKGROUND: Rupture of a true anterior choroidal artery (AChA) aneurysm in the cisternal segment is extremely rare, whereas cases of a distal AChA aneurysm associated with moyamoya disease are increasingly reported. CASE DESCRIPTION: A 58-year-old woman presented with a severe headache and vomiting. Computed tomography demonstrated a subarachnoid hemorrhage without intraventricular or intracerebral hemorrhaging. Cerebral angiogram findings revealed a proximal AChA aneurysm mimicking an internal carotid artery aneurysm at the origin of the AChA. Intraoperative findings demonstrated a ruptured aneurysm located on a bend of the proximal AChA in the carotid cistern. Neck clipping of the aneurysm with preservation of the AChA led to a good outcome. CONCLUSIONS: A rare case of ruptured true AChA aneurysm in the cisternal segment, unrelated to moyamoya disease, is presented as a cause of subarachnoid hemorrhage.

Extravasation from the Distal Anterior Choroidal Artery Aneurysm in Moyamoya Patient during Computed Tomographic Angiography

Three-dimensional computed tomographic angiography (CTA), a representative noninvasive radiologic technique, is being widely used for detecting vascular lesions in specific intracranial bleeding under a certain circumstance (acute nontraumatic subarachnoid hemorrhage). We encountered a case of extravasation of the contrast medium on CTA images that appeared as ribbon-like high-attenuation lesion from an aneurysm at the distal anterior choroidal artery in a young adult moyamoya patient. As CTA is used more frequently, it is imperative to understand such unusual but, potentially lethal image findings to conduct a prompt intervention.