Pediatric proximal anterior cerebral artery aneurysm: A case report

 

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Abstract

Intracranial aneurysms are extremely uncommon in children (≤ 18 years old) and their incidence increases with age. Their epidemiology is poorly understood and certain features like location, morphology and presentation make them unique in comparison to adults. The internal carotid artery bifurcation is the most frequent site for aneurysm in this age group. We report a case of an 8-year-old boy with history of sudden unconsciousness followed by generalized tonic clonic seizures. The computerized tomography scan revealed subarachnoid hemorrhage with blood seen in the left Sylvian fissure, along tentorium cerebelli and posterior falx. There was focal intracerebral hematoma in the left temporal lobe abutting the Sylvian fissure and blood could also be seen in the fourth, third and both lateral ventricles with mild ventriculomegaly. The digital subtraction angiography revealed a large intracranial aneurysm arising from the left proximal anterior cerebral artery just distal to left internal carotid artery bifurcation. The aneurysm was clipped using standard microsurgical techniques. The child did well postoperatively. Intracranial aneurysms are rare in childhood and proximal artery anterior cerebral artery aneurysms are amongst the rarer sites. This report highlights one such rare case.