Case presentation
The patient is a 66-year-old female. The patient has abrupt aphasia, dysarthria, and right facial drooping. After examination, a cystic aneurysm of the left middle cerebral artery (10×6×7mm) was found incidentally.
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Noncontrast CT showed that the local hyperdense signal of MCA was intraaneurysmal thrombosis (Fig. 1):
CTA showing a cystic aneurysm at the left M2 bifurcation (Figure 2). Panels A and B, showing hyperintensity (contrast media) within the aneurysm. Panels C and D, post-thrombotic hypointensity within the aneurysm. Panels E and F, left M2 superior stem infarction:
Hypercoagulability examination shows metastatic lung malignancy.
Intraaneurysm thrombus
Cerebral embolism caused by thrombosis within an aneurysm is a serious cerebrovascular disease. An aneurysm is an abnormal dilation of the wall of a blood vessel, forming a weak area of the blood vessel wall. When a blood clot forms inside an aneurysm, the clot may break off and travel with the bloodstream to other parts of the cerebral vascular system, causing a cerebral embolism.
The risk of cerebral embolism due to intraaneurysmal thrombosis is high because intraaneurysmal thrombus tends to break off and can cause serious cerebrovascular events. The aneurysm itself may also rupture, leading to subarachnoid hemorrhage, increasing the risk and harm to the patient.
For cerebral embolism caused by intraaneurysmal thrombosis, treatment strategies usually include pharmacologic and interventional therapy. Drug therapy is the prevention and treatment of thrombosis with anticoagulant or antiplatelet drugs. Interventional treatments include intra-arterial surgery to address the aneurysm by placing a stent within the blood vessel or performing vascular repair, reducing the risk of thrombosis and detachment.
总体而言，未破裂颅内动脉瘤不增加卒中的风险，但动脉瘤内血栓形成可引起缺血性卒中。 动脉瘤内血栓形成可能是外科或介入手术的指征。 文献出处：Stroke. 2023 Jun; 54(6):e237-e238. doi: 10.1161/STROKEAHA.123.043013. Epub 2023 May 4. Ischemic Stroke Secondary to Middle Cerebral Artery Branch Occlusion From a Thrombosed Saccular Aneurysm.