뇌동맥류로 오인된 후교뇌동맥 폐색

초록

PURPOSE : As a resulting to the diagnosis of intracranial aneurysm technique developed, also increased false positive aneurysm. Our institute have experience of posterior communicating(p-com) artery occlusion that mimicking the p-com aneurysm with subarachnoid hemorrhage. We reported our case with literature review and discussions MATERIALS AND METHODS : A 47-year-old man was admitted to emergency department due to sudden onset of headache during a excercise. Brain computed tomography and computed tomographic angiography showed a subarachnoid hemorrhage which were localizing in basal cistern, especially perimesencephalic cistern and a small contrast filling lesion in left posterior communicating artery and a total obstruction in proximal portion of right middle cerebral artery. Conventional digital subtraction angiography revealed a small saccular aneurysm protruding to inferolateral direction in left distal intracranial artery and a total obstruction in proximal portion of right middle cerebral artery with multiple collateral vessel such as both anterior cerebral arteries and right posterior cerebral artery, which was correlated with moyamoya disease probable. Brain perfusion magnetic resornace images with enhancement showed the increased mean transient time and cerebral blood volum in right middle cerebral artery territories. But we confused origin of SAH because of too small p-com aneurysm with good conture and perimesencephalic located SAH. After 2 weeks later, repeated angiography was performed. But these findings were same with previous angiogram. So we planned a aneurysmal clipping of right posterior communicating artery. Intraoperatively, the aneurysm was proved to be the proximal stumps of the occluded middle portion of the posterior communicating artery. RESULTS : Mimicking that aneurysm was some reported but like this case was rare. We have a many confused idea at preoperative peroid, but we made a reasons of SAH as a venous otigin of