Abstract
Aneurysms of the recurrent artery of Heubner (RAH) are known to be one of the uncommon
cerebral aneurysms, predominantly presenting with bleeding symptoms. Previously, nine
cases of the RAH aneurysms have been reported, all of which were treated surgically
or endovascularly and most cases developed postoperative cerebral infarct in the ipsilateral
caudate nucleus. Herein, we report a man presenting with transient ischemic attack
due to diffuse cerebral vasospasm from a minor non-disabling subarachnoid hemorrhage
(SAH) from an RAH aneurysm. He visited our hospital 7 days after the first experience
of a thunderclap headache complaining with transient unilateral motor weakness and
thin SAH in the right sylvian fissure. Diagnostic catheter angiography revealed a
dissecting fusiform aneurysm (8 mm in size) originating from the left RAH contralateral
to the thin SAH. Contrast-enhanced magnetic resonance vessel wall imaging (MR-VWI)
helped to identify the ruptured nature of the RAH aneurysm. Owing to his delayed ischemic
condition after minor SAH, he was conservatively treated with serial MR-VWI monitoring.
The aneurysm was spontaneously obliterated with an asymptomatic lacunar infarct in
the ipsilateral caudate nucleus in a month. Together, this case was considered as
the dissecting aneurysm of RAH with a favorable outcome after the conservative management.
Although long-term follow-up is mandatory because the disappearance of the vessel
wall enhancement does not necessarily secure the permanent cure of the lesion, serial
MR-VWI is helpful to diagnose the ruptured nature and monitor its chronological change
in combination with conventional radiological imaging techniques.
Keywords
MRI - recurrent artery of Heubner - vascular disorder - vessel wall imaging
