Abstract
Simultaneous rupture of more than one intracranial aneurysm is a rare event and difficult
to diagnose. In this case report, we present the case of a patient with a simultaneous
rupture of two middle cerebral artery (MCA) aneurysms with two separately localized
aneurysm-associated intracerebral hemorrhages (ICH). Initially, the patient presented
with headache and neck stiffness as well as progressive decrease of consciousness.
Computed tomography (CT) revealed a subarachnoid hemorrhage with a frontal and temporal
space-occupying ICH. CT angiography demonstrated two MCA aneurysms located in adjacency
to the ICHs, one located at the M1 segment and the other in the bifurcation of the
left MCA. Rupture of both aneurysms was confirmed during surgery, and both aneurysms
were clipped microsurgically without complications. Although rupture of one aneurysm
in patients with multiple aneurysms is the most common event, this case indicates
that simultaneous rupture should be kept in mind in patients with multiple aneurysms.
In patients with multiple aneurysms, the identification of the ruptured aneurysm(s)
is necessary to avoid leaving a ruptured aneurysm untreated.
Keywords
simultaneous aneurysm rupture - intracerebral hemorrhage - microsurgical clipping
- subarachnoid hemorrhage
