Bilateral Infarction of the Recurrent Arteries of Heubner Following Clipping of an Anterior Communicating Artery Aneurysm.
10.7461/jcen.2018.20.1.28
- Author:
Sang Hyub LEE
1
;
Chul Hee LEE
;
In Sung PARK
;
Jong Woo HAN
Author Information
1. Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea. chl68@gnu.ac.kr
- Publication Type:Case Report
- Keywords:
Aneurysm;
Subarachonid hemorrhage;
Heubner artery infarction;
Infarction
- MeSH:
Aneurysm;
Angiography;
Arteries*;
Brain;
Cerebral Angiography;
Emergency Service, Hospital;
Female;
Headache Disorders, Primary;
Humans;
Infarction*;
Infarction, Anterior Cerebral Artery;
Intracranial Aneurysm*;
Middle Aged;
Middle Cerebral Artery;
Neck;
Neurologic Manifestations;
Nimodipine;
Perfusion;
Subarachnoid Hemorrhage;
Vasospasm, Intracranial;
Vomiting
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2018;20(1):28-34
- CountryRepublic of Korea
- Language:English
-
Abstract:
A 50-year-old woman reported to the emergency department with thunderclap headache and vomiting. Non-enhanced brain computed tomography (CT) showed a subarachnoid hemorrhage of Hunt-Hess Grade II and Fisher Grade III. Brain angiography CT and transfemoral cerebral angiography (TFCA) revealed an aneurysm of the anterior communicating artery. A direct neck clipping was performed using the pterional approach. The post-operation CT was uneventful. Six days postoperatively, the patient became lethargic. The mean velocity (cm/s) of the middle cerebral artery peaked at 173 cm/s on the right side and 167 cm/s on the left. A TFCA revealed decreased perfusion in both recurrent arteries of Heubner (RAH), but no occlusion in either. Intra-arterial nimodipine injection was administered. On the 7th postoperative day, CT demonstrated a newly developed low-density lesion in the RAH territory bilaterally. The cause of the infarction was attributed to decreased perfusion caused by cerebral vasospasm. The patient was discharged with no definite neurologic deficit except for mild cognitive disorder.
