The dynamic, hemodynamic impact of a cervical dissection on an ipsilateral, intracranial saccular aneurysm has not been well illustrated. This 45-year-old female was found to have a small, supraclinoid aneurysm ipsilateral to a spontaneous cervical internal carotid artery dissection. With healing of the dissection, the aneurysm appeared to have significantly enlarged. Retrospective review of the magnetic resonance imaging (MRI) at the time of the initial dissection demonstrated thrombus, similar in overall morphology to the angiographic appearance of the "enlarged" aneurysm. As the dissection healed far proximal to the intradural portion of the internal carotid artery, this suggested that the aneurysm was likely a typical, saccular posterior communicating artery aneurysm that had thrombosed and then recanalized secondary to flow changes from the dissection. The aneurysm was coiled uneventfully, in distinction from more complex treatment approaches such as flow diversion or proximal occlusion to treat an enlarging, dissecting pseudoaneurysm. This case illustrates that flow changes from cervical dissections may result in thrombosis of downstream saccular aneurysms. With healing, these aneurysms may recanalize and be misidentified as enlarging dissecting pseudoaneurysms. Review of an MRI from the time of the dissection facilitated the conclusion that the aneurysm was a saccular posterior communicating artery aneurysm, influencing treatment approach.
Aneurysm* ; Aneurysm, False ; Carotid Artery, Internal ; Carotid Artery, Internal, Dissection ; Female ; Hemodynamics* ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Middle Aged ; Retrospective Studies ; Thrombosis

The dynamic, hemodynamic impact of a cervical dissection on an ipsilateral, intracranial saccular aneurysm has not been well illustrated. This 45-year-old female was found to have a small, supraclinoid aneurysm ipsilateral to a spontaneous cervical internal carotid artery dissection. With healing of the dissection, the aneurysm appeared to have significantly enlarged. Retrospective review of the magnetic resonance imaging (MRI) at the time of the initial dissection demonstrated thrombus, similar in overall morphology to the angiographic appearance of the "enlarged" aneurysm. As the dissection healed far proximal to the intradural portion of the internal carotid artery, this suggested that the aneurysm was likely a typical, saccular posterior communicating artery aneurysm that had thrombosed and then recanalized secondary to flow changes from the dissection. The aneurysm was coiled uneventfully, in distinction from more complex treatment approaches such as flow diversion or proximal occlusion to treat an enlarging, dissecting pseudoaneurysm. This case illustrates that flow changes from cervical dissections may result in thrombosis of downstream saccular aneurysms. With healing, these aneurysms may recanalize and be misidentified as enlarging dissecting pseudoaneurysms. Review of an MRI from the time of the dissection facilitated the conclusion that the aneurysm was a saccular posterior communicating artery aneurysm, influencing treatment approach.
Aneurysm* ; Aneurysm, False ; Carotid Artery, Internal ; Carotid Artery, Internal, Dissection ; Female ; Hemodynamics* ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Middle Aged ; Retrospective Studies ; Thrombosis

This is a case of a 35-year-old primigravid who was initially diagnosed by ultrasound (done abroad) at 12 weeks AOG with a live, singleton fetus having a sacrococcygeal mass. Congenital anomaly scan done from another local institution at 19 weeks AOG, showed a live, singleton fetus with the same aforementioned defect and a floating amorphous, echogenic structure inferior to and separate from the fetus, seemingly with extremities but without a cephalic pole, probably an acardiac twin. A repeat congenital anomaly scan at 23 weeks AOG done in our institution revealed a live, breech male fetus (pump twin) with what seemed to be another set of fetal lower limbs with talipes attached to the sacrococcygeal area of the well-developed fetus. Three-vessel umbilical cord of the pump twin was noted with normal SID ratio on color doppler. Ultrasound findings were suggestive of conjoined pump and acardiac twins. Patient underwent elective cesarean section at 38-39 weeks AOG, delivered an ischiopagustype, male conjoined twins (a well-developed term pump twin with an acardius acephalus twin) and another acardiac amorphous component completing a triplet. The most important factor in deciding on the correct choice of management is the early diagnosis of acardiac twin. Early diagnosis with ultrasound assists in prenatal management and counseling parents. Conservative management with close antepartum surveillance deserves consideration in cases of monozygotic twins with twin reversed arterial perfusion sequence.

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Twins, Conjoined ; Twins, Monozygotic ; Sudden Infant Death ; Talipes ; Triplets ; Fetus ; Lower Extremity ; Cesarean Section ; Ultrasonography, Doppler, Color ; Early Diagnosis ; Umbilical Cord