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Case report
Spontaneous subarachnoid hemorrhage due to ruptured cavernous internal carotid artery aneurysm after medical prolactinoma treatment
  1. Siri Sahib Khalsa1,
  2. Todd C Hollon1,
  3. Ravi Shastri2,
  4. Jonathan D Trobe3,
  5. Joseph J Gemmete2,
  6. Aditya S Pandey1
  1. 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Aditya S Pandey, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr, Room 3552 TC, Ann Arbor, MI 48109-5338, USA; adityap{at}med.umich.edu

Abstract

Aneurysms of the cavernous segment of the internal carotid artery (ICA) are believed to have a low risk of subarachnoid haemorrhage (SAH), given the confines of the dural rings and the anterior clinoid process. The risk may be greater when the bony and dural protection has been eroded. We report a case of spontaneous SAH from rupture of a cavernous ICA aneurysm in a patient whose large prolactinoma had markedly decreased in size as the result of cabergoline treatment. After passing a balloon test occlusion, the patient underwent successful endovascular vessel deconstruction. This case suggests that an eroding skull base lesion may distort normal anterior cranial base anatomy and allow communication between the cavernous ICA and subarachnoid space. The potential for SAH due to cavernous ICA aneurysm rupture should be recognised in patients with previous pituitary or other skull base lesions adjacent to the cavernous sinus.

  • Aneurysm
  • Subarachnoid
  • Stroke
  • Hemorrhage

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Footnotes

  • Republished with permission from BMJ Case Reports Published 8 June 2016; doi:10.1136/bcr-2016-012446

  • Contributors All authors were involved in acquisition and analysis of the data presented and the patient's case. All authors reviewed the submitted manuscript prior to submission. The manuscript was drafted by SSK and TCH. Critical review was performed by JJG and ASP. JJG and ASP supervised the project.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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