We report a case of interhemispheric and bifrontal cortical superficial siderosis in association with two intracranial aneurysms. The patient had no clinical history suggestive of aneurysm rupture, no feature of amyloid angiopathy or other apparent etiology for cortical siderosis. We performed high resolution brain MRI with dark blood T1 sequences before and after IV contrast injection. An anterior communicating aneurysm showed partial wall enhancement on the posterior wall whereas a left posterior communicating aneurysm did not. In the light of recent reports of the association of wall enhancement with unstable aneurysms, we considered wall enhancement to be a marker of inflammation and remodeling of the aneurysm wall, resulting in chronic hemorrhagic suffusion in the subarachnoid spaces. To our knowledge, this is the first report offering proof for a possible link between apparently unruptured aneurysms and cortical siderosis.
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Republished with permission from BMJ Case Reports Published 9 November 2016; doi:10.1136/bcr-2016-012680
Contributors BY: manuscript drafting, diagnosis, clinical care. RP: manuscript drafting and review, acquisition and interpretation of imaging, embolisation procedure. IZ, MD, SC, VW: manuscript review, clinical care. MM, RB: manuscript review, interpretation of imaging, embolization procedure.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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