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CASE REPORT
Aneurysmal wall imaging in a case of cortical superficial siderosis and multiple unruptured aneurysms
  1. Bertrand Yalo1,
  2. Raoul Pop2,4,5,
  3. Ielyzaveta Zinchenko1,
  4. Mihaela Diaconu1,
  5. Salvatore Chibbaro3,
  6. Monica Manisor2,4,
  7. Valerie Wolff1,
  8. Remy Beaujeux2,4
  1. 1Department of Vascular Neurology, Hopitaux universitaires de Strasbourg, Strasbourg, Alsace, France
  2. 2Department of Interventional Radiology, Institut Hospitalo-Universitaire, Strasbourg, France
  3. 3Department of Neurosurgery, Strasbourg University Hospitals, Strasbourg, France
  4. 4Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France
  5. 5Department of Neurology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
  1. Correspondence to Dr Raoul Pop, Department of Interventional Radiology, Institut Hospitalo-Universitaire, 1 Place de l'Hopital, S/C IRCAD, Strasbourg 67091, France; pop.raoul{at}gmail.com

Abstract

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.

  • Aneurysm
  • MRI
  • Vessel Wall

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Footnotes

  • 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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