posterior cerebellar aneurysm

[indytravl]

---

Members do not see this ad.

Does anyone have suggestions about this case?

60y somewhat anxious male had a concussion 30-40 years ago (direct head trauma to occiput after ejected from vehicle with loc xminutes & pta x15min, at a guess) & subsequent headaches (?migraine). 10y ago had what sounds like a couple of tia's with dysarthria, R facial weakness, altered sensation R face & hemibody. Then a couple of years ago had facial paresthesia that he "knew were different than the migraines".

MRA showed 2x3mm posterior cerebellar R aneurysm without interuption in psoterior circulation, 30-40% stenosis vertebral artery, & no mention of hemosiderin or other evidence of bleed. This year, CT angiogram doesn't show any aneyrsm.

Have heard that with good bp control, ~1/4 of pedicle aneurysms from AVM can resolve. There wasn't any AVM reported & wonder if anyone has suggestions about this. Can samll aneyursms disappear with better BP control? Does the study need to be repeated or a different study? It seems very unlikely that the remote concussion is connected to the aneurysm (though there may be an association with the headaches) but any thoughts about that?

Thank you for your time.

 

[typhoonegator]

At most centers, CTA is superior to MRA for detection of aneurysms due to increased resolution. It is certainly possible that the small "aneurysm" detected on MRA was artifactual and was therefore not seen on CTA. The only real way to tell is via either a repeat CTA with thin cuts through the region, or conventional angiogram.

I'm not sure I would want to put this person through a conventional angiogram with his long asymptomatic period and the small size of this possible aneurysm. You might just want to watch it with another interval CTA. But he's not my patient.

His altered sensations 10 years ago certainly could have been from the posterior circulation, but it is possible that they could have come from the anterior as well. It might be worth doing a more expanded TIA workup to avoid falling into the trap of trying to associate all his symptoms with this possible red herring.

 

[indytravl]

Thanks so much for your time, typhoonegator. It sounds like relatively conservative management for now was reasonable.

When had spoken with our radiologist, he felt likelihood of mislabelling a vessel seen on end or other artificat, a real possiblity because of the small size. We went back & forth about mra (which was the 2y old study showing aneurysm but no ischemia/infarct or hemorrhagic evidence) vs cta (which was the 3mo old study not showing aneurysm or anything else). As the pt was stable/asymptomatic for 24+ months; did not smoke; good bp & lipid panel, bmp, coags ok without meds; not overweight, diabetic, or vasculopathic; ekg ok & no report of palpitations/dyspnea, plan on repeating the cta 6 months.

Further tia workup with ultrasound/echo/telemetry prn after that visit...will let you know of any interesting twists in next chapter.
Thanks again