J Korean Neurosurg Soc.  2015 Nov;58(5):471-475. 10.3340/jkns.2015.58.5.471.

Deep Intracerebral Hemorrhage Caused by Rupture of Distal Lenticulostriate Artery Aneurysm : A Report of Two Cases and a Literature Review

• Choo YS
• Kim YB
• Shin YS
• Joo JY

• KMID: 2191414
• DOI: http://doi.org/10.3340/jkns.2015.58.5.471

Abstract

Intracerebral hemorrhage (ICH) is common among various types of storkes; however, it is rare in young patients and patients who do not have any risk factors. In such cases, ICH is generally caused by vascular malformations, tumors, vasculitis, or drug abuse. Basal ganglia ICH is rarely related with distal lenticulostriate artery (LSA) aneurysm. Since the 1960s, a total of 29 distal LSA aneurysm cases causing ICH have been reported in the English literature. Despite of the small number of cases, various treatment methods have been attempted : surgical clipping, endovascular treatment, conservative treatment, superficial temporal artery-middle cerebral artery anastomosis, and gamma-knife radiosurgery. Here, we report two additional cases and review the literature. Thereupon, we discerned that young patients with deep ICH are in need of conventional cerebral angiography. Moreover, initial conservative treatment with follow-up cerebral angiography might be a good treatment option except for cases with a large amount of hematoma that necessitates emergency evacuation. If the LSA aneurysm still persists or enlarges on follow-up angiography, it should be treated surgically or endovascularly.

Keyword

Aneurysm ruptured; Basal ganglia hemorrhage; Lenticulostriate artery

MeSH Terms

Aneurysm*
Angiography
Arteries*
Basal Ganglia
Basal Ganglia Hemorrhage
Cerebral Angiography
Cerebral Arteries
Cerebral Hemorrhage*
Emergencies
Follow-Up Studies
Hematoma
Humans
Radiosurgery
Risk Factors
Rupture*
Substance-Related Disorders
Surgical Instruments
Vascular Malformations
Vasculitis

Figure

• 

  Fig. 1 A : Computed tomography (CT) scan at admission shows left putaminal intracerebral hemorrhage (left), and CT angiography shows any abnormal vascular lesion (right). B : Initial magnetic resonance images (MRI) demonstrate no abnormal signal void in T2WI (left) and enhancing mass lesion adjacent to the hematoma in T1 contrast enhanced image (right). C : Initial left internal carotid artery angiogram shows a small aneurysm (arrows) at the distal lateral lenticulostriate artery (LSA) (left : AP view, right : lateral view). D : Follow up angiography after 2 weeks demonstrates complete disappearance of the distal lateral LSA aneurysm (left : AP view, right : lateral view). AP : anterorposterior.

• 

  Fig. 2 A : Non contrast CT at admission shows subtle basal cistern subarachnoid hemorrhage (left), and right caudate head intracerebral hematoma with intraventricular extension without acute hydrocephalus (right). B : First conventional cerebral angiography (AP view, left) and 3D reconstruction (right). The right M1 proximal trunk is aplastic, and distal flow consists of an abnormal arterial network. Aneurysm occurred in one parent artery of the right LSA, forming two small aneurysms. C : Follow-up cerebral angiography after 2 weeks shows enlargement of the aneurysms. (right : AP view, left : 3D reconstruction). D : Intraoperative cerebral angiography (AP view, left : distal subtraction angiography, right : native image) shows complete obliteration of aneurysmal sac by clips. AP : anteroposterior, LSA : lenticulostriate artery.

Reference

1. Ahn JY, Cho JH, Lee JW. Distal lenticulostriate artery aneurysm in deep intracerebral haemorrhage. J Neurol Neurosurg Psychiatry. 2007; 78:1401–1403. PMID: 18024696.

2. Albert FK, Wirtz CR, Forsting M, Jansen O, Polarz H, Mittermaier G, et al. Image guided excision of a ruptured feeding artery "pedicle aneurysm" associated with an arteriovenous malformation in a child : case report. Comput Aided Surg. 19973; 2:5–10. PMID: 9148874.

3. Bhat DI, Shukla DP, Somanna S. Subarachnoid hemorrhage from a ruptured proximal lenticulostriate artery aneurysm. Neurol India. 2012; 60:128–129. PMID: 22406808.

4. Binning M, Duhon B, Couldwell WT. Partially thrombosed lateral lenticulostriate aneurysm presenting with embolic stroke : case illustration. J Neurosurg Pediatr. 2010; 5:190. PMID: 20121369.

5. Cai X, Han S, Feske SK, Chou SH. Pearls and oy-sters : small but consequential : intracerebral hemorrhage caused by lenticulostriate artery aneurysm. Neurology. 2013; 80:e89–e91. PMID: 23439707.

6. Chalouhi N, Tjoumakaris S, Gonzalez LF, Dumont AS, Shah Q, Gordon D, et al. Onyx embolization of a ruptured lenticulostriate artery aneurysm in a patient with moyamoya disease. World Neurosurg. 2013; 80:436.e7–436.e10. PMID: 22484074.

7. Eddleman CS, Surdell D, Pollock G, Batjer HH, Bendok BR. Ruptured proximal lenticulostriate artery fusiform aneurysm presenting with subarachnoid hemorrhage : case report. Neurosurgery. 2007; 60:E949. discussion E949. PMID: 17460507.

8. Ellis JA, D'Amico R, Altschul D, Leung R, Connolly ES, Meyers PM. Medial lenticulostriate artery aneurysm presenting with isolated intraventricular hemorrhage. Surg Neurol Int. 2011; 2:92. PMID: 21748044.

9. Endo M, Ochiai C, Watanabe K, Yoshimoto Y, Wakai S. [Ruptured peripheral lenticulostriate artery aneurysm in a child : case report]. No Shinkei Geka. 1996; 24:961–964. PMID: 8914158.

10. Gandhi CD, Gilad R, Patel AB, Haridas A, Bederson JB. Treatment of ruptured lenticulostriate artery aneurysms. J Neurosurg. 2008; 109:28–37. PMID: 18590430.

11. Grabel JC, Levine M, Hollis P, Ragland R. Moyamoya-like disease associated with a lenticulostriate region aneurysm. Case report. J Neurosurg. 1989; 70:802–803. PMID: 2709122.

12. Gupta AK, Rao VR, Mandalam KR, Kumar S, Joseph S, Unni M, et al. Thrombosis of multiple aneurysms of a lateral lenticulostriate artery. An angiographic follow-up. Neuroradiology. 1989; 31:193–195. PMID: 2747901.

13. Harreld JH, Zomorodi AR. Embolization of an unruptured distal lenticulostriate aneurysm associated with moyamoya disease. AJNR Am J Neuroradiol. 2011; 32:E42–E43. PMID: 20075103.

14. Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score : a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001; 32:891–897. PMID: 11283388.

15. Heran NS, Heran MS, Woolfenden AR. A corticosteroid-responsive aneurysmal lenticulostriate vasculopathy. Neurology. 2003; 61:1624–1625. PMID: 14663060.

16. Horn EM, Zabramski JM, Feiz-Erfan I, Lanzino G, McDougall CG. Distal lenticulostriate artery aneurysm rupture presenting as intraparenchymal hemorrhage : case report. Neurosurgery. 2004; 55:708. PMID: 16929579.

17. Kalani MY, Martirosyan NL, Nakaji P, Spetzler RF. Microsurgical clipping of an unruptured lenticulostriate aneurysm. J Clin Neurosci. 2012; 19:1578–1580. PMID: 22925414.

18. Kaptain GJ, Sheehan JP, Kassell NF. Lenticulostriate artery aneurysm in infancy. Case illustration. J Neurosurg. 2001; 94:538. PMID: 11235964.

19. Kidoguchi J, Chiba M, Murakami T, Saiki I, Kanaya H, Tazawa M, et al. [A case of systemic lupus erythematosus associated with an aneurysm of the lenticulostriate artery]. No Shinkei Geka. 1987; 15:1221–1225. PMID: 3325845.

20. Kochar PS, Morrish WF, Hudon ME, Wong JH, Goyal M. Fusiform lenticulostriate artery aneurysm with subarachnoid hemorrhage : the role for superselective angiography in treatment planning. Interv Neuroradiol. 2010; 16:259–263. PMID: 20977857.

21. Kuroda S, Houkin K, Kamiyama H, Abe H. Effects of surgical revascularization on peripheral artery aneurysms in moyamoya disease : report of three cases. Neurosurgery. 2001; 49:463–467. discussion 467-468PMID: 11504126.

22. Lama S, Dolati P, Sutherland GR. Controversy in the management of lenticulostriate artery dissecting aneurysm : a case report and review of the literature. World Neurosurg. 2014; 81:441.e1–441.e7. PMID: 23246740.

23. Lan Z, Li J, You C, Chen J. Successful use of Gamma Knife surgery in a distal lenticulostriate artery aneurysm intervention. Br J Neurosurg. 2012; 26:89–90. PMID: 21767129.

24. Larrazabal R, Pelz D, Findlay JM. Endovascular treatment of a lenticulostriate artery aneurysm with N-butyl cyanoacrylate. Can J Neurol Sci. 2001; 28:256–259. PMID: 11513346.

25. Lehmann P, Toussaint P, Depriester C, Legars D, Deramond H. [Lenticulostriate aneurysms. Radioclinical study]. J Neuroradiol. 2003; 30:115–120. PMID: 12717298.

26. Maeda K, Fujimaki T, Morimoto T, Toyoda T. Cerebral aneurysms in the perforating artery manifesting intracerebral and subarachnoid haemorrhage--report of two cases. Acta Neurochir (Wien). 2001; 143:1153–1156. PMID: 11731866.

27. Matushita H, Amorim RL, Paiva WS, Cardeal DD, Pinto FC. Idiopathic distal lenticulostriate artery aneurysm in a child. J Neurosurg. 2007; 107(5 Suppl):419–424. PMID: 18459908.

28. McCormick WF, Rosenfield DB. Massive brain hemorrhage : a review of 144 cases and an examination of their causes. Stroke. 1973; 4:946–954. PMID: 4765001.

29. Murakami H, Mine T, Nakamura T, Aki T, Suzuki K. [Intracerebral hemorrhage due to rupture of true aneurysms of the lenticulostriate artery in moyamoya disease. Case report]. Neurol Med Chir (Tokyo). 1984; 24:794–799. PMID: 6084185.

30. Narayan P, Workman MJ, Barrow DL. Surgical treatment of a lenticulostriate artery aneurysm. Case report. J Neurosurg. 2004; 100:340–342. PMID: 15086244.

31. Ohta H, Ito Z, Nakajima K, Fukasawa H, Uemura K. [A case report of ruptured lenticulostriate artery aneurysm with arteriovenous malformation (author's transl)]. No To Shinkei. 1980; 32:839–846. PMID: 7470330.

32. Oka K, Maehara F, Tomonaga M. Aneurysm of the lenticulostriate artery--report of four cases. Neurol Med Chir (Tokyo). 1991; 31:582–585. PMID: 1723172.

33. Okuma A, Oshita H, Funakoshi T, Shikinami A, Yamada H. [A case of aneurysm in the cerebral myoyamoya vessel--aneurysmal rupture during cerebral angiography and spontaneous regression of the aneurysm (author's transl)]. No Shinkei Geka. 1980; 8:181–185. PMID: 7360320.

34. Petrela M, Xhumari A, Azdurian E, Vreto G. [Aneurysm of the terminal part of the lenticulostriate artery]. Neurochirurgie. 1992; 38:50–52. PMID: 1560885.

35. Sakai K, Mizumatsu S, Terasaka K, Sugatani H, Higashi T. Surgical treatment of a lenticulostriate artery aneurysm. Case report. Neurol Med Chir (Tokyo). 2005; 45:574–577. PMID: 16308516.

36. Schürmann K, Brock M, Samii M. Circumscribed hematoma of the lateral ventricle following rupture of an intraventricular saccular arterial aneurysm. Case report. J Neurosurg. 1968; 29:195–198. PMID: 5673318.

37. Takeuchi S, Takasato Y, Masaoka H, Hayakawa T, Otani N, Yoshino Y, et al. Bilateral lenticulostriate artery aneurysms. Br J Neurosurg. 2009; 23:543–544. PMID: 19718551.

38. Tsai YH, Wang TC, Weng HH, Wong HF. Embolization of a ruptured lenticulostriate artery aneurysm. J Neuroradiol. 2011; 38:242–245. PMID: 21257203.

39. Vargas J, Walsh K, Turner R, Chaudry I, Turk A, Spiotta A. Lenticulostriate aneurysms : a case series and review of the literature. J Neurointerv Surg. 2015; 7:194–201. PMID: 24574545.

40. Vates GE, Arthur KA, Ojemann SG, Williams F, Lawton MT. A neurocytoma and an associated lenticulostriate artery aneurysm presenting with intraventricular hemorrhage : case report. Neurosurgery. 2001; 49:721–725. PMID: 11523685.

41. Viswanathan A, Rakich SM, Engel C, Snider R, Rosand J, Greenberg SM, et al. Antiplatelet use after intracerebral hemorrhage. Neurology. 2006; 66:206–209. PMID: 16434655.

42. Wong GK, Chou HL, Poon WS, Zhu XL, Yu SC, Ahuja AT. Spontaneous resolution of an aneurysm arising from a penetrating branch of the middle cerebral artery. J Clin Neurosci. 2009; 16:601–602. PMID: 19201613.