Multiple intracranial aneurysms and abdominal aortic occlusion in a young woman: A case report

RATIONALE: Multiple intracranial aneurysms occur in 10% to 30% patients with cerebral aneurysms. PATIENT CONCERNS: We reported a case of multiple intracranial aneurysms concurrent with abdominal aortic occlusion (AAO) in a 29-year-old woman was admitted because of abrupt onset of severe headache, vomiting, and dizziness for 26 hours. She complained sudden onset of severe headache, vomiting, and dizziness. DIAGNOSES: Head computed tomography (CT) angiogram revealed 2 aneurysms of the anterior communicating artery (ACA) and a third aneurysm at the right middle cerebral artery (MCA). A diagnosis of multiple intracranial aneurysms concurrent with abdominal aortic occlusion (AAO) was made. INTERVENTIONS: We clipped the 2 aneurysms at the ACA via a right pterional approach. The transfemoral approach failed because of an unsuspected AAO. A right carotid artery approach was then employed to embolize the aneurysm at the right MCA with three coils. OUTCOMES: Magnetic resonance angiography (MRA) at 7 days after the embolization demonstrated complete disappearance of all the intracranial aneurysms, but AAO was still present. The patient remained asymptomatic during 5-years of follow-up. LESSONS: The case highlights the importance of a thorough physical examination, and in rare cases, AAO or other abdominal aortic abnormalities should be considered in young nonsmoking females. Successful treatment can be achieved by aneurysm clipping and embolization.