Rapid growth and rupture of a newly originated aneurysm near the clipped middle cerebral artery aneurysm

A 38-year-old man was admitted to our hospital because of severe headache following reduced level of consciousness on February 13, 1979. He was lethargic and showed neck stiffness. A lumbar puncture revealed bloody cerebrospinal fluid. Left carotid angiography showed a berry aneurysm of 11 mm in diameter at the bifurcation of the middle cerebral artery (MCA). Rebleeding occurred on February 21, and he fell into semicoma. But, his consciousness recovered to lethargy on the next day. On February 26, a direct intracranial operation was performed and a Sugita clip was placed to the aneurysmal neck. The postoperative course was uneventful. But, left carotid angiography on 8th day after operation showed a newly originated aneurysm proximal to the operated aneurysm. On the 12th postoperative day, he suddenly fell into coma. CT showed subarachnoid blood in the basal cisterns and intraparenchymal hematoma in the left temporal lobe. On the same day, left carotid angiography was performed and it showed the enlarged aneurysm. He died on the 19th day after operation. Autopsy was not performed. Three factors have been considered dealing with the recurrence of the operated aneurysm in the previous reports: first, local fragility of the vascular wall due to the clip edge. Secondly, macro- or microscopic residual aneurysmal neck, thirdly, broken or slipped clip. Our case had the following characteristics from the angiographical and operative findings: the orifice of the operated aneurysm was situated on the superior side of the parent artery and the aneurysm protruded posterosuperiorly at an angle of approximately 90 degrees to the long axis of M1.(ABSTRACT TRUNCATED AT 250 WORDS)