【投稿論文：Case Report】 Reversible cerebralvasoconstriction syndromeの既往を有し，精神性前兆を契機に診断された，遺残原始三叉神経動脈に合併した新生大型内頚動脈瘤の1手術症例

This paper presents a case of a de novo unruptured large internal carotid-posterior communicating artery (IC-PC) aneurysm associated with a persistent primitive trigeminal artery (PPTA), which presenting with cluster of psychic auras. The patient was 67-year-old woman. She suffered from reversible cerebral vasoconstriction syndrome (RCVS) over from two weeks to four months 26 years ago. During the RCVS period, the PPTA served as collateral pathway, and dramatic hemodynamic changes occurred around IC-PC. Meanwhile, the unruptured large IC-PC aneurysm buried in the anterior mediotemporal lobe was cause of psychic auras as one seizure type of temporal lobe epilepsy. Only one de novo aneurysm associated with PPTA had been reported in the literature before our case. Further, in this case, temporary hemodynamic factor might have triggered occurrence of the aneurysm, making this case noteworthy. The neck of the primary epileptogenic aneurysm was clipped and the dome was then cut off. The postoperative course was uneventful. The patient was free of psychic auras without anticonvulsants 6 months postoperatively.