Distal Anterior Cerebral Artery Aneurysm: An Infrequent Cause of Transient Ischemic Attack Followed by Diffuse Subarachnoid Hemorrhage: Report of a Case

We report a 54-year-old female who presented with a wide-based saccular aneurysm distal to the junction of the right pericallosal and callosomarginal arteries, showing acute onset of transient ischemia stroke initially, followed by diffuse spontaneous subarachnoid hemorrhage and supracallosal, intraventricular hemorrhage. Rotational 3-dimensional digital subtraction angiography clearly indicated the aneurysm location and shape. Pre-operatively, her Hunt and Hess grading was IV. Craniotomy with aneurysm trapping was performed in the acute stage. Postoperatively, her consciousness gradually improved but left hemipsresis remained. This clinical presentation, to our knowledge, has not been previously reported. We would like to emphasize that in patients with transient ischemic attacks presenting with hemiparesis, the possibility of a distal cerebral arterial aneurysm should be taken into consideration for prompt and appropriate management.