Deadly headache: Mirror aneurysm about a case report

Authors

  • Carlos Alberto Dávila Hernández Hospital IV “Augusto Hernández Mendoza” - EsSalud - Ica, Perú; Universidad Nacional “San Luis Gonzaga” – Facultad de Medicina Humana “Daniel  Alcides Carrión” – Ica, Perú. https://orcid.org/0000-0003-1737-9873
  • Luis Fernando Arriola Torres Hospital IV “Augusto Hernández Mendoza”, EsSalud – Ica, Perú
  • Jorge Eduardo Moreno Legua Hospital IV “Augusto Hernández Mendoza”, EsSalud – Ica, Perú
  • Carlos Andres Carrasco Farfan Universidad Científica del Sur, Lima, Perú.
  • Ramon Rolando Camara Reyes Universidad Científica del Sur, Lima, Perú.

DOI:

https://doi.org/10.35434/rcmhnaaa.2022.153.1375

Keywords:

headache, aneurysm, computed tomography angiography, Intracranial Aneurysm , Neurosurgery , Case Reports

Abstract

Introduction: Intracerebral aneurysms are incidental findings in imaging studies performed for other diagnoses. Case Report: 35-year-old female patient, who presented syncope after severe headache without yielding to conventional treatment with NSAIDs; with a history of long-standing headache and sporadic treatment. On examination: neurological: awake, facial asymmetry, dysarthria, decreased muscle strength in both lower limbs, no meningeal signs; the brain tomographic report without contrast indicated: expansive brain lesions of etiology to be determined at both sides of the diencephalon: rule out glioma vs aneurysms; cerebral Angiotac with contrast, reflects bilateral intracranial internal carotid and middle cerebral (mirror) aneurysms. Subsequently the patient was evaluated by the neurosurgeon on duty, who indicated to refer to a center of higher complexity, for not having the necessary instruments for surgery; patient died on the way to the referral center.  Conclusions: Being a rare pathology, it is not considered as a first option for diagnostic suspicion after a headache event.

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Author Biographies

Carlos Alberto Dávila Hernández, Hospital IV “Augusto Hernández Mendoza” - EsSalud - Ica, Perú; Universidad Nacional “San Luis Gonzaga” – Facultad de Medicina Humana “Daniel  Alcides Carrión” – Ica, Perú.

Médico Internista

Luis Fernando Arriola Torres, Hospital IV “Augusto Hernández Mendoza”, EsSalud – Ica, Perú

Médico Neurólogo

Jorge Eduardo Moreno Legua, Hospital IV “Augusto Hernández Mendoza”, EsSalud – Ica, Perú

Médico Pediatra

Carlos Andres Carrasco Farfan, Universidad Científica del Sur, Lima, Perú.

Médico Cirujano

Ramon Rolando Camara Reyes, Universidad Científica del Sur, Lima, Perú.

Médico Cirujano

References

Kleinloog R, de Mul N, Verweij BH, Post JA, Rinkel GJE, Ruigrok YM. Risk Factors for Intracranial Aneurysm Rupture: A Systematic Review. Neurosurgery. 2018; 82(4):431-440. doi: 10.1093/neuros/nyx238.

Sweeney K, Silver N, Javadpour M. Subarachnoid haemorrhage (spontaneous aneurysmal). BMJ Clin Evid [Internet]. 2016 [Cited 2022 March 15]; 2016: 1213. Available from: https://bit.ly/3WAkTDD

Meissner I, Torner J, Huston J 3rd, Rajput ML, Wiebers DO, Jones LK Jr, et al. Mirror aneurysms: a reflection on natural history. J Neurosurg. 2012; 116(6):1238-41. doi: 10.3171/2012.1.JNS11779.

Singer RJ, Ogilvy CS, Rordorf G. Unruptured intracranial aneurysms. UpTodate [Internet]. 2022. Available from: https://bit.ly/3TfUwzC

Steiner TJ; World Headache Alliance. Lifting the burden: The global campaign against headache. Lancet Neurol. 2004; 3(4):204-5. DOI: 10.1016/S1474-4422(04)00703-3

Wolpert SM. On the radiologic diagnosis of cerebral aneurysms with plain films and cerebral angiography: a historical survey. American Journal of Neuroradiology [Internet]. 1995 [Cited 2022 Feb 15]; 16(1):181 – 184. Available from: https://bit.ly/3TfHJNC.

Requejo F. Ceciliano A, Cárdenas R, Villasante V, Jaimovich R, Zúccaro G. Aneurismas cerebrales en la infancia: Un solo nombre para diferentes enfermedades. Rev. argent. Neurocir [Internet]. 2010 [Cited 2022 Feb 15]; 24(3): 131-6. Disponible en: https://bit.ly/3tqPLJr

Aguilar-Pérez ML. Influence of stents as flow diverters on the hemodynamic conditions of intracranial aneurysms: a CFC study [Tesis]. Computational Imaging and Simulation Technologies in Biomedicine (CISTIB) Universitat Pompeu Fabra; 2010. Disponible en: https://bit.ly/3hmac7b.

King JT Jr. Epidemiology of aneurysmal subarachnoid hemorrhage. Neuroimaging Clin N Am [Internet]. 1997 [Cited 2022 Feb 15];7(4):659-668. Disponible en: https://bit.ly/3WCURzx

Liu HJ, Zhou H, Lu DL, Jiao YB, Chen SF, Cheng J, et al. Intracranial Mirror Aneurysm: Epidemiology, Rupture Risk, New Imaging, Controversies, and Treatment Strategies. World Neurosurg. 2019; 127:165-175. doi: 10.1016/j.wneu.2019.03.275.

Rosi Junior J, Gomes dos Santos A, da Silva SA, Iglesio RF, Caldas JGMP, Rabelo NN, et al. Multiple and mirror intracranial aneurysms: study of prevalence and associated risk factors. British Journal of Neurosurgery. 2020;35(6):780–4. doi: 10.1080/02688697.2020.1817849

Rajagopal N, Yamada Y, Balaji A, Kawase T, Kato Y. Multiples of multiple: Case series of mirror aneurysms and review of literature. Int J Surg Case Rep. 2019; 61:141-146. doi: 10.1016/j.ijscr.2019.07.037.

Friedman BW, Hochberg ML, Esses D, Grosberg B, Corbo J, Toosi B, et al. Applying the International Classification of Headache Disorders to the emergency department: an assessment of reproducibility and the frequency with which a unique diagnosis can be assigned to every acute headache presentation. Ann Emerg Med. 2007; 49(4):409-19. doi: 10.1016/j.annemergmed.2006.11.004.

Evans R, Rozen T, Mechtler L. Neuroimaging and the other diagnostic testing in headache. Wolff's Headache and Other Head Pain; 8° ed. Estados Unidos: Oxford University Press; 2008:63-93. Available from: https://bit.ly/3NJdTA1

Lee, Young-jun; Parreira, Tiago; Matouk, Charles C; et al. Clinical characteristics and preferential location of intracranial mirror aneurysms: a comparison with non-mirror multiple and single aneurysms. Neuroradiology. 2015. 57(1), 35-40. DOI:10.1007/s00234-014-1437-9

Tian, Z., Zhang, Y., Jing, L., Liu, J., Zhang, Y., & Yang, X. Rupture risk assessment for mirror aneurysms with different outcomes in the same patient. Frontiers in Neurology. 2016; 7: 219. doi: 10.3389/fneur.2016.00219.

Published

2022-10-10

How to Cite

1.
Dávila Hernández CA, Arriola Torres LF, Moreno Legua JE, Carrasco Farfan CA, Camara Reyes RR. Deadly headache: Mirror aneurysm about a case report. Rev. Cuerpo Med. HNAAA [Internet]. 2022 Oct. 10 [cited 2024 Nov. 21];15(3):456-8. Available from: http://cmhnaaa.org.pe/ojs/index.php/rcmhnaaa/article/view/1375