Objectives

Aneurysms associated with hemorrhagic moyamoya disease (MMD) are reported to stabilize or recede following revascularization.

Case report/results

A 29 year-old male with no past medical history presented obtunded with diffuse intraventricular hemorrhage and vascular imaging demonstrating bilateral MMD without any associated aneurysms. He underwent a delayed right-sided STA-MCA bypass and pial synangiosis, and was subsequently discharged on hospital day 24 with a modified Rankin Scale score (mRS) of 2. He returned eleven days later from a rehabilitation facility with recurrent IVH. A saccular 5 mm right P4 segment posterior cerebral artery aneurysm was seen on a diagnostic angiogram and embolized with Onyx glue.

Conclusions

Distal posterior circulation artery aneurysmal rupture is a rare cause of hemorrhagic MMD. This case demonstrates the capacity of these aneurysms to re-rupture following revascularization and underscores the importance of treating the aneurysms directly.

中文翻译：

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烟雾病血运重建后大脑后动脉瘤再破裂

目标

据报道，与出血性烟雾病 (MMD) 相关的动脉瘤在血运重建后稳定或消退。

病例报告/结果

一名 29 岁男性，既往无病史，表现为弥漫性脑室内出血，血管成像显示双侧 MMD，无任何相关动脉瘤。他接受了延迟的右侧 STA-MCA 搭桥和软脑膜联合血管形成，随后在住院第 24 天出院，改良 Rankin 量表评分 (mRS) 为 2。11 天后，他因复发性 IVH 从康复机构返回。在诊断性血管造影上看到一个 5 mm 右侧 P4 段大脑后动脉的囊状动脉瘤，并用 Onyx 胶栓塞。

结论

远端后循环动脉动脉瘤破裂是出血性 MMD 的罕见原因。该病例证明了这些动脉瘤在血运重建后再次破裂的能力，并强调了直接治疗动脉瘤的重要性。