Introduction: Neurocysticercosis is a common CNS disease caused by the larva Taenia solium4. It usually occurs endemically in rural areas developing countries and its incidence is 0.1 to 4%,4.
Most patients are asymptomatic and when symptomatic they can present with seizures, headaches, and hydrocephalus4. Cerebrovascular disease is fairly uncommon and most of the times it can cause vasculitis involving both large and small vessels2.Only a few cases of subarachnoid hemorrhage due to an nflammatory brain aneurysm have been reported1,2,3.
Methods: Case Report.80-year-old Spanish-speaking man presented with significant headaches and confusion. CTA demonstrated subarachnoid hemorrhage and a L 2mm MCA aneurysm with an adjacent cystic lesion.
Operation. Left frontotemporal craniotomy with clipping left middle cerebral artery aneurysm and evacuation of neurocysticercosis cyst
Results: Discussion.
All neurocystercosis inflammatory aneurysm cases reported were found to be adjacent to a cystecercus cyst1,2,3. This makes it suspicious for an inflammatory origin.
It s been reported that direct clipping of a neurcystecercosis inflammatory aneurysm is more difficult mainly due to inflammatory changes in the vessels walls which make it more friable and so increases the possibility of intraoperative rupture1. Four cases were reported and only one has been clipped while the rest were trapped, wrapped or proximal artery clipping1,2,3
In this case we did not experience any difficulty clipping the aneurysm.
At this moment we do not know if there is a role for antiparasitic therapy in the presence of a cystecercosis inflammatory brain aneurysm. For this reason in the presence of subarachnoid hemorrhage we recommend surgical management of the aneurysm with or without albendazol treatment.
Conclusions: An inflammatory aneurysm should be suspected in the case of subarachnoid hemorrhage adjacent to a neurocystercosis lesion.Surgeon should be aware that it might be more friable and chances of intraoperative rupture are higher. The role for medical treatmentis not yet determined.
Patient Care: Consider inflammatory aneurysms in the context of SAH and cystic lesion.
Be prepared to possible intra operative difficulties associated with inflammatory aneurysm management
Learning Objectives: Consider inflammatory aneurysm in the case of subarachnoid hemorrhage with adjacent neurocystercosis lesion.
Be prepared for possible friable lesion, difficult to clipp and higher chances of intraoperative rupture are higher.
Further investigation is needed regarding the role of medical therapy
References: 1. Kim IY, Kim TS, Lee JH, Lee MC, Lee JK , Jung KL, Shin J. Inflammatory aneurysm due to neurocysticercosis. J Clin Neurosci. 2005 Jun;12(5):585-8.
2. Huang PP , Choudhri HF, Jallo G, Miller DC. Inflammatory aneurysm and neurocysticercosis: further evidence for a causal relationship? Case report. Neurosurgery. 2000 Aug;47(2):466-7; discussion 467-8.
3. Soto-Hernandez JL, Gomez-Llata Andrade S, Rojas-Echeverri LA, Texeira F, Romero V. Subarachnoid hemorrhage secondary to a ruptured inflammatory aneurysm: a possible manifestation of neurocysticercosis: case report. Neurosurgery. 1996 Jan;38(1):197-9; discussion 199-200.
4. Monteiro de Almeida S, Bleggi Torres LF. Neurocysticercosis—Retrospective Study of Autopsy Reports,a 17-Year Experience.
J Community Health DOI 10.1007/s10900-011-9389-z
5. Yao K Bederson JB. Infectious Intracranial Aneurysm. Youmans Neurological Surgery. Chapter 122. Pg 2102