Background: Giant aneurysms (GAs) must be regarded as dynamic lesions with respect to their growth and intraluminal thrombus formation, occasionally giving rise to thromboembolic events. Little is known about spontaneous thrombosis of unruptured GAs leading to focal neurological deficits which can mimic arteriosclerotic, epileptic or neoplastic disease.
Methods: Three patients (2 men, 27 and 68 years old, and 1 woman, 32 years old) presented with progressive neurological deficits. Neuroradiological studies showed unruptured GAs [two of the middle cerebral artery (MCA), one of the anterior communicating artery] displaying spontaneous near complete intraluminal thrombosis. In one of the cases with a giant MCA aneurysm, acute thrombosis was followed by infarction of the corresponding territory.
Results: Partial excision of the intraluminal thrombus was performed in the anterior communicating artery lesion. Wrapping followed by an extracranial-intracranial bypass and stepwise trapping successfully excluded one MCA lesion from circulation. The other MCA aneurysm was treated conservatively. All three patients showed full recovery neurologically after treatment.
Conclusion: The reported clinical history of three patients who developed rapid focal progressive neurological deterioration following acute spontaneous thrombosis can be attributed to the acute swelling of the aneurysmal mass. Their pattern of consecutive rapid clinical improvement represents a previously undescribed clinical course of unruptured GAs.
Copyright 2002 S. Karger AG, Basel