10th Annual Meeting. 5th Annual Stroke Center Workshop. Society of Vascular and Interventional Neurology. November 8-11, 2017, Boston, MA: Abstracts

Introduction: Giant serpentine brain aneurysms on neuroimaging present as large (>25 mm) partially thrombosed globoid mass lesions containing eccentric serpiginous vascular channels with multiple entry and exit points (Coanda effect).Their clinical presentation is usually due to mass effect, surrounding edema and herniation.Commonly affected arteries include Middle Cerebral Artery, Vertebral artery and Posterior Cerebral Artery.Parent artery occlusion with endovascular coils alone or in combination with surgical bypass has been used in the past to manage such complicated vascular lesions.Methods: Case-report of a patient presenting with giant MCA serpentine aneurysmResults: A 60-year female presented for evaluation of chronic daily headaches complicated by gait difficulty, left hand weakness and cognitive slowing.Initial examination showed cognitive impairment, left face and arm weakness and bilateral extensor plantar response.A non-contrast CT head showed a heterogeneously calcified 5 x 5.3 x 5 cm right frontotemporal mass lesion with mid-line shift.MRI brain gradient-echo sequence showed laminated hemosiderin deposition inside the thrombus, postcontrast peripheral enhancement and mass effect.Immediately after the admission, her rapidly deteriorating neurological status prompted urgent intervention.Cerebral angiogram showed a 12-cm long right MCA giant serpentine dissecting aneurysm.Surgical bypass or clipping were deemed technically inaccessible because of the extensive thrombus surrounding the aneurysm and significant mass effect.Balloon test occlusion followed by occlusion of the dysplastic MCA segment by endovascular coiling was chosen for treatment of the aneurysm.Follow up CT head showed complete obliteration of the aneurysm.It was complicated by malignant MCA ischemic stroke requiring urgent decompression hemicraniectomy.After rehabilitation, she showed recovery with residual left side hemiplegia.The Society of Vascular and Interventional Neurology 10th Annual Meeting Conclusions: Our patient showed a complicated course following endovascular coil occlusion which was done in the setting of severe mass effect and worsening clinical condition of the patient.We recommend a case-based approach in such complicated patients.