Spontaneous Thrombosis of Basilar Artery Aneurysm After Subarachnoidal Hemorrhage in a Patient With Thrombophilia and Recurrent Deep Venous Thrombosis

Abstract

We report a patient with combined thrombophilia—protein C deficiency and mild hyperhomocysteinemia with total spontaneous thrombosis of a basilar tip aneurysm after subarachnoid hemorrhage, without neurological deficit. At admission, the patient had headache, drowsiness, and nausea, with no neurological deficit. Computed tomography (CT) did not show the presence of subarachnoid blood, and magnetic resonance examination revealed discrete remains of a subarachnoid hemorrhage in projections of temporal, frontal and occipital lobes, with no vascular abnormalities. Initial angiography showed a small basilar tip aneurysm and the patient was scheduled for endovascular treatment. A second angiography, performed before the planned endovascular treatment, did not show the aneurysm and complete thrombosis was suspected. A follow-up angiogram, 6 months after this event, showed preserved posterior cerebral circulation with no aneurysm present. The patient was discharged in good condition, without neurological deterioration. We did not find any previous reports of similar conditions.

Keywords

basilar artery intracranial aneurysm subarachnoid hemorrhage total spontaneous thrombosis thrombophilia protein C deficiency hyperhomocysteinemia

References

Cohen JE , Itshayek E. , Gomori JM , et al. Spontaneous thrombosis of cerebral aneurysms presenting with ischemic stroke. J Neurol Sci. 2007;254(1-2):95-98.

Brownlee RD , Tranmer BI , Sevick RJ , Karmy G. , Curry BJ Spontaneous thrombosis of an unruptured anterior communicating artery aneurysm: an unusual cause of ischemic stroke. Stroke. 1995;26(10):1945-1949.

Ohta H. , Sakai N. , Nagata I. , Sakai H. , Shindo A. , Kikuchi H. Spontaneous total thrombosis of distal superior cerebellar artery aneurysm . Acta Neurochir (Wien). 2001;143(8):837-843.

Hamilton MG , Dold O. Spontaneous disappearance of an intracranial aneurysm after subarachnoid hemorrhage . Can J Neurol Sci. 1992;19(3):389-391.

Schaller B. , Lyrer P. Focal neurological deficits following spontaneous thrombosis of unruptured giant aneurysms. Eur Neurol. 2002;47(3):175-182.

Koivisto T. Prospective outcome study of aneurysmal subarachnoid hemorrhage: Endovascular versus surgical treatment. Dissertation. University of Kuopio, Finland, 2002.

Cohen JE , Rajz G. , Umansky F. , et al. Thrombosis and recanalization of symptomatic non-giant saccular aneurysm. Neurol Res. 2003;25(8):857-859.

Sakaki T. , Kinugawa K. , Tanigake T. , et al. Embolism from intracranial aneurysms. J Neurosurg . 1980;53(3):300-304.

Shiraishi S. , Fujimura M. , Kon H. , et al. Thrombosed vertebral artery aneurysm presenting with hemorrhage and bulbar compression: report of two cases. Clin Neurol Neurosurg. 2005;107(2): 123-127.

10.

Oger E. Incidence of venous thromboembolism: a community-based study in western France . Thromb Haemost. 2000;83(5): 657-660.

11.

Rosendaal FR Thrombosis in the young, epidemiology and risk factors, a focus on venous thrombosis. Thromb Haemost . 1997; 78(1):1-6.

12.

Koster T. , Rosendaal FR , Briet E. , et al. Protein C deficiency in a controlled series of unselected outpatients: an infrequent but clear risk factor for venous thrombosis (Leiden Thrombophila study). Blood. 1995;85(10):2756-2761.

13.

Lensen RPM , Rosendaal FR , Koster T. , et al. Apparent different thrombotic tendency in patients with factor V Leiden and protein C deficiency due to the selection of patients. Blood. 88(11): 4205-4208.

14.

Cakir O. , Ayıldız O. , Goz M. , Sit D. , Eren N. Myocardial infarction and venous thrombosis in a 42-year old woman with heterozygous methylenetetrahydrofolate reductase (MTHRF) gene mutation, hyperhomocysteinemia, and protein C deficiency. Int J Cardiol . 2007 ;117(3):e98-e100.

15.

Franken DG , Vreugdenhil A. , Boers GH , Verrips A. , Blom HJ , Novakova IR Familial cerebrovascular accidents due to concomitant hyperhomocysteinemia and protein C deficiency type 1. Stroke. 1993 ;24(10):1599-1600.

16.

Takagi H. , Umemoto T. Homocysteinemia is a risk factor for aortic dissection. Med Hypotheses. 2005;64(5):1007-1010.

17.

Lee KC , Joo JY , Lee KS , et al. Recanalization of completely thrombosed giant aneurysm: case report. Surg Neurol. 1999; 51(1):94-98.