Disappearance and reappearance of a cerebral aneurysm.

A 42-year-old male was hospitalized with acute-onset aphasia and right hemiparesis due to acute middle cerebral artery (MCA) superior division infarction. A computerized tomography angiography (CTA), obtained for evaluation of stroke etiology and vessel status, revealed a partially thrombosed unruptured saccular aneurysm on left MCA bifurcation (figure a, b). Following fractional Figure:CT angiogram shows a partially thrombosed left MCA bifurcation aneurysm in addition to superior division occlusion (a,b). Another CTA obtained after recurrence and deterioration (six days later) shows complete thrombosis of the aneurysm and MCA main stem distally (c,d). Follow-up CTA obtained 18 days after the first event documents complete recanalization of the aneurysm (9-mm in diameter) (e,f). neurological recovery, he developed sudden onset global aphasia and right hemiplegia on the sixth day of hospitalization. A second CTA, obtained for evaluating the possibility of an endovascular intervention to achieve acute recanalization, showed complete disappearance of the aneurysm along with thrombosis of the distal M1 segment of the left MCA (figure c,d). In addition, disseminated thrombosis of the great arteries including ascending and descending aorta, bilateral subclavian and iliac arteries were noted. Interventional treatment was then not attempted and intravenous heparin was initiated.