Anévrismes intracrâniens multiples

A 33 years old woman, treated for hypertension on monotherapy for a year, was admitted on emergency for sudden onset headache. Clinical examination revealed a conscious patient, blood pressure= 13/7, with the presence of frank meningeal syndrome, no fever. Cerebral CT showed subarachnoid hemorrhage at the right middle cerebral valley. The arteriography objectified three aneurysmal dilations at the right posterior communicating artery of about 8.3mm, also at the M2 segment of the right middle cerebral arterys of about 4 mm (A) and finally at the left cerebral bifurcation of about 4mm (B). The patient underwent endovascular treatment of the two right aneurysms and was given a three months appointment to secure the aneurysm. The prevalence of intracranial aneurysms in the general population is evaluated from 1 to 5%. Only 15% of these patients have multiple aneurysms and 7% of them have more than four aneurysms. The therapeutic strategy is to first secure the aneurysm bled and subsequently treating other aneurysms according to their size and risk of bleeding.