An 9 year-old boy with a history of chronic, intermittent headaches suddenly collapsed while on a school trip.

An initial CT of the brain revealed an extensive subarachnoid hemorrhage (SAH), with mild hydrocephalous. He underwent temporary endoventricular drainage and a cerebral angiogram (Figure 1) which demonstrated a small “blister” aneurysm or dissection of the right Internal Carotid Artery(ICA) terminus. 

Based on his young age and wide-neck morphology, surgical exploration and microsurgical clipping of this aneurysm was successfully performed by pediatric neurosurgeon John A. Grant, M.D., to prevent life-threatening recurrent hemorrhage. Angiograms immediately following clipping and at 6 months (Figure 2) confirms complete exclusion of the aneurysm. 

He has made a full recovery and has returned to school and all activities.
Figure 1: A) NCT diffuse SAH with mild hydrocephalous B) DSA of “blister” aneurysm right ICA Terminus C) 3D DSA of aneurysm
Figure 2: Post Clip DSA A) Immediate Post Op and B) at 6 months
KEY LEARNING POINTS:
  1. Although rare, ruptured cerebral aneurysms can occur in young children and adolescents and should be considered in the evaluation of persistent headaches or loss of consciousness.
  2. Pediatric aneurysm presentations requires life-long screening for recurrences and de-novo aneurysm development.
  3. Successful treatment and recovery requires an expert team of vascular neurosurgeons and neurointerventionalists to tailor the treatment for each patient.
REFERENCES:
  1. Intracranial Non-traumatic Aneurysms in Children and Adolescents Angelika Sorteberg, Daniel Dahlberg Curr Pediatr Rev. 2013 Nov; 9(4): 343–352. doi: 10.2174/221155281120100005
  2. Intracranial aneurysms in the pediatric population: case series and literature review J Huang, MJ McGirt, P Gailloud, RJ Tamargo Surgical neurology, 2005 – Elsevier https://doi.org/10.1016/j.surneu.2004.11.023
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