Ruptured Gint Fusiform Aneurysm in an Infant: Case Report and Review of the Literature

Main Article Content

Dimitrios Panagopoulos Maro Gavra Efstathios Boviatsis


Background: Intracranial aneurysms are exceedingly rare in neonates, accounting for less than 2% of all relevant cases that occur during the first decade of life. More precisely, intracranial aneurysms in children (less than 18 years old) are rarely been recorded, and their epidemiology is poorly investigated. Details about this pathology in this specific population are lacking. Because of the scarcity of this entity along with the peculiar characteristics of this patient group, the treatment of aneurysms of the cerebral circulation of these patients is challenging. The prevalence of Intracranial aneurysms in children is much lower than in adults· apart from that, several differences exist, centered on their etiology, demographic variables, aneurysm location, aneurysm morphological characteristics, clinical presentation, and outcome in pediatric and adult intracranial aneurysms. We describe the case of aneurysmal subarachnoid hemorrhage and extra-axial hemorrhage in an infant, as well as the review of the relevant current literature.

Case description: We report the case of a three months old infant who was admitted to our hospital due to episodes of vomiting, associated with loss of consciousness and an epileptic ictus. An MRI-MRA scan and a digital subtraction angiography were immediately performed, which revealed the presence of a giant fusiform aneurysm near the origin of the right anterior cerebral artery. Because of the location and shape of the aneurysmal sac, the ipsilateral internal carotid artery was totally occluded with detachable coils. At follow-up, the child experienced normal psychomotor development with no motor deficit.

Conclusions: Intracranial aneurysms should be considered in the differential diagnosis of infants and neonates who present with acute raised intracranial pressure. Even though rupture of an intracranial aneurysm in this age group is rare, subarachnoid hemorrhage is the most common mode of presentation. Intracranial aneurysms are frequently larger than 10 mm and located on the middle cerebral artery. The treatment could be surgical or endovascular, depending on the characteristics of the aneurysm. Seizures and cranial nerve involvement are the most common presenting features in children. The most commonly encountered sites of origin for such aneurysms are the posterior circulation, along with the internal carotid artery bifurcation. Current literature and case series suggest that there is increased incidence of giant, posttraumatic, and mycotic aneurysms in children. Based on the most recently published data, the treatment of ruptured and unruptured pediatric aneurysms is related with an increased incidence of an uneventful outcome, which reaches 95% in the current series. Pediatric intracranial aneurysms are more commonly encountered in male patients and have a predilection for the terminal ICA bifurcation.

Article Details

How to Cite
PANAGOPOULOS, Dimitrios; GAVRA, Maro; BOVIATSIS, Efstathios. Ruptured Gint Fusiform Aneurysm in an Infant: Case Report and Review of the Literature. Medical Research Archives, [S.l.], v. 11, n. 8, aug. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 02 oct. 2023. doi:
Review Articles


1. Goia A,Garrido E, Lefebvre M, Langlois O, Derrey S, Papagiannaki C, Gilard V. Ruptured intracranial aneurysm in a neonate: case report and review of the literature. World Neurosurg 2020;140:219-223. doi: 10.1016/j.wneu.2020.05.018
2. Agid R, Jonas Kimchi T, Lee S-K, Ter Brugge KG. Diagnostic characteristics and management ofintracranial aneurysms in children. Neuroimaging Clin N Am 2007;17:153-163.
3. Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial aneurysms in the pediatric population: case series and literature review. Surg Neurol.2005;63:424-432.
4. Jordan LC, Johnston SC, Wu YW, Sidney S,Fullerton HJ. The importance of cerebral aneurysms in childhood hemorrhagic stroke: a population-based study. Stroke 2009;40:400-405.
5. Buis D.R, van Ouwerkerk W.J.R. Takahata H, Vandertop W.P. Intracranial aneurysms in children under 1 year of age: a systematic review of the literature. Childs Nerv Syst 2006;22 (11):1395–1409.
6. Pollo C, Meagher-Villmure K, Bernath MA, Vernet O, Regli L. Ruptured cerebral aneurysm in the early stage of life—acongenital origin? Neuropediatrics 2004;35:230–233.
7. Orozco M, Trigueros F, Quintana F, Dierssen G.Intracranialaneurysms in early childhood. Surg Neurol 1978;9:247–252.
8. Kim BR, Kim JH, Kim KW, Choe WJ, Park JS.Anesthetic management of a preterm neonateintracranial aneurysm clipping. Korean J Anesthesiol 2014;67(suppl):S85.
9. Norris JS, Wallace MC. Pediatric intracranial aneurysms. Neurosurg Clin N Am 1998;9:557–563.
10. Laughlin S, terBrugge KG, Willinsky RA, Armstrong D.C, Montanera W.J, Humphreys R.P. Endovascular management of paediatric intracranial aneurysms. Interv Neuroradiol 1997;3: 205–214.
11. Humphreys RP, Pirouzmand F. Arteriovenous malformations and intracranial aneurysms in children. In: Winn HR,Dacey RG (eds) Youmans neurological surgery. Saunders, Philadelphia 2004; 3447–3459.
12. Proust F, Toussaint P, Garnieri J, Hannequin D, Legars D, Houtteville JP, Freger P. Pediatric cerebral aneurysms. J Neurosurg 2001;94:733–739.
13. Hulsmann S, Moskopp D, Wassmann H. Management of aruptured cerebral aneurysm in infancy. Report of a case of a ten-month-old boy. Neurosurg Rev 1998;(21):161–166.
14. Roche JL, Choux M, Czorny A, Dhellemmes P, Fast M, Frerebeau P, Lapras C, Sautreaux JL. Intracranial arterial aneurysm in children. A cooperative study. A propos of 43 cases. Neurochirurgie 1998;34:243–251.
15. Lasjaunias P, Wuppalapati S, Alvarez H,Rodesch G, Ozanne A. Intracranial aneurysms inchildren aged under 15 years: review of 59 consecutive children with 75 aneurysms. Childs Nerv Syst 2005;21:437-450.
16. Gemmete JJ, Toma AK, Davagnanam I, Robertson F, Brew S. Pediatric cerebral aneurysms. Neuroimaging Clin N Am 2013;23:771-779.
17. Pope FM, Kendall BE, Slapak GI, Kapoor R, Mc Donald W.I, Compston D.A, et al. Type III collagen mutations cause fragile cerebral arteries.Br J Neurosurg 1991;5:551-574.
18. Sorteberg A, Dahlberg D. Intracranial non-traumatic aneurysms in children and adolescents. Curr Pediatr Rev 2013;9:343-352.
19. Treatment of pediatric intracranial aneurysms: case series and meta-analysis. Treatment of pediatric intracranial aneurysms: case series and meta-analysis. J Neurointerven Surg 2019;11:257-264.
20. Garg K, Singh P.K, Sharma B.S, Chandra P.S, Suri A, Singh M, Kumar R, Kale S.S, Mishra N.K, Gaikwad S.K, Mahapatra A.K. Childs Nerv Syst 2014; 30(5): 873-883.
21. Herman JM, Rekate HL, Spetzler RF. Pediatric intracranialaneurysms: simple and complex cases. Pediatr Neurosurg 1991;17: 66–72, discussion 73.
22. Krishna H, Wani AA, Behari S, Banerji D, Chhabra DK, Jain VK. Intracranial aneurysms in patients 18 years of age or under, are they different from aneurysms in adult population? Acta Neurochir(Wien) 2005;147:469–476, discussion 476.
23. Muszynski CA, Carpenter RJ Jr, Armstrong DL. Prenatal sonographic detection of basilar aneurysm. Pediatr Neurol 1994;10:70–72.
24. Mehrotra A, Nair AP, Das KK, Srivastava A, Sahu RN, Kumar R. Clinical and radiological profiles and outcomes in pediatric patients with intracranial aneurysms. J Neurosurg Pediatr 2012;10:340–346.
25. Sharma BS, Sinha S, Mehta VS, Suri A, Gupta A, MahapatraAK. Pediatric intracranial aneurysms—clinical characteristics and outcome of surgical treatment. Childs Nerv Syst 2007;23:327–333.
26. Koroknay-Pal P, Niemela M, Lehto H, Kivisaari R, Numminen J,Laakso A, Hernesniemi J. De novo and recurrent aneurysms inpediatric patients with cerebral aneurysms. Stroke 2013; 44:1436–1439.
27. Jian BJ, Hetts SW, Lawton MT, Gupta N. Pediatric intracranial aneurysms. Neurosurg Clin N Am 2010;(21):491–501.
28. Allison JW, Davis PC, Sato Y, James CA, Haque SS, Angtuaco EJ, Glasier CM. Intracranial aneurysms in infants and children.Pediatr Radiol 1998;28:223–229.
29. Almeida GM, Pindaro J, Plese P, Bianco E, Shibata MK. Intracranial arterial aneurysms in infancy and childhood. Childs Brain 1977;3:193–199.
30. Amacher LA, Drake CG. Cerebral artery aneurysms in infancy, childhood and adolescence. Childs Brain 1975;1:72–80.
31. Meyer FB, Sundt TM Jr, Fode NC, Morgan MK, Forbes GS, Mellinger JF. Cerebral aneurysms in childhood and adolescence. J Neurosurg 1989;70:420–425.
32. Hetts SW, Narvid J, Sanai N, Lawton MT, Gupta N, Fullerton HJ, Dowd CF, Higashida RT, Halbach VV. Intracranial aneurysms in childhood: 27-year single-institution experience. AJNR Am J Neuroradiol 2009;30:1315–1324.
33. Sanai N, Quinones-Hinojosa A, Gupta NM, Perry V, Sun PP, Wilson CB, Lawton MT Pediatric intracranial aneurysms: durability of treatment following microsurgical and endovascular management. J Neurosurg 2006;104:82–89.
34. Gerosa M, Licata C, Fiore DL, Iraci G. Intracranial aneurysms of childhood. Childs Brain 1980;6:295–302.