Middle Cerebral Artery Aneurysm in a Premature Neonate
A 26-day-old female patient had normal delivery in prematurity at the gestation of 34th week. During delivery, any medical assistances were not required and the patient was normal on the physical examinations. Routine sonography of the brain did not show any significant findings. And then, the patient has been treated with antibiotics under the impression of sepsis for approximately 2 weeks. On the 26th day after birth, reduced spontaneous activity, bulging of the anterior fontanel and right hemiparesis were observed. Computed tomography (CT) showed a large subcortical hemorrhage with intraventricular hemorrhage and subarachnoid hemorrhage in the left cerebral hemisphere. A 1 cm sized, round enhancing lesion suspected of the cerebral aneurysm was found together (). Light reflex of both pupils was prompt with no dilatations. It was thought that subarachnoid hemorrhage of Hunt-Hess grade IV was caused by rupture of infectious aneurysm. At first, frameless stereotactic aspiration of the intracerebral hematoma and extraventricular drainage were performed. Gram stain and culture for cerebrospinal fluid and hematoma were done together. After that, the patient kept stable without further neurological deteriorations. The follow-up CT angiograms showed a large intracerebral hemorrhage due to rebleeding and a 3×7 mm sized saccular aneurysm on the middle cerebral artery bifurcation (). Analysis of cerebrospinal fluid and echocardiogram showed no significant results. The patient underwent hematoma evacuation and aneurysmal neck clipping with craniotomy. Any findings suggested of the infectious origin were not found intraoperatively although resection of aneurysm sac could not be accomplished due to adherent perforators (). The neurological deficits have been improved gradually during follow-up period. 3 months after craniotomy, ventriculoperitoneal shunt was performed for hydrocephalus ().