Unruptured anterior communicating artery aneurysms presenting with seizure: Report of three cases and review of literature
This 35-year-old right handed gentleman, without any past history of medical illness, presented with history of two episodes of seizures in the last one year. His seizure semiology was suggestive of aura of epigastric pain followed by generalized tonic –clonic movement of all four limbs followed by loss of consciousness, without any post ictal confusion or focal neurological deficit. He gave no significant past history and his routine investigations results were also normal. Scalp EEG did not show any epileptiform discharges. CT brain plain showed a hyperdense lesion anterior to the sella on left side from the midline. MRI brain revealed a 24 × 18 mm saccular aneurysm arising from anterior communicating artery which was hypointense on T1-T2 with peripheral hypointensity on T2 and with evidence of thrombus. CT angiography confirmed the presence of a partially thrombosed, multilobulated, anterior communicating artery aneurysm in the left A1-A2 junction, and directed superolateraly with a size of 11 × 5 × 6 mm and neck of 4.5 mm []. He underwent left pterional craniotomy and clipping of aneurysm with removal of thrombus and excision of sac. The cortex surrounding the aneurysm did not look abnormal and was not removed. Presently, he is seizure free for the last 6-month on a single antiepileptic drug.