Unruptured anterior communicating artery aneurysms presenting with seizure: Report of three cases and review of literature
This 61-year-old male, with no history of any comorbid factors, presented with history of focal twitching over the left half of face for the last six months. He gave no history of aura, generalization or involvement of limbs. General, systemic, and neurological examination was unremarkable and scalp electroencephalogram (EEG) did not show any epileptiform discharges. Magnetic Resonance Imaging (MRI) of brain showed a well defined globular lesion in the suprasellar area, 13 × 12 × 11 mm in size, hypointense on T1, T2 with peripheral hyperintesity on T2 []. Computerized tomographic angiogram (CTA) head revealed a saccular aneurysm arising from the anterior communicating artery of size 15 × 12 mm, with neck of 5 mm. Digital substraction angiography (DSA) confirmed the presence of the saccular aneurysm measuring 10.8 × 6.8 mm directed antero-inferiorly with a neck of 5.2 mm []. Intraoperatively, the aneurysm was found to be large, thrombosed with a small flowing part. The aneurysm was surgically managed. The rim of cortex around the aneurysm appeared compressed but not gliotic, and hence was not removed. The patient is presently seizure free on 2 years follow-up on a single antiepileptic.