Multiple intracranial aneurysms associated with neurofibromatosis: A case report

Abstract

We report a case of multiple intracranial aneurysms associated with neurofibromatosis (NF) in a 30 year old man. On seeking medical advice, the man presented a disseminated, cutaneous NF and complained of severe headache and vomiting. His blood pressure was 170/100 mmHg, but his cardiovascular system was otherwise found to be normal. Computed tomography revealed diffuse subarachnoid hemorrhage, and selective internal carotid angiography identified two separate aneurysms at the bifurcation of the right middle cerebral artery and at the anterior communicating artery. For treatment, an orbito cranial craniotomy was performed, and a ruptured anterior communicating artery aneurysm and an unruptured middle cerebral artery aneurysm were successfully clipped. However on the 13th postoperative day, the patient suddenly lost consciousness and right carotid angiography revealed diffuse vasospasms affecting the C2 portion of the internal carotid artery, the middle cerebral artery, and the anterior cerebral artery. At 7 weeks postoperatively, the patient who developed severe left hemiparesis was discharged. Although 21 cases of a cerebral aneurysm associated with NF have been reported in the literature, a rupture of an aneurysm associated with NF is extremely rare and the prognosis is very poor. The authors stress the necessity of screening such cases with three dimensional CT or MR angiography so as to achieve an early diagnosis, and elective repair of unruptured aneurysms in patients with NF.