Long-term surveillance in an infant with spontaneous obliteration of pial arteriovenous malformation and large intranidal aneurysm: A unique case observation.

Background: Spontaneous obliteration of untreated cerebral arteriovenous malformations (AVMs) is rare, occurring in <1% of cases, and is even less common in pediatric populations. The mechanisms driving spontaneous regression of brain AVMs remain poorly understood, and long-term surveillance in pediatric patients is infrequently documented. Case Description: The authors reported a remarkably rare instance of spontaneous thrombosis in a pial AVM accompanied by a large intranidal aneurysm in a 10-month-old infant, initially presenting with a nocturnal seizure. Diagnostic imaging revealed a ruptured intranidal aneurysm causing acute hemorrhage in the left anterior interhemispheric subdural space, extending into adjacent areas. Further, magnetic resonance imaging (MRI) and magnetic resonance angiography delineated the AVM in the left superior frontal gyrus, associated with a thrombosed aneurysm and surrounding edema. Cerebral angiography confirmed the AVM's origin from the left anterior cerebral artery, displaying early venous drainage and small, indirect feeders not amenable to endovascular treatment. Over time, serial imaging showed the aneurysm's transition from partial to complete thrombosis. Subsequent MRIs and angiographic assessments up to age 10 confirmed complete resolution of the AVM and aneurysm, with focal hyperemia persisted until age 16, when recurrent AVM was identified. Conclusion: We document a rare spontaneous regression of a pial AVM with an intranidal aneurysm influenced by specific vascular factors. Despite this, spontaneous thrombosis should not replace vigilant long-term monitoring in pediatric neurovascular care.

Spontaneous thrombosis of a large unruptured intracranial aneurysm causing ischemic stroke due to occlusion of the parent artery: A case report and literature review.

Spontaneous thrombosis of an unruptured large or giant saccular intracranial aneurysm is a well-known phenomenon and can cause ischemic stroke (IS), which is a rare event. The possible pathogenic mechanisms of IS include distal embolic occlusion secondary to migration of the intra-aneurysmal thrombus, occlusion of the parent artery lumen caused by the retrograde extension of the aneurysmal thrombosis, external compression of the parent artery due to the increased aneurysmal mass effect. Among these, IS due to simultaneous thromboses of the aneurysm and its parent artery is extremely rare, with only a few cases reported in the literature. Herein, we present a case of a 18-year-old woman who suffered an acute IS, attribute to spontaneous complete thrombosis of an unruptured large saccular aneurysm of the right middle cerebral artery with occlusion of the parent artery, and we review the literature simultaneously.

Spontaneous thrombosis and calcification of giant cavernous carotid artery aneurysm: A rare case and management insights.

Background: Giant cavernous carotid artery aneurysms (>25 mm) are rare (3-5%), with some prone to spontaneous thrombosis (10-20% complete). We present a unique case of one of the largest aneurysms spontaneously thrombosing and calcifying. Case Description: A 57-year-old with persistent right-sided headaches had a substantial hyperdense mass in the right middle cranial fossa, eroding petrous bone. Magnetic resonance imaging and digital subtraction angiography revealed a giant cavernous segment fusiform aneurysm of the right internal carotid artery (ICA) with spontaneous thrombosis and distal ICA occlusion. Collateral circulation maintains the cerebral blood supply. Despite anatomical challenges, conservative management was chosen due to the patient's stability. Conclusion: This case highlights the complex interplay between thrombosed giant aneurysms and affected vessels, with unique features such as cross-flow, calcification, and bone erosion. We advocate conservative management for stable cases, supported by literature, emphasizing vigilant follow-up. This expands the spectrum of aneurysm presentations and encourages further research into their dynamics.

Spontaneous thrombosis of deep brain arteriovenous malformation in a patient with intraventricular and subarachnoid hemorrhage.

The most common manifestation of brain arteriovenous malformations (BAVM) is intracranial hemorrhage. The incidence of ruptured BAVM is 3.5 per 100,000 people per year. The mortality rate of ruptured BAVM within 1 month after diagnosis was 12.7%. Spontaneous thrombosis occurs in less than 1.5% of ruptured BAVMs. This phenomenon was still elusive. Up until now, the gold standard of imaging examination has been cerebral digital subtraction angiography (DSA), whose sensitivity and specificity reach 100%. We reported the spontaneous thrombosis of a ruptured deep BAVM. An 18-year-old woman presented with severe headache and vomiting. The patient also complained of seizures. There was no body weakness, skewed face, or slurred speech. Cerebral computed tomography (CT) showed extensive hemorrhage in the ventricular system and subarachnoid space. Cerebral DSA showed a left subcortical BAVM and was found to have spontaneous thrombosis 3 weeks later when the patient was about to be embolized. Spontaneous thrombosis of ruptured BAVM may occur after intracranial hemorrhage. In this patient, spontaneous thrombosis occurred within 3 weeks.

A rare case report of spontaneous thrombosis in unruptured giant intracranial aneurysm.

Unruptured giant intracranial aneurysms (GIAs) are characterized by their size, which exceeds 25 mm, and these conditions account for approximately 5% of all aneurysm cases. Furthermore, it typically develops in women during the fifth to seventh decade of life. Compared to small aneurysms, which cause subarachnoid hemorrhage, GIAs can manifest as masses or ischemic effects caused by thromboembolism. An elderly female patient, aged 67, was admitted to the hospital with a primary complaint of sudden facial sensory loss on the left side and vomiting. There was also a history of double vision accompanied by left ocular movement disturbance and gradually developed localized headache on the left side. Furthermore, a contrast head magnetic resonance angiography (MRA) revealed the presence of a high-flow giant aneurysm, measuring 30.7 × 31.8 × 27.2 mm in the cavernous segment of the left internal carotid artery (ICA). Cerebral angiography showed the absence of flow on the left ICA due to total occlusion. After cerebral angiography, the patient remained conscious but exhibited some neurological deficits, which were identical to the initial symptoms observed during hospitalization. Cases of spontaneous thrombosis in GIA are extremely rare. However, radiological examination, particularly angiography, can be used to diagnose spontaneous thrombosis in unruptured GIAs to ensure that the patient receives the right treatment.

Spontaneous Thrombosis of a Hepatic Pseudoaneurysm Following Blunt Liver Injury.

Hepatic pseudoaneurysm (HPA) is a rare complication of liver injury in children. Prophylactic embolization is preferable to prevent life-threatening hemorrhage due to pseudoaneurysm rupture. We present the case of a four-year-old boy who sustained a grade III liver injury from blunt abdominal trauma. He was conservatively managed since he was hemodynamically stable. Follow-up contrast-enhanced computed tomography (CECT) performed 10 days following the injury revealed an HPA measuring 4 mm × 4 mm × 3 mm. Herein, we chose conservative treatment for HPA as the patient was asymptomatic and hemodynamically stable. Conservative treatment was successful, and HPA spontaneously resolved 23 days following the injury without radiologic or surgical intervention. Although there are studies reporting asymptomatic HPAs that have spontaneously resolved, the natural history of HPAs remains unknown. Conservative treatment may be an option for asymptomatic HPA; however, to identify factors contributing to spontaneous thrombosis, further evaluation is needed.

Spontaneous thrombosis of vein of Galen malformation managed with surgical resection: a case­based review.

INTRODUCTION: Vein of Galen malformation (VOGM) is an exceptionally uncommon form of congenital intracranial vascular malformations. It is highly unusual for this lesion to spontaneously thrombose. The clinical presentation of a patient may range from being asymptomatic to critically ill. The underlying pathophysiological mechanisms that cause spontaneous thrombosis are still poorly understood. METHODS AND RESULTS: The literature on spontaneous thrombosis of VOGM was systematically reviewed, analyzed, and summarized with a focus on its pathophysiology, types, clinical presentations, diagnosis, management, and outcomes. It was also illustrated with a case presentation. The case presents an unusual presentation and location of a VOGM in a 2-year-old boy who was successfully treated with surgical resection. CONCLUSIONS: A handful of cases of thrombosed VOGM have been reported worldwide where surgery was used to treat the condition. Low-flow fistulas of the mural type are prone to spontaneous thrombosis, have delayed clinical presentations, and are typically diagnosed in young children. Among the many possible manifestations, hydrocephalus is by far the most common. In the absence of blood flow, MRI is the diagnostic test of choice. Depending on the patient's symptoms, surgery to either remove the aneurysm or divert the cerebrospinal fluid usually results in a good prognosis.

A rare case of spontaneous thrombosis in saccular cerebral aneurysm in a patient with subarachnoid hemorrhage.

Cerebral aneurysm is a known cause of spontaneous subarachnoid hemorrhage (SAH). Furthermore, this condition is often asymptomatic, but the occurrence of a rupture can lead to fatal complications. The incidence of spontaneous thrombosis in saccular aneurysm is rare, with an incidence rate of 1%-2%. The most common sites include the middle cerebral artery (MCA) (41%), posterior communicating artery (PCOMM) (15%), and posterior inferior cerebellar artery (PICA) (11%). A head computed tomography angiography (CTA) with contrast is a common diagnostic tool for detecting SAH in the temporoparietal area, hippocampal gyrus, and right fissure of Sylvie. In some cases, saccular aneurysm can be found in the segment bifurcation of the right middle cerebral artery. A cerebral angiography was carried out, specifically digital subtraction angiography, which revealed the presence of visible blister remnants of aneurysm in the form of spontaneous thrombosis. After 1 year, another angiography evaluation was performed to assess the condition of the patient. Furthermore, the results showed no evidence of recanalization and there were no new neurologic deficits. Although spontaneous thrombosis led to the healing of aneurysm in some cases, secondary recanalization remained a possibility. Therefore, it was essential to monitor any incidence of this complication. Precise knowledge of the mechanism of spontaneous thrombosis could lead to the development of new therapeutic approaches. Spontaneous thrombosis in cases of saccular aneurysm is a rare occurrence, which can provide temporary or permanent benefits to the patient. Therefore, periodic evaluation is required to assess the condition of the patient.

Pseudoaneurysm of the breast following blind palpation-guided core needle biopsy: a case report and literature review.

Core needle biopsy is currently the most widely used basic diagnostic method for the diagnosis of breast masses; it is a minimally invasive procedure with excellent specificity and sensitivity and negligible complication rates, particularly when image-guided. However, complications tend to be higher when performed blindly. Hematoma remains the most common complication resulting from this procedure. Iatrogenic pseudoaneurysm is a rare complication with no previous report in Nigeria. In this report, we present a case of breast pseudoaneurysm occurring after 2 blind, palpation-guided core needle biopsies in a 51-year-old known hypertensive woman at a Nigerian tertiary hospital. Spontaneous thrombosis of the pseudoaneurysm occurred over three months after the second blind biopsy.

Spontaneous thrombosis of a giant common hepatic artery aneurysm-A case report.

Splachnic aneurysms (hepatic artery aneurysms) are a rare entity ranging from atypical symptoms to devastating rupture.

Spontaneous thrombosis of a vein of Galen malformation associated with acute sinusitis: a case report.

The vein of Galen malformation is caused by an abnormal shunting between choroidal arteries and the median prosencephalic vein during embryological development, leading to increased blood flow to the deep cerebral veins, intracranial damage, and systemic repercussions. Idiopathic spontaneous thrombosis of a vein of Galen malformation is rare, and its association with acute sinusitis has not been reported in the literature. We present the case of a girl with a postnatal diagnosis of a vein of Galen malformation at the age of 16 months, with secondary pulmonary hypertension that was adequately controlled with spironolactone. At 3 years old, while expecting elective endovascular treatment, the patient developed spontaneous thrombosis of the vein of Galen malformation, concomitant to an acute sinusitis episode, with complete resolution of the vascular malformation and secondary pulmonary hypertension. The patient continued with normal neurological development over a 5-year follow-up. We discuss the main pathophysiologic mechanisms that can explain spontaneous thrombosis of VOGMs and the patient's outcome. Awareness of different mechanisms that can lead to spontaneous thrombosis can help in the decision-making process and prompt targeted approaches to individual patients with a vein of Galen malformation.

Large cavernous carotid artery aneurysm with spontaneous thrombosis: is there more to a change in morphology than there seems to be? Illustrative case.

BACKGROUND: The pathogenesis and endovascular treatment strategy for spontaneously thrombosed unruptured cerebral aneurysms have not yet been comprehensively described. OBSERVATIONS: The authors reported on a 78-year-old woman who had large bilateral unruptured cavernous carotid artery aneurysms that induced chronic disseminated intravascular coagulation and acquired factor XIII deficiency. The right aneurysm was symptomatic and partially thrombosed. Hemorrhagic diathesis and abnormal values of laboratory data improved after administration of recombinant human thrombomodulin followed by endovascular treatment in which three pipeline embolization devices were deployed for the right aneurysm. LESSONS: To the best of the authors' knowledge, this was the first report of an unruptured cerebral aneurysm leading to coagulation disorders with clinical manifestation that was treated successfully by endovascular intervention after intensive perioperative management.

Complete spontaneous thrombosis in unruptured non-giant intracranial aneurysms: A case report and systematic review.

BACKGROUND AND AIM: Spontaneous partial or complete thrombosis of saccular unruptured intracranial aneurysm (UIAs) is a known occurrence in giant aneurysms. However, spontaneous complete thrombosis of non-giant aneurysms is a rare event in the natural history of UIAs. The aim of this paper is to report on the cases from literature of complete spontaneous thrombosis with a view to identify possible factors associated with this phenomenon. MATERIAL AND METHODS: We performed a systematic review of the current literature on spontaneous complete thrombosis of saccular, non-giant, unruptured UIAs, including a case that we treated at our institution. We analysed the possible risk factors for thrombosis, association with ischemic events, rupture and recanalization. We reviewed the possible management's strategies for this group of patients described in literature to date. RESULTS: We identified 26 patients for a total of 27 thrombosed aneurysms from the literature review (including our case). Thrombosis was prevalent in women, in the anterior circulation and in larger aneurysms. Endovascular events in the parent artery, either spontaneous or iatrogenic, were associated with spontaneous thrombosis in 4 cases. In 47 % of cases an antiplatelet treatment (AP) was introduced. Rupture and recanalization of the aneurysm were observed in 14 % and 33 % respectively. A larger size was the only factor statistically associated with rupture (P = 0041). AP was not statistically associated with recanalization or rupture of the aneurysm. CONCLUSION: Complete spontaneous thrombosis is not a curative event. Its natural history is associated with recanalization, rupture and ischemic stroke. Conservative treatment with a clinical-radiological follow up and treatment with AP is a safe option for small aneurysms. Definitive aneurysmal exclusion should be considered in medium and large aneurysms due to the significant risks associated with untreated aneurysms.

Multiple Cranial Dural and Pial Arteriovenous Fistulas with Occlusion of All After Embolization of Primary Superior Sagittal Sinus Dural Fistula.

BACKGROUND: We present a rare case of multiple intracranial arteriovenous fistulas (AVFs). A young female presented with headache and a left eyelid pulsatile swelling. CASE DESCRIPTION: Magnetic resonance imaging demonstrated numerous dilated cortical veins, along with a prominent left superior ophthalmic vein. A diagnostic cerebral angiogram revealed 5 distinct AVFs including 4 dural AVFs (dAVFs) and a pial AVF (pAVF). The largest dAVF was at the superior sagittal sinus. The others included bilateral ethmoidal, torcular, and a pAVF arising of the right pericallosal artery. She was treated by endovascular transarterial Onyx embolization. Only the superior sagittal sinus fistula was treated via middle meningeal artery feeders with complete occlusion. Immediate follow-up angiogram also showed complete spontaneous occlusion of the untreated dAVFs and pial AVF. CONCLUSIONS: This case is exceedingly unique considering the multiplicity of AVFs, concurrent presence of pial and dural AVF, and spontaneous occlusion of all untreated AVFs after embolizing the largest shunting fistula.

Spontaneous aortic thrombosis in neonates: a case report and review of literature.

Neonatal aortic thrombosis is a rare occurrence but can be life-threatening. Most aortic thrombosis in neonates is related to umbilical artery catheters. A case of a neonate with a spontaneous aortic thrombosis is described here along with a comprehensive review of the literature for cases of neonatal aortic thrombosis not related to any intravascular device or procedure. The aetiologies of these spontaneous thromboses and the relevance of hypercoagulable disorders are discussed. The cases were analysed for odds of death by treatment method adjusted for era. The reference treatment method was thrombolysis and anticoagulation. No other treatment modality had significantly lower odds than the reference. Surgery alone had higher odds for death than the reference, but this may be confounded by severity of case. The management recommendations for clinicians encountering neonates with spontaneous neonatal aortic thrombosis are discussed.

Spontaneous Thrombosis of Giant Dissecting Fusiform Middle Cerebral Aneurysm After Double-Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass: A Case Report of Decision-Making in a Limited Resource Environment.

BACKGROUND: The treatment of giant fusiform middle cerebral artery (MCA) aneurysms remains daunting owing to their tendency to be associated with precarious end-vessel anatomy and the need for complex microsurgical techniques to appropriately address the aneurysm and the vasculature at risk. Extracranial-intracranial bypass revascularization remains a valuable tool for treating these complex lesions. In the present report, we have described a rare occurrence in which the creation of a double-barrel superficial temporal artery (STA-MCA) bypass facilitated spontaneous obliteration of the aneurysm. We have also highlighted our decision-making process, which was affected by operating in a low-to-middle income country with limited resources. CASE DESCRIPTION: A 32-year-old man had presented with recurrent ischemic events in the left MCA distribution and subsequent subarachnoid hemorrhage due to rupture of a giant complex fusiform MCA aneurysm. The patient underwent double-barrel STA-MCA bypass and was scheduled for second-stage clip reconstruction or partial trapping. Postoperative imaging studies revealed progressive thrombosis of the M1 segment, resulting in occlusion of the aneurysm without subsequent trapping or clipping. The patient recovered remarkably without further repeat hemorrhage or ischemic injury. We also reviewed the reported data. CONCLUSIONS: Double-barrel STA-MCA bypass is a potential salvage surgical technique to treat selected ruptured complex giant fusiform MCA aneurysms. In rare selected cases, the flow alteration induced by the bypass alone can potentially facilitate aneurysm thrombosis.

A Case of Wallenberg's Syndrome Presenting with Spontaneous Thrombosis of a Vertebral Artery Aneurysm.

Complete spontaneous thrombosis of intracranial aneurysms is uncommon. Although this type of thrombosis is largely asymptomatic, in rare cases it can be accompanied by parent artery occlusion and ischemic stroke. There are limited reports of complete thrombosis of an unruptured aneurysm of the internal carotid artery and middle cerebral artery. Furthermore, there are no reports of occlusion of the vertebral artery caused by thrombosis of an aneurysm. The mechanisms of spontaneous thrombosis are not established. However, aneurysm morphology, arteriosclerosis, and stagnation of aneurysm flow have been suggested. Herein, we present a novel case of Wallenberg's syndrome caused by a fusiform aneurysm in which complete thrombosis of the proximal vertebral artery occurred. We discuss the mechanisms of thrombosis caused by an unruptured aneurysm, which may be useful for managing such patients who present with transient ischemic attacks.

Thrombotic Aneurysm of Posterior Inferior Cerebellar Artery.

BACKGROUND: Spontaneous thrombosis of an intracranial aneurysm is rare but is common in fusiform or large cystic aneurysms, which result in subarachnoid hemorrhage after rupture. This case reports a 47-year-old woman with subarachnoid hemorrhage who developed spontaneous thrombosis of an aneurysm due to rupture of the posterior inferior cerebellar aneurysm. CASE DESCRIPTION: The patient was admitted to the hospital with history of sudden headache and vomiting for 3 days. According to early imaging findings, she was initially diagnosed as having a cavernous hemangioma with hemorrhage in the left cerebellum, but according to the intraoperative pictures and postoperative pathologic results, the diagnosis was an aneurysm with thrombosis. CONCLUSIONS: This case represents a rare but important complication of ruptured intracranial aneurysm, which can be easily misdiagnosed or ignored. It should be given great attention and considered in patients with subarachnoid hemorrhage who are negative for imaging examinations.

Completely Thrombosed Giant Intracranial Aneurysm with Spontaneous Thrombosis of the Parent Artery: Is It Nature's Divine Intervention and a Self-Cure?

BACKGROUND: Although partial thrombosis is common with intracranial aneurysms, complete aneurysmal thrombosis is extremely rare. An even rarer and seldom reported phenomenon is the spontaneous complete occlusion of the parent artery in the presence of a thrombosed aneurysm. Given the unclear natural history of this phenomenon, therapeutic decision making may be rather difficult. Here we report a case of right cavernous carotid artery aneurysm with spontaneous right internal carotid artery (ICA) thrombosis in a 45-year-old man. CASE DESCRIPTION: Our patient presented almost 1 month after an episode of sudden-onset severe holocranial headache associated with vomiting that had resolved completely within 2 days. He was neurologically intact at the time of presentation. A computed tomography (CT) scan done at the time of ictus showed a rounded hyperdensity with the epicenter at the right parasellar region along with nonvisualization of the ipsilateral ICA on CT angiography. Magnetic resonance imaging (MRI) suggested a diagnosis of a completely thrombosed right cavernous segment ICA aneurysm. Intra-arterial angiography confirmed a complete ipsilateral ICA thrombosis and a good arterial cross-flow from the left side to the bilateral anterior and middle cerebral artery territories. We started the patient on oral aspirin and a close clinicoradiologic follow-up after having decided against any active intervention. CONCLUSIONS: Spontaneous thrombosis of an intracranial aneurysm and the parent artery is rare, with only a few cases reported in the literature. In the absence of symptoms and adequate collateral circulation, these patients are perhaps best managed conservatively.

Deep Vein Thrombosis: A Rare Cause of Acute Testicular Pain. Case Report: Literature Review.

INTRODUCTION: Thrombosis is defined as the formation of a clot in a blood vessel that obstructs the flow of blood to the peripheral tissues. The incidence of thromboembolic disease ranges from 0.7 to 1.2% within urology. CASE REPORT: A 40-year-old warehouse worker male presented to the emergency department with worsening of a month's lasting scrotal pain. Physical examination showed the presence of an enlarged and painful left testicle with no other findings. Right testicle, penis and abdominal examination showed no abnormalities whatsoever. Bilateral varicocele with a partial thrombosis of the left one associated with left inguinal hernia was diagnosed by performing an urgent testicular ultrasound test. Conservative treatment was first given. However, since pain was not relieved, surgery was indicated with left varicocelectomy and a left inguinal hernia repair procedure leading to complete symptoms control and normal testicular flow in the control Doppler ultrasound study 2 months after the surgery. CONCLUSION: Spontaneous thrombosis of the pampiniform plexus is a rare entity where the management remains controversial. The clinical case we report here shows that surgery may be considered an effective option.