Two Case Reports of Ruptured Distal Posterior Inferior Cerebellar Artery Aneurysms

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We present two cases of ruptured distal posterior inferior cerebellar artery (distal-PICA) aneurysms and discuss treatment strategies. Case 1 involved a 37-year-old woman who presented in a drowsy state following a sudden headache. A second computed tomographic study revealed a subarachnoid hemorrhage with a cerebellar hematoma. Vertebral angiography revealed a distal-PICA aneurysm. We performed neck clipping of the aneurysm and removed the hematoma. Case 2 involved a 67-year-old woman who suffered a sudden headache. Her consciousness declined to a comatose state. Computed tomography revealed a massive cerebellar hematoma. Because of impending herniation, we performed the operation without preoperative angiography. The operation revealed a ruptured distal-PICA aneurysm in the hematoma. Ruptured distal-PICA aneurysms are sometimes complicated by cerebellar hematomas, which worsen the neurologic outcome to that associated with a severe-grade subarachnoid hemorrhage. We believe that these case must be treated as cerebellar hematomas and require emergency surgery.
昭和大学・昭和医学会の論文