Ischemic Stroke as a Warning Sign of Impending Aneurysmal Rupture: A Report of Two Cases

• Published in: NMC Case Report Journal Vol. 8; no. 1; pp. 85 - 88
• Main Authors: OKAMURA, Kazuaki, MOROFUJI, Yoichi, IZUMO, Tsuyoshi, SATO, Kei, FUJIMOTO, Takashi, HORIE, Nobutaka, MATSUO, Takayuki
• Format: Journal Article
• Language: English
• Published: Japan The Japan Neurosurgical Society 2021
• Subjects: aneurysm; Case Report; hemodynamic-induced inflammation; ischemic stroke; subarachnoid hemorrhage; warning sign; aneurysm; hemodynamic-induced inflammation; warning sign; subarachnoid hemorrhage; ischemic stroke
• ISSN: 2188-4226; 2188-4226
• DOI: 10.2176/nmccrj.cr.2020-0040

Ischemic stroke associated with intracranial aneurysm is rare but potentially happens because of emboli originating from aneurysm sac or aneurysmal thrombosis extension to the parent artery. We describe two patients who present subarachnoid hemorrhage (SAH) soon after ischemic stroke. Case 1. A 51-year-old woman with a history of multiple endovascular therapy for ruptured basilar top aneurysm presented with double vision. Magnetic resonance imaging (MRI) revealed infarcts in the right thalamus and left occipital cortex. Four days after ischemic stroke, she suffered from sudden onset headache, computed tomography (CT) showed diffuse SAH with intraventricular hemorrhage. Case 2. A 62-year-old man presented with right facial palsy and sensory disorder. MRI revealed an infarct in the left pons. Four days after ischemic stroke, he became comatose and CT showed diffuse SAH. Both cases develop ischemic stroke adjacent to the aneurysms and subsequently cause devasting aneurysm rupture, suggesting ischemic stroke as a warning sign of aneurysm rupture. In such cases, early treatment of the aneurysm should be considered.