De novo formation of familial cerebral aneurysms: Case report

OBJECTIVES: The factors regulating the formation and growth of cerebral ane urysms are poorly understood. We report the case of a patient whose grandfa ther had a cerebral aneurysm and who developed numerous de novo aneurysms o f varying size 9 years after the treatment of a first aneurysm. This observ ation sheds light on the cause and growth of cerebral aneurysms in familial cases that may be pertinent to sporadic cases. CLINICAL PRESENTATION: A 58-year-old man was admitted to the Montreal Neuro logical Institute in 1956 for an ultimately fatal, autopsy-proven, ruptured internal carotid artery aneurysm. His granddaughter was first admitted to the same institution in 1984 after suffering a subarachnoid hemorrhage from a ruptured right terminal internal carotid artery aneurysm that was succes sfully treated. Four-vessel cerebral angiography did not reveal other aneur ysms. The granddaughter was readmitted to the hospital 9 years later after a new, lumbar puncture-proven subarachnoid hemorrhage occurred. Cerebral an giography demonstrated that the previously clipped aneurysm did not fill. H owever, five new aneurysms were present. INTERVENTION: An anterior communicating artery aneurysm, thought to be the one that bled, was surgically clipped, and a large right posterior communic ating artery aneurysm was coiled endovascularly. The remaining, smaller ane urysms were left untreated. CONCLUSION: The appearance of five new aneurysms during a 9-year interval s uggests that there may be a genetic factor operating in the development of cerebral aneurysms in families and that this may produce a more widespread cerebral arteriopathy than is generally appreciated. Patients with treated cerebral aneurysms from families in which two or more individuals have cere bral aneurysms, and perhaps their first and second degree relatives who hav e had negative angiograms, should be considered for periodic follow-up cere brovascular imaging to rule out the subsequent development of de novo aneur ysms.