Spontaneous disappearance and reappearance of a ruptured cerebral aneurysm: One case found in a group of 33 consecutive patients with subarachnoid hemorrhage who underwent repeat angiography

The spontaneous disappearance and reappearance of a ruptured cerebral aneur ysm is generally assumed to be a rare phenomenon although the actual incide nce is unknown. Among 39 consecutive cases of acute subarachnoid hemorrhage (SAH), 33 were studied by three-dimensional computed tomographic angiograp hy (CTA) within 6 h after the onset of SAH, followed by digital subtraction angiography (DSA) within 24 h after the ictus. OF those patients, one, a 5 8-year-old woman, had a saccular aneurysm at the distal anterior cerebra I artery. the aneurysm was clearly demonstrated by CTA 2.5 h after the SAH on set, but was nor shown by a subsequent DSA performed 8.5 h after the ictus. A follow-up DSA detected the neck of aneurysm on day 11, and the whole ane urysm was visualized on day 19. The observations in this particular case su ggest that the spontaneous disappearance of a ruptured cerebral aneurysm ma y occur during the ultra-early stage of SAH and that reappearance may Follo w during the next Few weeks. The patient did not suffer complications such as vasospasm or systemic hypotension nor was she treated with antifibrinoly tic agents. The aneurysmal shape and the surrounding clot are considered as putative factors possibly related to the intermittent appearance of the an eurysm.