Radiology Grand Rounds XVII

Here is a case of Pediatric Aneurysm for the Radiology Grand Rounds submitted by Dr MGK Murthy, Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

The incidence of congenital aneurysms in the general population is about 1-2%. Clinically, a ruptured aneurysm presents as sudden onset of severe headache. In cases of subarachnoid hemorrhages, the most common aneurysms are posterior communicating, 38%; anterior communicating, 36%; middle cerebral, 21%. These three locations account for 95% of all ruptured aneurysms. The basilar artery accounts for only 2.8% and posterior fossa aneurysms are even less common. Posterior fossa aneurysms are as such uncommon. PICA (Posterior inferior cerebellar artery) aneurysms are extremely rare. In this child we can see that aneurysm producing mass effect and no leak has occurred. The speciality of paediatric aneurysms are increased incidence in posterior fossa and a higher incidence of giant aneurysms (more than 2.5 cm diameter) and there is diversity of type and these are more often located in peripheral location . In this case of a eleven year old boy congenital saccular variety is possible.

Childhood intracranial aneurysms are exceedingly uncommon. Diagnosis of intracranial aneurysms in childhood may be difficult because of their infrequency and confusing clinical presentation. The first report of an aneurysmal SAH in a child was published in 1871 in the German pathology literature, when Eppinger detailed the case of a 15-year-old boy, a gymnast who collapsed while exercising. Postmortem analysis revealed an intracerebral hemorrhage associated with an aneurysm as well as a stenosis of the aorta. The development of contemporary neuroimaging has contributed greatly to the study, understanding, diagnosis, and treatment of pediatric intracerebral aneurysms. The emergence of CT and MR imaging studies obtained with contrast agents has allowed noninvasive, detailed characterization of aneurysms and the structures surrounding them.

Take Home Message-- Aneurysms unequivocally occur in children and cause SAH. Giant aneurysms and lesions in the posterior fossa are relatively more common in children than in adults. The termination of the CA and the ACA are disproportionately common sites of aneurysm formation in the anterior circulation of children. Traumatic and infectious aneurysms occur more frequently in children than in adults, but this may reflect a relative paucity of spontaneous aneurysms in children. Vasospasm occurs in children but appears to be better tolerated. Surgical outcomes in children appear to be moderately better than in adults.

Reference- Medscape ( Registration required). Intracranial Aneurysms

Also, the pioneering experience of Teleradiology Providers for an Indian Village settings has been accepted as a letter to editor in Radiology. Read the full text here-

Teleradiology: A Rural Indian Center's Pioneering Experience

I hope you enjoyed this edition of Radiology Grand Rounds submissions are requested for the next Radiology Grand Rounds posted every month last sunday. If you interested in hosting any of the future issues contact me at sumerdoc-AT-yahoo-DOT-com.