Cerebral aneurysms in pediatrics

A 6-month-old baby boy presented to them with irritability and generalized lethargy over the past week. 

The child had been suffering from an upper respiratory tract infection for three weeks. The baby was born through a vaginal delivery after an uncomplicated pregnancy. No abnormalities were encountered during the postnatal period.

The patient was immediately intubated upon hospitalization, owing to the low Glasgow Coma Scale (GCS) and for airway protection. Physical examination before the intubation elicited a low-grade fever along with right hemiplegia and hyperreflexia of the right limbs. 

A Computed Tomography (CT) scan revealed a left fronto¬temporo¬parietal intracranial bleed – 5cm x 1.5 cm x 2.6 cm. Additionally, a subarachnoid hemorrhage was detected. 

A left decompressive craniectomy was undertaken for the evacuation of clot with intracranial pressure catheter insertion. Upon dura opening, it was observed that the brain was edematous and the clot was located at the Sylvian fissure. A pulsatile mass was detected at the temporal region which was confirmed to be an aneurysm on a doppler ultrasound. 

Post-surgical cerebral angiogram showed a dumb¬bell shaped aneurysm at the M3 segment of the left middle cerebral artery. A second surgery was conducted – excision of the left distal M3 aneurysm was performed; it easily coagulated after placement of the aneurysm clip. 

The infant recovered remarkably with only minimal post-operative neurological deficit. 

The most common site for aneurysm in pediatric age-groups are the internal carotid bifurcation and aneurysms of the posterior circulation. Frequently, aneurysms in children tend to be of large or giant types. Saccular aneurysms are often associated with hemorrhage.