Hemiparkinsonism Due to Coiled Posterior Cerebral Artery Aneurysm

Giant aneurysms involving the posterior cerebral artery (PCA) are rare.Theoretically a giant PCA aneurysm can cause parkinsonian symptom as a result of compression on substantia nigra but there is no actual case report.Few reported cases of aneurysms causing secondary parkinsonism involved middle cerebral artery and vertebral artery.[1][2][3][4][5] Other commonly known secondary causes of parkinsonism are repeated head trauma, infection, metabolic disorders (Wilson's disease, hypoparathyroidism, pseudohypoparathyroidism), drugs (neuroleptics, Metoclopramide), toxins (1-methyl-1,2,4,6 tetrahydropyridine, carbon monoxide) etc. 6 Tang et al reported hemiparkinsonism as the presenting feature in a case of primary intracranial hemangiopericytoma.7 We present a case of hemiparkinsonism developing after coiling of a large PCA aneurysm.A 32-year-old female presented with severe headache, vertigo and episodes of diplopia of two months duration.Her fundus was normal and there was no other abnormal neurological sign.At that time she had no tremor, bradykinesia, rigidity or gait problems.Her routine haematological and serum biochemical parameters were within normal limits.Neuroimaging and angiogram revealed a partially thrombosed saccular aneurysm of 18 mm x 16 mm x 21 mm arising from P 2 -P 3 segment junction of left PCA with a narrow neck and mass effect on midbrain at the level of inferior colliculus (Figure 1, Figure 2, supplementary figure).P 4 branches of the left PCA were not seen.Large and giant aneurysms are some of the most challenging vascular pathologies in the central nervous system.Endovascular coil embolization of these lesions is being used increasingly as a safer alternative to surgical clipping and the same was undertaken in this case.8,9 A 6F guiding catheter was positioned in right vertebral artery via the right femoral route under general anaesthesia followed by positioning of an Excelsior 10-18 microcatheter in the left PCA aneurysm over transcend 14 wire.The P 3 segment of the left PCA and aneurysm was occluded with multiple GDC coils.Post embolization left carotid angiogram revealed reformation of the distal branches through the anterior choroidal artery.The PCA was preserved and the aneurysm was almost completely obliterated (Figure 3).She was not considered for steroid therapy before, during or after the operation.After four weeks of endovascular coiling, she developed rest tremor of her right hand and started dragging her right leg while walking.She also complained of slowing down in all her motor activities.She had no complaint of diplopia or blurring of vision.All these motor symptoms were insidious in onset and progressed with time.On examination, she had rest tremor,

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.