• Gustavo Chagoya, Arsalaan Salehani, B Ethan Tabibian, Nicholas M B Laskay, Brandon M Fox, Nidal B Omar, Bart Thaci, Joshua D Bernstock, Galal A Elsayed, and Mark R Harrigan.
• Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: gchagoya@uabmc.edu.
• World Neurosurg. 2021 Jan 1; 145: 205-209.

BackgroundAneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Among the most common sequelae of aSAH is delayed cerebral ischemia. Hyperdynamic therapy (fluid supplementation and hypertension) is used to increase cerebral perfusion. However, the safety of hyperdynamic therapy in patients with separate unruptured, unsecured intracranial aneurysms is not well-established. Herein, a rare case demonstrating the rapid evolution and rupture of an incidental unsecured aneurysm in the setting of hyperdynamic therapy is presented.Case DescriptionA 56-year-old woman without significant medical history presented with aSAH secondary to rupture of a 3-mm left posterior inferior cerebellar artery aneurysm. After endovascular treatment of this aneurysm, she developed symptomatic vasospasm prompting initiation of hyperdynamic therapy. Seven days after initiation of hyperdynamic therapy, she experienced rupture of an incidental pericallosal artery aneurysm that was found to have increased in size during the hyperdynamic therapy. She ultimately survived and was functionally independent approximately 1 year after her initial ictus.ConclusionsThis case demonstrates that enlargement and rupture of an incidental, previously unruptured aneurysm may occur during hyperdynamic therapy.Copyright © 2020 Elsevier Inc. All rights reserved.

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