• Yosuke Sato, Kazuhiro Ando, Makoto Kawaguchi, and Kenichi Kakinuma.
• Department of Neurosurgery, Cerebrovascular Center, Niigata Rosai Hospital, Japan Organization of Occupational Health and Safety, Niigata, Japan. Electronic address: yanda2011@gmail.com.
• J Stroke Cerebrovasc Dis. 2017 Oct 1; 26 (10): e206-e209.

IntroductionDistal medial lenticulostriate artery (LSA) aneurysms associated with isolated intraventricular hemorrhage (IVH) are extremely rare. We report a very rare case of the isolated IVH due to the rupture of the distal medial LSA pseudoaneurysm that was not visible at the initial angiography but later emerged and grew.Case ReportA 61-year-old woman with a history of hypertension had sudden onset of severe headache and mild consciousness disturbance. The computed tomography scan revealed the IVH, but the initial angiographies showed no evidence of aneurysm. The follow-up magnetic resonance imaging revealed that an intraventricular mass, arising from the right distal medial LSA, emerged and grew into the right anterior horn. Considering the risk of rebleeding, we resected the mass lesion via the transsulcal transventricular approach. The postoperative imaging showed complete obliteration of the mass lesion. Histopathological analysis indicated the pseudoaneurysm. The patient was discharged without any neurological deficit.ConclusionsThe careful and repetitive follow-up imaging should be done in the cases with isolated IVH even if the initial image evaluations are unrevealing. The transsulcal transventricular approach can be the most minimally invasive surgical option for intraventricular lesion.Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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