• Marvin Darkwah Oppong, Ramazan Jabbarli, Alexander Radbruch, Ulrich Sure, and Philipp Dammann.
• Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany. Electronic address: marvin.darkwahoppong@uk-essen.de.
• World Neurosurg. 2019 Dec 1; 132: 103-105.

BackgroundWe present a case of a concurrent rupture of a middle cerebral artery (MCA) aneurysm and thrombosis of the associated vessel.Case DescriptionA male patient presented with acute onset of hemiparesis and nuchal pain. A computed tomography scan revealed a right sided frontotemporal intracerebral hemorrhage and a basal subarachnoid hemorrhage. Owing to obliteration of the M1 segment of the MCA, no aneurysm was visible on digital subtraction angiography. Because of otherwise typical imaging for a subarachnoid hemorrhage, surgical exploration of the MCA was performed. During surgery, a thrombosed MCA bifurcation aneurysm was identified, clipped, and subsequently, endovascular (partly) recanalization of the MCA was performed.ConclusionsIn extremely rare cases of aneurysm rupture and subsequent thrombosis of the associated vessel, a 2-stage approach seems to be feasible. In the present case, initial surgical securing of the aneurysm followed by endovascular recanalization of the occluded vessel provided good results.Copyright © 2019 Elsevier Inc. All rights reserved.

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