• Raper Daniel M S DMS Department of Neurological Surgery, University of California, San Francisco, California, USA., W Caleb Rutledge, Ethan Winkler, and Adib A Abla.
• Department of Neurological Surgery, University of California, San Francisco, California, USA.
• World Neurosurg. 2020 Feb 1; 134: 141-144.

BackgroundSubarachnoid hemorrhage resulting from spontaneous perforation of a small intracranial vessel, with resultant pseudoaneurysm formation, has not been widely reported in the literature.Case DescriptionWe present the case of a 71-year-old patient with rupture of a small aneurysm of a duplicated left anterior choroidal artery causing an acute third nerve palsy. The aneurysm was not able to be treated endovascularly without sacrifice of the parent vessel. At surgery, a pseudoaneurysm was seen completely separate from the parent vessel, which was actively bleeding through a hole in the vessel. The pseudoaneurysm was indenting the oculomotor nerve. After confirmation of adequate collateral flow, the abnormal segment of vessel was trapped and the pseudoaneurysm removed with surrounding clot. The patient's cranial nerve palsy resolved.ConclusionsThis case illustrates an unusual sequela of subarachnoid hemorrhage presenting a unique challenge in surgical management.Copyright © 2019 Elsevier Inc. All rights reserved.

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