Asymptomatic cerebral aneurysm in stroke patients eligible for intravenous thrombolytic therapy.

PURPOSE: To report two cases of acute ischemic stroke with anterior communicating artery aneurysm presented to emergency room within 3 hours after onset, and to review the literature. CASE REPORT: Two cases of previously unreported anterior communicating artery aneurysm were candidates for intravenous thrombolysis for their acute stroke. Recombinant tissue plasminogen activator was eventually withdrawn by other reasons. The aneurysms presented as nodular lesions with slightly increased density just above sellae turcica on non-contrasted computed tomography and were later diagnosed by magnetic resonance angiography. CONCLUSION: Asymptomatic cerebral aneurysm could be undiagnosed by non-contrasted computed tomography.Careful reading at selected regions can reduce pitfalls. Computed tomographic angiography and magnetic resonance angiography are alternative screening tools for thrombolysis if available in ER.The composite effect of r-tPA on cerebral aneurysms is still uncertain. A more inclusive definition of cerebral aneurysms and miscellaneous vascular anomalies in current criteria of thrombolysis is recommended.