Multiple fusiform aneurysms of the distal middle cerebral artery showing different radiological courses: A case report

Middle cerebral artery (MCA) fusiform aneurysms may occur in the proximal MCA, and distal MCA fusiform aneurysms are rare. Here we present a rare case of subarachnoid hemorrhage (SAH) with multiple fusiform aneurysms in the M3 portion, which showed different morphological changes. A 43-year-old left-handed man with sudden aphasia and left-side hemiparesis had SAH with intraparenchymal hemorrhage in the right parietal lobe. Digital subtraction angiography (DSA) revealed multiple fusiform aneurysms in the M3 portion. Repeat DSA performed on day 29 demonstrated morphological changes in one fusiform aneurysm. We performed aneurysm trapping, and pathological examination indicated a dissecting aneurysm. Three-dimensional computed tomography angiography performed 4 months after onset revealed a decrease in other fusiform aneurysmal dilatations. This case showed two different clinical courses of fusiform aneurysms (regrowth and reduction). Frequent and close radiological examinations are necessary for ruptured multiple fusiform aneurysms.