Risk factors and treatment approach for subarachnoid hemorrhage in a patient with nine intracranial aneurysms

Introduction In about one-third of the patients with aneurysmal subarachnoid bleeding, multiple intracranial aneurysms are confirmed. Risk factors such as female sex, smoking, hypertension, and age over 60 tend to be associated with multiple aneurysms. In this paper, we also discuss family predisposition and the treatment approach for multiple cerebral aneurysms. Case outline Here, we present a case of a 64-year-old female patient, with spontaneous subarachnoid hemorrhage that had nine intracranial aneurysms. The patient was treated for hypertension for a long time, excessive smoker, and two of her nearest members of the family died from intracranial bleeding. The patient was fully conscious, without any neurological impairment. Subarachnoid bleeding was diffuse and neither brain-computer tomography finding or digital subtraction angiography could not suggest the source or location of bleeding among nine presented aneurisms. Magnetic resonance imaging had to be done, and the T1W fast spin-echo sequence showed a 9 mm large ruptured an aneurysm at the basilar tip, after contrast application, beside others. Three days after the insult, endovascular embolization was done and two basilar aneurysms were excluded from the circulation, including the one that bled. Conclusion The patient had the majority of risk factors for multiple intracranial aneurysms. Knowledge of the family predisposition of multiple intracranial aneurysms allowed us to make a proper diagnostics of a patient's descendant and reveal a new patient.