Multiple cerebral fusiform aneurysms involving the posterior and anterior circulation including the anterior cerebral artery: a case report

Multiple fusiform aneurysms occurring in a single patient are very uncommon. Fusiform aneurysms affecting the anterior circulation are extremely rare and reported cases involve the middle cerebral artery and internal carotid artery. We report here a case of a 55-year-old African American male who had a history of multiple strokes and who was found unresponsive prior to his latest hospital admission. Neuroimaging was remarkable for multiple fusiform aneurysms involving segments of the anterior, middle and posterior cerebral arteries as well as subarachnoid and intraparenchymal hemorrhage. Unfortunately even after aggressive medical management, the patient did not show any signs of recovery and further management entailed comfort care measures only. The patient passed away shortly thereafter. Post-mortem examination confirmed the presence of multiple fusiform aneurysms with involvement of both the posterior and anterior circulation including the anterior cerebral artery as well as subarachnoid and intraparenchymal hemorrhage. Interestingly, there was no apparent site of aneurysm rupture identified to explain the hemorrhage. Our case is unusual in that the multiple fusiform aneurysms were found to extensively involve both the anterior and posterior circulation. Furthermore, our case demonstrates involvement of the anterior cerebral artery by fusiform aneurysms, which is also a very rare event.