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Methods: Case-report of a patient presenting with giant MCA serpentine aneurysm

Results: A 60-year female presented for evaluation of chronic daily headaches complicated by gait difficulty, left hand weakness and cognitive slowing. Initial examination showed cognitive impairment, left face and arm weakness and bilateral extensor plantar response. A non-contrast CT head showed a heterogeneously calcified 5 x 5.3 x 5 cm right frontotemporal mass lesion with mid-line shift. MRI brain gradient-echo sequence showed laminated hemosiderin deposition inside the thrombus, postcontrast peripheral enhancement and mass effect. Immediately after the admission, her rapidly deteriorating neurological status prompted urgent intervention. Cerebral angiogram showed a 12-cm long right MCA giant serpentine dissecting aneurysm. Surgical bypass or clipping were deemed technically inaccessible because of the …