To present a case of a ruptured distal anterior cerebral artery aneurysm in a patient with Neurofibromatosis type 1 (NF1) and to review existing literature on similar cases.
Approach:
Case Description: A 44-year-old man with NF1 presented with sudden headache, dizziness, and transient syncope. Imaging revealed a ruptured saccular aneurysm in the right A3 segment of the ACA, leading to intraventricular hemorrhage and moyamoya-like vasculopathy.
Treatment Method: Endovascular coil embolization was performed successfully, achieving complete aneurysm occlusion while preserving the parent artery.
Follow-Up: Long-term follow-up showed durable occlusion of the aneurysm but progression of moyamoya syndrome and a new untreated aneurysm.
Key Findings:
Endovascular coil embolization is a safe and effective first-line treatment for ruptured distal ACA aneurysms in NF1 patients.
Successful treatment of one aneurysm does not eliminate the risk of new cerebrovascular lesions in NF1.
Interpretation:
The case highlights the complexity of managing NF1-related cerebrovascular conditions and the necessity for ongoing vascular surveillance.
Limitations:
The rarity of similar cases limits the generalizability of findings.
Long-term outcomes and management strategies for new lesions remain under-researched.
Conclusion:
Indefinite vascular surveillance is warranted in NF1 patients due to the progressive nature of cerebrovascular disease.
