Occult aneurysmal hemorrhage in a child. Case report and literature review.

A unique case of the diagnosis and treatment of a ruptured cerebral aneurysm in a 5-year-old male is presented. The child presented with subarachnoid hemorrhage, and initial CT imaging indicated a right posterior communicating artery aneurysm. Cerebral angiography and MRI/MRA were normal. Repeat cerebral angiogram 3 weeks later was also normal. Sixteen months later, an angiogram was performed to evaluate a subtle carotid bruit found on exam. A carotid bifurcation aneurysm pointing inferior and posterior was found. Craniotomy to clip the aneurysm was performed, and marked adherent gliosis around the lesion was found, supporting the fact that this was the causal lesion of his bleed in the past. Albeit a single case report, it underscores the need for very long-term follow-up and evaluation of idiopathic pediatric subarachnoid hemorrhage.