"Double Trouble": Ultra-Early Formation and Rupture of a De Novo Terminal Basilar Artery Aneurysm After Aneurysmal Subarachnoid Hemorrhage.

INTRODUCTION

The formation of de novo intracranial aneurysms (DNIAs) often occurs months or years after the initial identification of an intracranial aneurysm. Consensus on surveillance after surgery remains elusive.

CASE PRESENTATION: A 53-year-old woman presented with a recurrent subarachnoid hemorrhage (SAH) caused by a rapidly expanding de novo basilar tip aneurysm, which developed and ruptured within 6 days of a previous SAH due to the rupture of a posterior communicating artery aneurysm. Both SAH incidents were successfully treated with microsurgical clipping. A computed tomography angiography at a 1-year follow-up did not detect any DNIAs.

CONCLUSION

DNIAs can form within days after primary surgery. Therefore, conducting early postoperative angiography is crucial to detect and manage DNIAs and prevent SAH, especially in high-risk cases. In addition, since DNIAs are more prone to rupture, early clinical intervention is recommended.