Clipping of a ruptured cerebral aneurysm in a toddler: a case report and review of aneurysmal treatment in children.

Background: Pediatric intracranial aneurysms account for 5% of all aneurysms and less than 10% of all aneurysms cause non-traumatic intracranial hemorrhage in children. They are most commonly secondary to trauma, infection, or genetic etiologies; however, case reports have described iatrogenic intracranial aneurysms. We describe a case of a ruptured aneurysm with an associated intracranial hematoma that was treated by surgical clipping and clot evacuation.

Case description: The patient was a 15-month-old boy without a history of trauma or infection, who developed acute-onset nausea and subsequent neurological deterioration and status epilepticus. Imaging demonstrated a 13-mm saccular anterior cerebral artery aneurysm with accompanying large left frontal intraparenchymal hematoma and intraventricular hemorrhage. He was treated with urgent craniotomy for surgical clipping and clot evacuation. An external ventricular drain was placed to treat the hydrocephalus. The patient subsequently received a ventriculoperitoneal shunt with rehabilitation disposition. There was a family history of intracranial aneurysms and cavernous malformations; however, genetic testing was negative. One year later, he is developing his speech and has ambulated independently.

Conclusions: We highlight the importance of expeditious care in toddlers with rapidly deteriorating neurological examination results and associated intracranial findings. We demonstrate the rarity of intracranial aneurysms in a toddler and the need for further study on this topic, as there is no clear etiology for this finding in this patient.