Thalamic hemorrhage due to ruptured aneurysm at the feeder of a tentorial dural arteriovenous fistula in the Galen region mimicking a hypertensive hemorrhage

Introduction

Thalamic hemorrhage caused by cerebrovascular disease is unusual. We describe a rare case of thalamic hemorrhage due to rupture of an aneurysm at the feeder of a tentorial dural arteriovenous fistula in the Galen region mimicking a hypertensive hemorrhage.

Case presentation

A 78-year-old woman with sudden-onset right hemiparesis was diagnosed with left thalamic hemorrhage. Cerebral angiography revealed hemorrhage caused by rupture of an aneurysm at the feeder artery of a dural arteriovenous fistula at tentorial edge near the vein of Galen. The aneurysm was located at the distal site of a long circumflex branch from the left posterior cerebral artery. Trans-arterial embolization of the aneurysm was performed using N-butyl cyanoacrylate. The procedure was successful and the patient experienced no complications or re-bleeding.

Conclusions

Dural arteriovenous fistula sometimes shows aneurysm at a feeder artery. We need to consider the possibility of vascular diseases involvement even if parenchymal hemorrhage appears to be typical hypertensive case.