Clipping of an Unruptured Intracranial Aneurysm – A Case Rep
A 69-year-old woman developed a sudden drooping on the left side of the face while having dinner with her family. Her daughter noticed slurred speech and alerted emergency medical services immediately.

Her home medication consisted of pantoprazole only. Upon admission to the emergency room, the patient was alert but slightly confused. Further neurological examination revealed a left-sided hemiparesis and motor speech disorder. The remaining cranial nerves were unaffected. No sensory or coordinative dysfunctions were detected. Shaved hair over the right temple exposed a well-healing, 10-cm-long recent wound. The patient reported having had brain surgery two weeks earlier, but upon further questioning denied a preceding trauma, infection, tumor disease, or cerebral bleeding.

The aneurysm of the right middle cerebral artery was found incidentally via magnetic resonance imaging ordered after the patient complained of a short period of slight gait disturbances. To avoid a subarachnoid hemorrhage and consecutive complications like vasospasms, the patient elected microsurgical treatment. Clipping was managed by keyhole approach. A craniotomy 30 mm in diameter was performed over the right Sylvian fissure. The aneurysm was dissected after securing proximal control of the distal M1 segment of the right MCA.

Treatment with nimodipine was continued for an additional two weeks. Within this time the symptoms disappeared completely. The patient made a full recovery, which is remarkable in such a major stroke. After 11 days the woman was discharged with no symptoms.

Points to Remember:-
1. It is not commonly known that cerebral vasospasm may occur after surgical clipping of a UIA. Here presented is the case of a patient developing DCI due to vasospasm after an uneventful surgical occlusion of an unruptured MCA aneurysm.
2. This patient with a surgically treated UIA developed vasospasm in the absence of an SAH. It is crucial to discern that the absence of a subarachnoid hemorrhage in patients with UIA does not preclude the presence of cerebral vasospasms.

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Dr. Y●●●●●●t G●●●●●i Anaesthesiology
It' s a game of subconscious mind which modern medicine and the doctors who are too much impregnated by the belief system of the modern medicine and preachings of the pharna mafia of USA and not ready or open to accept the better possibilities from alternative medicines and cannot understand such things beyond the understanding of the modern medicine and then they quote such happenings which are beyond their limited understanding of limited mind , as unusual or idiopathic or something else!!!... Read more
Sep 26, 2019Like