Giant ICA Aneurysm in Pregnancy: A Case Report

Date

2019-03-05

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Hoang, Christine
Naik, Divya

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Background: Giant internal carotid artery (ICA) aneurysm in pregnancy is rare, especially without a history of trauma. There are many risk factors for the development of intracranial aneurysms, including hypertension, smoking, carotid artery stenosis, and hypercholesterolemia. 85% of saccular aneurysms arise from the arteries of the circle of Willis, with the ICA accounting for 30%. Aneurysms are hard to diagnose while asymptomatic and become challenging to manage during pregnancy, especially when a patient is late in the third trimester. Case Information: A 22-year-old G2P0010 female in the third trimester presented to the ED complaining of headache secondary to left orbital socket infection onset. The patient was initially diagnosed at 31 weeks with an eye infection but saw no improvement with antibiotics. Upon return to the ED at 36 weeks, physical exam revealed left eye exophthalmos, dysconjugate gaze, and blurred vision. She had no history of trauma, past cardiac events, or complications with the current pregnancy. Her risk factors included developing HTN during the third trimester as well as obesity with a BMI of 40.34. In addition, the patient reported occasional smoking. Imaging was ordered, and patient was admitted to the hospital after MRI without contrast revealed a giant left paraophthalmic ICA aneurysm measuring 2.6 cm. Neurosurgery recommended delivery before pursuing treatment, and after MFM consult, antenatal steroids were administered. At 36 weeks, 3 days intrauterine pregnancy, a primary low transverse Cesarean section was performed with no complications. 9 days after delivery, neurosurgery performed a successful pipeline embolization of the aneurysm. 8 months following the surgery patient had an MRA w/wo contrast completed that showed no evidence for residual aneurysm. Conclusions: It is rare for giant ICA aneurysm to occur during pregnancy without a history of trauma. Upon review of the literature, this case was found to be unique in that there were less than a handful of cases with ICA aneurysm presenting during the third trimester, with most cases presenting post-partum. Although the patient was pre-term, maternal risks with delaying delivery did not outweigh potential benefit to the infant, with management notable in pursuing antenatal steroids before delivery. A main takeaway from this case was the importance of maintaining a multidisciplinary approach in developing the best treatment plan.

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