Mirror aneurysm: With video.

A 57 year old female presented with acute onset headache started from 1 month before the current visit. The headache was located on the left frontotemporal area and had increased during the month. On brain CT scan, there were bilateral round hyperdense lesions in the sylvian fissure which were flow void on brain MRI indicating aneurysms.

Brain DSA (digital subtraction angiography) was performed. The videos of angiographies before and after coiling are shown here.

Movie 1: Brain digital subtraction angiography (DSA) demonstrating a small aneurysm in right middle cerebral artery bifurcation

Movie 2: Brain digital subtraction angiography (DSA) demonstrating a larger aneurysm in left middle cerebral artery bifurcation

Movie 3: Brain digital subtraction angiography (DSA) demonstrating the obliterated aneurysm after coiling, indicating that the aneurysm has been removed from brain circulation

Discussion

‘Mirror-like’ or ‘twin’ aneurysms comprise just fewer than 5% of overall aneurysms; they are placed bilaterally on analogous arteries.[1] Such aneurysms are extremely rare and have been described in some previous case reports.[1-6] In a study by Meissner et al., of the 3120 patients with aneurysms, around 12% had mirror aneurysms, which were more common in women and in patients with a family history of aneurysm or subarachnoid hemorrhage (SAH).[6]

It is of significant importance that in the case of mirror aneurysms, the treatment approach seems to not differ from other forms of multiple aneurysms.