[A case of duplication of the middle cerebral artery with ruptured aneurysm on its origin during pregnancy (author's transl)].

A rare case of duplication of the middle cerebral artery with a ruptured aneurysm on its origin during pregnancy was reported. A 29-year-old woman, primipara, was admitted to our clinic at 17 weeks' gestation on June 26, 1979 with a history of sudden onset of severe headache and vomiting, followed by unconsciousness fit for 30 minutes. The patient displayed typical features of subarachnoid hemorrhage. Lumbar puncture revealed bloody CSF. Right carotid angiogram 20 days after admission demonstrated duplication of the middle cerebral artery arising from the terminal internal carotid artery and a small aneurysm at its origin. There was evidence of associated spasm in the internal carotid artery, M1 and A1 portion without hematoma. The patient was treated conservatively for 2 months and then aneurysm surgery was performed. At operation, under the hypotensive anesthesia, on August 21, 1979, the presence of duplication of the middle cerebral artery on the right side and ruptured aneurysm on its origin were confirmed. The neck of aneurysm was completely clipped. Fetal heart rates were monitored by Doptone monitor during the operation. Postoperative course was excellent. Three months postoperatively, the patient went into spontaneous labor, at 40 week's gestation, and delivered a healthy infant. Clinical management of subarachnoid hemorrhage in pregnancy and the relationship between anomaly of the middle cerebral artery and aneurysm were discussed with the literature.