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Unruptured cerebral aneurysms presenting as recurrent transient neurologic deficits

Departments of Neurology (Drs. Stewart and Hinton), Radiology (Dr. Diehl), and Surgery-Neurosurgery tDrs. Samson and Ditmore), Southwestern Medical School, University of Texas Health Science Center at Dallas.

Recurrent transient neurologic deficits were evaluated clinically in four patients. In three patients, the symptoms included recurrent transient homonymous hemianopia, episodic weakness and numbness of the left arm and leg, and recurrent sudden loss of speech and of strength in the right arm. In these three patients, the episodes were first thought to be transient ischemic attacks (TIAS). A fourth patient had repeated confusional spells, in which a recurrent musical theme excluded other thoughts. This was associated with dizziness and difficulty in naming. A partial complex seizure was thought responsible. In each of the cases the symptoms lasted less than 30 minutes and were not associated with loss of consciousness, headache, or stiff neck. Electroencephalogram (EEG), brain scan, lumbar puncture, and computed tomography (CT) scan were normal. In all patients, cerebral arteriography unexpectedly revealed an unruptured cerebral aneurysm. The locations of the aneurysms were appropriate to the symptoms, which remitted in the three patients treated surgically for the aneurysm. Although the pathophysiology is uncertain, an ischemic process may be implicated.

Address correspondence and reprint requests to Dr. Stewart, Department of Neurology, Southwestern Medical School, University of Texas Health Science Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75235.

Accepted for publication June 11, 1979.

Presented in part at the thirty-first annual meeting of the American Academy of Neurology, Chicago, April 1979.

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