Abstract 305: Infantile Intraparenchymal Hemorrhage Due to Ruptured Acom Aneurysm Treated with Stent‐Coil Embolization: Clinical Course and Management

A 5.5‐month‐old infant presented with an episode of acute agitation, characterized by crying, refusal to feed, and a focal seizure involving the left arm and leg lasting 1‐2 minutes. Following the seizure, the infant fell asleep but experienced another brief seizure during transport to the hospital. Initial assessment at a private hospital in Mersin, Turkey, led to a referral to our center, where imaging revealed an intraparenchymal hemorrhage in the left frontobasal region. The hemorrhage extended into all ventricles and the right retrosellar area, with notable rightward shift and ventricular enlargement. CTA confirmed a ruptured Acom aneurysm with a bleb. An endovascular approach with minimally invasive hematoma evacuation was planned initially. The patient underwent preoperative preparation with clopidogrel and ASA, and received stent‐coil embolization for the anterior communicating artery aneurysm. Postoperative imaging confirmed no significant change in the hemorrhage, and hematoma evacuation was deferred. The patient's sedation was gradually reduced, and extubation was successful. Follow‐up MR imaging indicated hematoma resorption, and no new bleeding occurred. The patient gradually transitioned to oral feeding and began physical therapy. Recovery was monitored with routine neurological assessments, and a physical therapy program was initiated to support rehabilitation. At the 1‐year follow‐up, left‐sided weakness had improved, with moderate muscle tightness noted. Follow‐up MRA demonstrated no residual filling in the Acom aneurysm, and the patient continued with only ASA therapy after six months.