C39 A nightmare on basilar street: the challenge of multiple intracranial dysplastic aneurysms

<h3>Introduction</h3> Multiple intracranial unruptured aneurysms pose a therapeutic challenge, particularly when dysplastic, partially thrombosed or on the vertebrobasilar system, due to its dismal prognosis and potentially life-threatening rupture risk. <h3>Case Description</h3> We report the case of a 67-year-old female with sudden-onset diplopia, dysarthria and left hemiataxia. Brain-CT/CTA revealed an acute infarction of the left cerebellar hemisphere and a large irregular partially-thrombosed aneurysm of the basilar artery, and smaller intracranial aneurysms. The partially thrombosed aneurysm compressed the left cerebral crus and the left SCA. DSA identified nine other intracranial aneurysms in the anterior and posterior circulations. The partially thrombosed aneurysm was treated with a stent extending from the left P1-P2 transition across the basilar trunk. On a second session, three saccular aneurysms of the right internal carotid artery were treated with a flow-diverter. The patient was discharged clinically improved. Two days after discharge, the patient was admitted with severe headache, cervicalgia and clinical worsening. CT revealed severe acute SAH. Emergent DSA failed to show active rupture signs of the aneurysms. The patient died soon after. <h3>Conclusions</h3> This case emphasizes the challenging management of multiple dysplastic intracranial aneurysms and the obscure natural history and dismal prognosis of vertebrobasilar aneurysms. <h3>Conflict of Interest</h3> No