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Case 3

Berry aneurysm

A 33 year old female with galactorrhoea

This 33 year old female with galactorrhoea and a slightly raised prolactin level was referred for MRI to exclude a pituitary adenoma.

She had a history of chronic renal failure for several years and was on long term haemodialysis. She gave a history of collapse and unconsciousness three years ago, which was investigated but no treatment was given.

Findings

The pituitary gland appears normal. There is no evidence of an adenoma. In the region of the terminal part of the right internal carotid artery there is an area of focal dilatation which is compressing the optic nerve and chiasm on that side.

An MR angiogram (MRA) sequence demonstrates a focal high signal lesion arising from the origin of the right anterior cerebral artery (white arrow).

Diagnosis

Berry aneurysm of terminal internal carotid artery. Normal pituitary.

Discussion

The patient's history was reviewed on discovering this abnormality. The previous episode of collapse was due to a subarachnoid haemorrhage (SAH), documented on CT and lumbar puncture. However a four vessel angiogram at the time did not demonstrate an aneurysm and no further treatment was given. The angiogram was therefore reviewed and even with hindsight the aneurysm was not visible.

Polycystic kidney disease is associated with an increased incidence of Berry aneurysms. However this patient's renal failure was due to glomerulonephritis!

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