The sequential rupture of two cerebral aneurysms

The treatment of patients with multiple cerebral aneurysms in the acute period of subarachnoid hemorrhage may be associated with strategy difficulties, since it is not always obvious which of the aneurysms is responsible for intracranial hemorrhage. This aspect is of paramount importance, since it is the ruptured aneurysm should be first treated. The combination treatment of all multiple aneurysms during one surgical intervention using all possible facilities (microsurgery, endovascular surgey or hybrid technologies) is the ideal. However, in the acute period of hemorrhage, this is not always possible. Currently, the criteria for revealing the ruptured aneurysms among the multiple ones are well known and they are helpful in the most cases. However the sequential rupture of two aneurysms is described in few papers, and it must be taken into account, even with a low probability. There are no more than a dozen such cases described in the literature. This article demonstrates a clinical case of a 58 year old woman with subarachnoid-parenchymal hemorrhage, in whom, according to brain computed tomography and intraoperative situation, it is highly likely that two cerebral aneurysms rupture can be assumed.