European Journal of Cardiovascular Medicine

Background: The perforating artery aneurysm arising from stem of perforating artery away from parent artery should be considered separate entity from those arising from parent artery in the adjacent to their origin or incorporating their origin.  Case report: A 34 years old, right-handed gentleman, presented to with multiple episodes of right sided facial and extremity tingling numbness and minimal weakness of extremities, episodes lasted for few minutes to maximum of 30 minutes. On examination there was no neuro deficit with all other vital parameters within normal limits. CT scan & MRI examination showed perimesencephalic cisren and suprasellar cistern SAH. Digital Substraction Angiography showed Aneurysm on the basilar top perforator. Very tiny perforator artery arising from basilar top is harbouring the aneurysm distally. It was decided to conserve this patient. Patient fully recovered over a period of 2 weeks. Repeat angiogram after 6 weeks showed complete resolution of the aneurysm. Conclusion: A conservative approach may be considered for selected cases where potential atherosclerosis is not present and where consecutive imaging shows a decrease in size and flow of the aneurysm. The surgical approach can be considered the next best mode of management Conservative observation for certain cases with periodic angiography follow-up was considered in order to prevent the patients from potential iatrogenic effects.