The patient is a 47-year-old man.

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Presentation transcript:

The patient is a 47-year-old man. The patient is a 47-year-old man. He presented in his 20s with 2 large fusiform aneurysms of his cavernous carotid arteries. He later developed an aneurysm of his basilar artery and had a subarachnoid hemorrhage from a dissecting aneurysm of his PICA (not shown). A, CTA image demonstrates a large fusiform aneurysm of the right cavernous carotid artery (long white arrow) and a thrombosed/calcified aneurysm of the left cavernous carotid artery (short white arrows). There is also an aneurysm of the basilar tip (curved black arrow). B, Right ICA cerebral angiogram shows a large fusiform aneurysm of the right petrocavernous carotid artery (straight black arrows) and a basilar tip aneurysm (curved black arrow). C, There was suspicion for underlying connective tissue disease. The patient underwent a skin biopsy. Electron microscopy of the skin biopsy shows multiple abnormally enlarged collagen fibers (black circles) consistent with collagen flowers. These are typically seen in Ehlers-Danlos syndrome. The patient later underwent genetic testing for Loeys-Dietz, Ehlers-Danlos, and Marfan syndromes. The findings of all tests were negative. W. Brinjikji et al. AJNR Am J Neuroradiol 2017;38:915-922 ©2017 by American Society of Neuroradiology