European Journal of Radiology 81 (2012) 1388–1389

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European Journal of Radiology
journal homepage: www.elsevier.com/locate/ejrad

Letter to the Editor
Co-existence of bilateral fetal type posterior cerebral artery and
the bilateral giant internal carotid artery aneurysms in an ataxic
patient
Dear Editor,
We encountered a very unusual case of bilateral unruptured
giant internal carotid artery aneurysms in a patient with hypoplastic vertebrobasilar system. Fifty-five year old man admitted to
our outpatient clinic with the complaints of dizziness and imbalance. The neurological exam was unremarkable except mild truncal
ataxia. Computed tomography (CT) and CT angiography (CTA)
revealed two giant aneurysms; the right-sided one was a saccular
internal carotid artery (ICA) aneurysm (45 mm × 35 mm × 33 mm
in size) extending to the posterior communicating artery and
the left-sided one was a fusiform supraclinoid ICA aneurysm
(26 mm × 16 mm × 15 mm in size) (Fig. 1A–C). Additionally, both

vertebral arteries were seriously hypoplastic and the basilar artery
was atrophic in the mid portion with its thin portion distally. It was
noted that there is a bilateral (so called fetal) origin of the posterior
cerebral artery from the ICA with hypoplasia of the vertebrobasilar
system. Upon these findings in CTA, we planned digital subtraction
angiography; however patient did not give written consent after
being informed about the procedure. Patient was discharged off
the hospital even though he was informed regarding the potentially
life threatening unruptured aneurysms. The symptomatology of the
patient was unlikely related to the direct compressive effects of the
aneurysms, instead; insufficient blood supply to cerebellum due
to the hypoplastic vertebrobasilar system seemed as the cause of
truncal ataxia. In the relevant literature, we did not encounter such
concomitant occurrence of bilateral giant aneurysms and bilateral fetal type posterior cerebral artery in a patient complaining
of ataxia. In conclusion, even though it is arguable, giant bilat-

Fig. 1. CT Angiography: Axial (A), Coronal (B) and 3D-reconstructed (C) images show bilateral internal carotid artery aneurysms and fetal type posterior cerebral artery.
0720-048X/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ejrad.2011.03.087

Letter to the Editor / European Journal of Radiology 81 (2012) 1388–1389

eral ICA aneurysms may have negative hemodynamic influence on
the vaguely established compensatory perfusion mechanism from
anterior to posterior circulation in the setting of hypoplastic vertebrobasilar system.
Konuralp Ilbay
Department of Neurosurgery, Kocaeli University,
Kocaeli, Turkey
Ozgur Ismailoglu
Baki S. Albayrak ∗

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Department of Neurosurgery, Suleyman Demirel
University, Cunur-Isparta 32260, Turkey
∗ Corresponding author. Tel.: +90 532 308 9772;

fax: +90 246 211 2450.
E-mail address: serdarbaki@gmail.com
(B.S. Albayrak)
25 March 2011
28 March 2011