Report of two cases of a rare cause of subarachnoid hemorrhage including unusual presentation and an emerging and effective treatment option

Purpose: To report two cases of a rare cause of subarachnoid hemorrhage (SAH), including unusual presentation and an emerging and effective treatment option. Case reports: Ruptured basilar perforator artery aneurysm is a rare cause of SAH. Catheter angiography in the immediate post hemorrhage period may be unrevealing. We report two cases of ruptured basilar pontine perforator aneurysms. In one of these cases the perforator aneurysm was not apparent on the initial or the 1 week follow-up angiograms. Both patients returned for follow-up angiography 2 months later by which time aneurysmal filling and conspicuity had increased. Both patients were treated solely with two overlapping Neuroform stents. Follow-up angiograms demonstrated complete resolution of the aneurysms in both patients. Conclusions: Rupture of aneurysms arising from basilar artery perforators is a rare cause of SAH and attention to this area should be part of an interventionist's search pattern. Aneurysms in this area may not be apparent in the immediate post rupture setting and delayed post hemorrhage angiography has a role in detecting this entity. Stent monotherapy may be effective in treating these lesions.