A 64-year-old Syrian man with rare Circle of Willis variants involving the posterior communicating artery and posterior cerebral artery presented with multiple intracranial aneurysms and subarachnoid hemorrhage, treated successfully with stent-assisted coil embolization and discharged after 18 days.
Key Findings
Background
A patient with rare Circle of Willis variants involving the posterior communicating artery and posterior cerebral artery developed multiple intracranial aneurysms and subarachnoid hemorrhage.
The patient was a 64-year-old man with a history of hypertension and psoriatic arthritis.
He presented with sudden severe headache and walking difficulties without loss of consciousness.
CT angiography demonstrated multiple intracranial aneurysms alongside the Circle of Willis variants.
The variants involved both the posterior communicating artery and posterior cerebral artery.
Results
The Circle of Willis variants identified in this case may have contributed to aneurysm formation.
Variants of the posterior communicating artery and posterior cerebral artery were identified on CT angiography.
The authors note that 'the prevalence of aneurysm formation increases in the presence of Circle of Willis variants.'
Multiple aneurysms were present, suggesting a possible relationship between these specific variants and aneurysm multiplicity.
The authors call for further studies exploring the relationship between variant type and the number and size of cerebral aneurysms.
Results
The patient was successfully treated with oral Nimodipine and stent-assisted coil embolization of the ruptured aneurysm.
Oral Nimodipine was administered to prevent cerebral vasospasm.
Stent-assisted coil embolization was performed on the ruptured aneurysm.
The patient's symptoms and clinical condition improved a few days after embolization.
The patient was discharged after 18 days of hospitalization.
Conclusions
This case is reported to be the first documented case report from Syria, and possibly the first ever, detailing such Circle of Willis variants associated with cerebral aneurysms.
The authors describe it as 'the first documented case report from Syria, and possibly the first ever, detailing such Circle of Willis variants associated with cerebral aneurysms.'
Subarachnoid hemorrhage from ruptured intracranial aneurysm is characterized as 'a type of stroke with high rates of mortality and disability.'
The case underscores the need for further epidemiological studies on the relationship between Circle of Willis variants and cerebral aneurysm characteristics.
What This Means
This research describes a single patient case involving a 64-year-old man in Syria who experienced a sudden severe headache and difficulty walking. Brain imaging revealed that he had bleeding around his brain (subarachnoid hemorrhage) caused by a burst blood vessel aneurysm, and that he also had multiple other aneurysms. Importantly, he had unusual variations in the structure of a critical ring of blood vessels at the base of the brain called the Circle of Willis — specifically involving two arteries at the back of the brain. The doctors suggest these structural variations may have contributed to the development of multiple aneurysms.
The patient was treated with a medication called Nimodipine to reduce the risk of dangerous blood vessel spasms, and the burst aneurysm was sealed using a minimally invasive procedure called stent-assisted coil embolization, where a small mesh tube and coils are inserted to block blood flow into the aneurysm. His condition improved within days, and he was discharged from the hospital after 18 days.
This research suggests that certain rare variations in the Circle of Willis may be linked to the formation of multiple brain aneurysms, which is important for understanding why some people develop these dangerous blood vessel abnormalities. The authors highlight that this appears to be the first reported case of this specific combination of Circle of Willis variants and multiple aneurysms from Syria, and call for larger studies to better understand how different structural variations in brain blood vessels relate to aneurysm risk, size, and number.
Mosi M, Alfarra H, Soliman N, Alshaar M, Alshaar M, Hamzeh G. (2026). Rare circle of Willis variants associated with multiple intracranial aneurysms and subarachnoid hemorrhage: A case report.. Medicine. https://doi.org/10.1097/MD.0000000000050402