Aneurysms of the large basilar artery (BA) occasionally cause
cranial nerve palsy and motor disorder through mass effect. Since 1967, five cases of
cerebral aneurysm leading to
parkinsonism have been reported. Herein, we describe a rare case of progressive
parkinsonism caused by the recurrence of a large
aneurysm of the basilar tip after
stent-assisted coil embolization. A 66-year-old man visited our hospital with an asymptomatic large
aneurysm (maximum diameter, 21 mm) of the BA tip. Magnetic resonance imaging (MRI) revealed no perianeurysmal
edema. Coil embolization with a Y-configuration
stent with cross-placement was performed. Although
thrombus formation occurred and the perforator
infarction was complicated, complete occlusion was achieved. Three months later, the patient developed progressive and severe
parkinsonism. MRI revealed mild enlargement of the
aneurysm and perianeurysmal mesencephalic
edema with minor neck recurrence. A trial administration of
levodopa and additional
stent-assisted coil embolization were performed.
Levodopa dramatically improved
parkinsonism; thus, the patient's symptoms were controlled by a continuous
levodopa regimen. In a large BA-tip
aneurysm patient, moderate regrowth and minor neck recurrence occurred after initial treatment, and chronic compression of the midbrain caused
secondary parkinsonism. In such cases, it is important to consider
levodopa administration and therapeutic strategies to prevent recurrence or regrowth.