{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:39:42Z","timestamp":1770352782233,"version":"3.49.0"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"11","license":[{"start":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T00:00:00Z","timestamp":1710115200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>The authors report the case of a patient with occipital headache whose imaging studies revealed no abnormalities but who died 1 day later due to vertebral artery (VA) aneurysm rupture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A male in his 40s with no relevant medical history had been taking over-the-counter medication for headache several times a month. One day before he visited our neurosurgery department, he experienced occipital headache, took the usual medicine, and applied a warm compress. Brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) studies returned no abnormal findings, and he went home. On the following day, his wife found his lifeless body in rigor mortis and requested a medicolegal autopsy. Preautopsy brain computed tomography showed diffuse subarachnoid hemorrhage (SAH). Histopathologically, there was no obvious VA dissection. The vascular wall at the rupture site lacked internal elastic lamina and media, it was covered only with thin fibrous connective tissue, and the adventitia was expanded. The cause of death was determined to be SAH due to rupture of a VA blister aneurysm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>In our patient, brain MRI and MRA studies returned no abnormal findings. However, he died suddenly the next day. Autopsy identified SAH due to rupture of a blister-like VA aneurysm without dissection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23723","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T13:01:10Z","timestamp":1710162070000},"source":"Crossref","is-referenced-by-count":0,"title":["A vertebral artery aneurysm that elicited occipital pain, showed no abnormalities on imaging studies, but ruptured the next day: illustrative case"],"prefix":"10.3171","volume":"7","author":[{"given":"Masaaki","family":"Kawauchi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Chiba Shintoshi Rurban Clinic, Inzai, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyongsong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Chiba, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Go","family":"Inokuchi","sequence":"additional","affiliation":[{"name":"Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"J Neurosurg","first-page":"948","article-title":"Intracranial vertebral artery dissection resulting in fatal subarachnoid hemorrhage: clinical and histopathological investigations from a medicolegal perspective","volume":"110","author":"Ro A","year":"2009","unstructured":"Ro A, Kageyama N, Abe N, Takatsu A, Fukunaga T Intracranial vertebral artery dissection resulting in fatal subarachnoid hemorrhage: clinical and histopathological investigations from a medicolegal perspective. J Neurosurg. 2009;110(5):948\u2013954."},{"issue":"5","key":"b2","series-title":"AJNR Am J Neuroradiol","first-page":"856","article-title":"A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms","volume":"37","author":"Peschillo S","year":"2016","unstructured":"Peschillo S, Cannizzaro D, Caporlingua A, Missori P A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms. AJNR Am J Neuroradiol. 2016;37(5):856\u2013861."},{"key":"b3","series-title":"Acta Neurochir Suppl (Wien)","first-page":"51","article-title":"Nationwide surveillance of IC anterior (or dorsal) wall aneurysm: with special reference to its dissecting nature","volume":"103","author":"Satoh A","year":"2008","unstructured":"Satoh A, Sugiyama T, Hongo K, Kakizawa Y, Ishihara S, Matsutani M Nationwide surveillance of IC anterior (or dorsal) wall aneurysm: with special reference to its dissecting nature. Acta Neurochir Suppl (Wien). 2008;103:51\u201355."},{"issue":"3","key":"b4","series-title":"J Neurosurg","first-page":"303","article-title":"Aneurysms protruding from the dorsal wall of the internal carotid artery","volume":"65","author":"Nakagawa F","year":"1986","unstructured":"Nakagawa F, Kobayashi S, Takemae T, Sugita K Aneurysms protruding from the dorsal wall of the internal carotid artery. J Neurosurg. 1986;65(3):303\u2013308."},{"issue":"3","key":"b5","series-title":"World Neurosurg","first-page":"38","article-title":"Ruptured blister-like aneurysm arising from the proximal posterior cerebral artery","volume":"147","author":"Park S","year":"2021","unstructured":"Park S, Miyakoshi A, Yoshida S, Arai D, Kawanabe Y, Sato T Ruptured blister-like aneurysm arising from the proximal posterior cerebral artery. World Neurosurg. 2021;147(3):38\u201341."},{"issue":"2","key":"b6","series-title":"Neurosurgery","first-page":"253","article-title":"Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms","volume":"45","author":"Mizutani T","year":"1999","unstructured":"Mizutani T, Miki Y, Kojima H, Suzuki H Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery. 1999;45(2):253\u2013260."},{"issue":"4","key":"b7","series-title":"J Neurosurg","first-page":"1037","article-title":"Natural course of intracranial arterial dissections","volume":"114","author":"Mizutani T","year":"2011","unstructured":"Mizutani T Natural course of intracranial arterial dissections. J Neurosurg. 2011;114(4):1037\u20131044."},{"issue":"2","key":"b8","series-title":"J Stroke Cerebrovasc Dis","first-page":"486","article-title":"Fatal intracranial aneurysm and dissections causing subarachnoid hemorrhage: an epidemiological and pathological analysis of 607 legal autopsy cases","volume":"27","author":"Mori S","year":"2018","unstructured":"Mori S, Takahashi S, Hayakawa A, Saito K, Takada A, Fukunaga T Fatal intracranial aneurysm and dissections causing subarachnoid hemorrhage: an epidemiological and pathological analysis of 607 legal autopsy cases. J Stroke Cerebrovasc Dis. 2018;27(2):486\u2013493."},{"issue":"6","key":"b9","series-title":"Stroke","first-page":"1868","article-title":"Increased wall enhancement during follow-up as a predictor of subsequent aneurysmal growth","volume":"51","author":"Gariel F","year":"2020","unstructured":"Gariel F, Ben Hassen W, Boulouis G,  Increased wall enhancement during follow-up as a predictor of subsequent aneurysmal growth. Stroke. 2020;51(6):1868\u20131872."},{"issue":"10","key":"b10","series-title":"J Neurosurg","first-page":"1","article-title":"Circumferential wall enhancement in evolving intracranial aneurysms on magnetic resonance vessel wall imaging","volume":"131","author":"Omodaka S","year":"2018","unstructured":"Omodaka S, Endo H, Niizuma K,  Circumferential wall enhancement in evolving intracranial aneurysms on magnetic resonance vessel wall imaging. J Neurosurg. 2018;131(10):1\u20137."},{"issue":"1","key":"b11","series-title":"Neuropathology","first-page":"104","article-title":"Pathology of a dissecting intracranial aneurysm","volume":"20","author":"Sakata N","year":"2000","unstructured":"Sakata N, Takebayashi S, Kojima M, Masawa N, Suzuki K, Takatama M Pathology of a dissecting intracranial aneurysm. 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