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Pulseless disease associated with a ruptured intracranial vertebral aneurysm.

A case is presented of a 55-year-old man with pulseless disease, associated with an intracranial aneurysm located at the right vertebral-posterior inferior cerebellar artery, which ruptured to cause an episode of subarachnoid hemorrhage. Surgical treatment for the ruptured saccular aneurysm was carried out via the right suboccipital approach and the aneurysmal neck was clipped. On the second postoperative day, he suffered an attack of myocardial ischemia. Thereafter, the postoperative course was uneventful except for transient hoarseness and dysphagia. It is unknown whether the aneurysm and pulseless disease occurred independently or whether the aneurysm developed secondarily from the altered hemodynamic flow produced by the pulseless disease; however, it can be presumed that abnormal intracranial hemodynamic forces did play some role in the development of the aneurysm.