Cerebral aneurysm with rupture

Non-contrast CT

A small amount of high attenuation material within the dependent portion of the left circular sulcus likely represents a small amount of subarachnoid blood. No other intracranial hemorrhage was identified.

Hyperdensity seen within the suprasellar cistern corresponds to the large left terminal MCA aneurysm described below.

Bilateral periventricular and deep white matter hypoattenuation is likely in keeping with chronic small vessel ischemia. Large calcified pineal gland. Ventricles and sulcal pattern are age appropriate.

CTA

There is a large, lobulated, anteriorly directed aneurysm arising from the terminal left ICA, with a 3 mm neck. Further 2 mm aneurysm at the right M1 bifurcation.

Large left carotid terminus aneurysm measuring 14 x 6 mm. Infundibulum of the PCOM.

During the procedure, the patient developed a severe left-sided headache with moderate confusion. Angiographic extravasation was identified.

The groin was closed with a 6Fr angioseal and patient was transferred for an urgent CT.

Marked bilateral extensive subarachnoid hemorrhage admixed with contrast (in keeping with rupture during DSA) is demonstrated overlying each cerebral cortex and also within the basal cisterns. There is some hemorrhage present within the fourth ventricle. There is a large amount of blood lying anterior to the brainstem. There is a large aneurysm on the left side. This lies medial to or adjacent to the origin of the left middle cerebral artery and approximates 11 mm in size.