CT brain (non-contrast)
Non-contrast axial images through the brain have been obtained.
There is extensive infra and supratentorial subarachnoid haemorrhage demonstrated centred at the suprasellar cistern and extending into the premedullary cistern, cerebellopontine cistern,
into bilateral Sylvian fissures, along the floor of the middle cranial fossa and falx cerebri anteriorly.
There is also widespread sulci haemorrhage seen in bilateral frontal, anterior temporal and parietal as well as right anterior occipital lobe. Confluent areas of right posterior frontal and parietal haemorrhage appear predominantly parenchymal, measure up to 2.2 x 1.3 cm in the axial plane and demonstrate surrounding vasogenic oedema. Associated mass effect further results in effacement of the right lateral ventricle and 5mm left sided midline shift.
A 2 x 1.5 cm area of ill-defined hypodensity is shown in the right frontal ACA/MCA watershed territory and appears most suspicious for an area of established infarction.
No intraventricular blood. No midline shift. No focal mass identified.
CTA COW (aortic arch to vertex)
Volume acquisition from the vertex to the aortic arch has been obtained with dynamic administration of intravenous contrast and reviewed in multiple planes.
There is adequate opacification of the first and second segment of the right vertebral artery. No opacification is seen in the distal aspect of the third segment and in the fourth segment for a length of approx 4cm. Opacification of the distal aspect of the right V4 for a length of approx 11mm just before its confluence with the left vertebral artery is thought secondary to backfilling. The right sided PICA is not identified.
The appearance of the left vertebral artery is normal. Focal calcification is evident of bilateral V4 segments.
Left V4 focal stenosis of moderate severity.
Peripheral right MCA dilatation suspicious for mycotic aneurysm.
Extensive subarachnoid haemorrhage as described above. Small amount of intraventricular blood. Rule out mycotic aneurysm with DSA