PICA aneurysm with pure primary intraventricular hemorrhage

Case contributed by Gregor Savli
Diagnosis certain

Presentation

Patient who had plasmacytoma, platelet count of 80 and INR 1.3, presented with coma, GCS 3.

Patient Data

Age: 70 years
Gender: Male

Almost pure primary intraventricular hemorrhage is seen on the initial non-contrast scan. There is only a small amount of blood in the cerebellopontine cistern. There is no blood elsewhere.

On CTA, the cause was identified - a small, 3.5 mm wide, left PICA aneurysm (or possibly pseudoaneurysm, the patient unfortunately expired prior to DSA) in its supratonsillar segment, which manifested itself as a pure intraventricular hemorrhage. 

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