Presentation
Severe headache not improved or responding to analgesic.
Patient Data
A well-defined round-shaped hyperattenuating lesion is seen in the prepontine cistern measuring 16.2 x16.4 mm suggesting a basilar artery aneurysm. No other aneurysm was identified.
Normal appearance of both cerebral hemispheres and the posterior fossa with normal grey/white matter differentiation. No evidence of intra- or extra-axial hemorrhage. No evidence of infarction, mass, brain edema or midline shift.
A normal ventricular system, basal cistern, Sylvian fissures and convexity sulci.
Impression:
A well-defined oval-shaped hyperattenuating lesion is seen in the course of basilar artery most likely basilar artery aneurysm for further assessment.
Compared to the CT study about 3 hours apart.
- newly developed extensive subarachnoid hemorrhage centered in basal cisterns extending to Sylvian fissure and smearing the cortical sulci
- evidence of intraventricular extension (extension to 4th ventricle) newly developed mild hydrocephalus and generalized sulcal effacement suggestive of cerebral edema
- an interrupted and loss of definition of the hyperattenuating aneurysm lesion was seen in the course of the basilar artery by surrounding subarachnoid blood
- no evidence of midline shift is seen
IMPRESSION :
A newly developed subarachnoid hemorrhage is suggestive of a resultant ruptured basilar artery aneurysm, for further urgent interventional neurosurgeon consultation.
The annotated image demonstrates interrupted and loss of definition of the hyperattenuating aneurysm lesion seen in the course of the basilar artery.
The leakage was probably where the bulge was noted on the left side (arrow).
Case Discussion
This is a female patient who presented to ER with a severe headache, she underwent CT brain and revealed a basilar artery aneurysm and there was no evidence of aneurysm leakage.
Three hours later, the patient suddenly collapsed, GCS 3/15 and then requested for CT brain again to rule out a ruptured aneurysm and the CT confirmed a ruptured basilar artery aneurysm.
The leakage was probably where the bulge was (arrow).
Unfortunately, this patient had no imaging follow up after being referred to a specialized neuro center.
Case courtesy: Dr Sameh Salah, Dr Haytham Ramzi and Dr Safwat Almoghazi
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