Presentation
Sudden collapse and disturbed level of consciousness.
Patient Data
Extensive subarachnoid hemorrhage is seen smearing the basal cisterns as well as the Sylvian fissures and bilateral frontoparietal cortical sulci most significant on the left Sylvian fissure. Associated right extra-axial hematoma about 3 x 2.7 x 3 cm is noted centered upon the left Sylvian fissure with possible intraparenchymal component. No intraventricular blood is noted.
Aneurysmal dilatation of the distal M1 segment of the left middle cerebral artery (MCA) is noted, it measures about 9 x 7.8 x 5.8 mm in its maximal axial and craniocaudal dimensions with a narrow about 1.5 mm neck. Associated right extra-axial hematoma about 3 x 2.7 x 3 cm is noted centered upon the left Sylvian fissure with possible intraparenchymal component. No intraventricular blood is noted.
A similar small aneurysmal dilatation at the bifurcation of the right MCA / junction of M1 and M2 segments of the right middle cerebral artery (MCA) is noted as well that measures about 5.2 x 2.8 X 4 mm with a narrow about 1 mm neck.Ectatic dilatation of the supraclinoid portions of the internal carotid artery is noted on either side.
Mild atherosclerotic changes of the scanned extra-cranial as well as intracranial carotid arteries and cerebral arteries with mild regular outline and scattered atheromatous plaques.
Case Discussion
Bilateral saccular aneurysms at the bifurcation of each MCA with ruptured saccular / berry aneurysmal dilatation of the distal M1 segment of the left middle cerebral artery and extensive subarachnoid hemorrhage (SAH).
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