Presentation
Sudden syncope with persistent headache.
Patient Data
Large acute extra-axial/subarachnoid hematoma with epicenter at the anterior interhemispheric fissure. A few areas of low attenuation within this hematoma are in keeping with the "swirl sign". Minimal perihaematoma edema.
Case Discussion
The location of hematoma and the low density spherical shaped lesion from the anterior communicating artery raise high suspicion of rupture ACOM artery aneurysm.
The presence of a "swirl sign" indicates acute hematoma expansion.
The volume of hematoma, the degree of cerebral edema, hydrocephalus, midline shift, basal cistern effacement and brainstem herniation are important prognostic factors which are important to be included in the CT report for the neurosurgeon to make definite decisions and management.