Pretzel sign (serpentine aneurysm)

Last revised by Frank Gaillard on 28 Feb 2022

The pretzel sign is seen on DSA and is indicative of a serpentine aneurysm 1.

The sign refers to the sinusoid configuration of the intra-aneurysmal vascular channel seen in serpentine aneurysms, giving it the appearance of a pretzel.

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Cases and figures

  • Figure 1: pretzel
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  • Case 1: Left MCA serpentine aneurysm
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