Aneurysmal subarachnoid hemorrhage with intra-axial extension

Right intra-axial hematoma within the right frontal-temporal region measuring 62 mm in maximum dimension. Peri hematoma edema.

Subarachnoid blood in the basal cisterns, extending into the Sylvian fissures bilaterally and along the right frontal lobe sulci. Further subarachnoid blood in the pre-pontine cistern.

No frank intraventricular blood. Near complete effacement of right lateral ventricle. Approximately 7 mm midline shift to the left. Prominence of the temporal horns particularly in the left lateral ventricle, is suggestive of a degree of early hydrocephalus. Likely right uncal herniation. No cerebellar tonsillar descent. No acute infarcts.

Opinion:

Extensive subarachnoid blood, and large right frontal temporal intra-axial hematoma. Given the extent of subarachnoid blood, the intra-axial hemorrhage more likely represents parenchymal extension of an aneurysmal subarachnoid hemorrhage rather than a primarily intra-axial hemorrhage with secondary subarachnoid extension - further evaluation with CT intracranial angiogram is advised.

Likely early hydrocephalus and midline shift.

6 mm aneurysm originating from the junction between the first and second segments of right middle cerebral artery. No other arterial aneurysm demonstrated.

The pre-communicating segments of the posterior cerebral arteries bilaterally are relatively cylender in caliber, with more normal caliber posterior communicating arteries and post-communicating segments of the posterior cerebral arteries.

The previously demonstrated right frontal temporal hematoma is of similar size. Subarachnoid blood as before. Midline shift to the left and prominence of the temporal horns of the lateral ventricles with partial effacement of right lateral ventricle, as before.

Opinion:

6 mm right middle cerebral artery aneurysm at the junction between the first and second segments.