Presentation
Severe headache, vomiting and loss of consciousness for two hours.
Patient Data
Extensive subarachnoid hemorrhage (blood in the basal cisterns, sylvian fissures, interhemispheric fissure and few sulci). Well-defined hyperdense structure (likely a hematoma) measuring 2.3 x 2.4 x 2.3 cm in the anterior interhemispheric fissure raising the suspicion of ruptured anterior communicating artery aneurysm. No intraparenchymal or intraventricular hemorrhage, acute infarction or midline shift is seen. Mildly dilated lateral and third ventricles without any periventricular CSF leak.
CT angiography
Small aneurysm measuring about 5 x 4 mm, arising from the anterior communicating artery. Spasm noted in the A1 segment of the right anterior cerebral artery (ACA). Morphology of the rest of the circle of Willis is normal.
Case Discussion
Small anterior communicating artery saccular aneurysm with extensive subarachnoid hemorrhage. The patient was transferred to the regional radiological interventional center where successful endovascular coiling was done.