Presentation
Presents with headache, nausea, and blurry vision. Intact on neurological exam, but has "worst headache of life". CT ordered in the emergency department for further evaluation.
Patient Data
Age: 65 years old
Gender: Female
From the case:
Basilar tip aneurysm with coiling
Axial non-contrast
There is an 8 x 10 mm lobular area of hyperattenuation anterior to the midbrain. A tiny amount of hyperattenuation along the right central sulcus is compatible with a small amount of subarachnoid hemorrhage.
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Axial C+ arterial phase
Better evaluation of a bilobed aneurysm at the tip of the basilar artery. No other aneurysm identified. The patient was then taken for cerebral angiography and intervention.
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Frontal Right vertebral artery
Right vertebral artery injection:
Irregular bilobed basilar artery tip aneurysm:
- left lobe measures 8 x 6 x 4 mm
- right lobe measures 9 x 7 x 4 mm
- the aneurysm is partially incorporating origin of the right posterior cerebral artery P1 segment, with anterior pointed lobulation worrisome for potential site of rupture
- small left sided fenestration at the vertebrobasilar junction. Otherwise unremarkable angiographic appearance of the right distal V2, V3 and V4 segments, right posterior inferior cerebellar artery, as well as the basilar artery and its branches, including the bilateral posterior cerebral arteries.
Subsequent coiling of the aneurysms with platinum microcoils.