Presentation
Seizure.
Patient Data
Right frontal convexity sulcal high-density consistent with subarachnoid blood.
The suprasellar, interpeduncular, prepontine, quadrigeminal plate, ambient and civilian cisterns are patent with no subarachnoid blood in these cisterns.
No intraventricular blood.
No ventricular dilatation.
Conclusion: Subarachnoid blood as described above, the distribution is not in a typical berry aneurysm distribution. The emergency department has been informed of these findings.
Left carotico ophthalmic aneurysm, pointing superiorly measuring 7 x 6 x 7 mm with a 4 mm neck. No other aneurysms.
Particularly no right MCA bifurcation or distal aneurysms.No significant intra or extra cranial stenosis.
Bovine type arch anatomy with common origin of the right brachiocephalic and left common carotid arteries.
Conclusion: Left carotico-ophthalmic aneurysm as above. The pattern of distribution of the subarachnoid blood does not correlate with this aneurysm.
There is a 7 mm left carotico-ophthalmic aneurysm, with a 4 mm base. The ophthalmic artery arises from the base of the aneurysm.
No further aneurysms; no vascular malformations.
There is mild atheroma at the ICA origins bilaterally, causing 30% left ICA narrowing, and without right ICA origin NASCET stenosis. In addition, mild right M1 MCA narrowing.
Case Discussion
This patient presented to the emergency department with seizures. No history of a headache. CT brain demonstrated a right frontal convexity SAH and further CTA brain and DSA showed a 7mm left a carotico-ophthalmic aneurysm. This aneurysm was possibly an incidental finding. The case was discussed with the treating team and referred for complementary MRI Brain and aneurysm treatment planning, whether surgical or endovascular.
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