Giant internal carotid artery aneurysm
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Presentation
Headache, left-sided weakness, superficial sensory disturbances.
Patient Data
Brain MRI shows a contrast-enhancing abnormal signal mass in the terminal segment of the right internal carotid artery (C7 segment), measuring approximately 26x26 mm, with well-defined borders compressing the right brainstem and pons, accompanied by surrounding brain oedema. The mass shows heterogeneous high-to-low signal intensity on T1W, T2W, FLAIR, and scattered low signal on GRE (indicating blood clots at different stages), with no diffusion restriction, and mild peripheral enhancement post-contrast. MRA shows a stalk connected to the C7 segment of the right internal carotid artery.
A small infarction is noted in the right pons at the level of the lesion, with marked diffusion restriction.
An empty sella was noted.
A few nodular lesions are noted in the periventricular and subcortical white matter bilaterally, consistent with small vessel disease (Fazekas 1)
Case Discussion
The MRI findings are consistent with a giant saccular aneurysm of the C7 segment of the right internal carotid artery, causing a significant mass effect, compressing the right pons and brainstem, resulting in surrounding brain oedema and a right pontine infarction.
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