Presentation
Severe headache prompting imaging. No neurological findings. No history of trauma.
Patient Data
Partially thrombosed aneurysm of Left PCA. No subarachnoid hemorrhage.
Partially thrombosed left posterior cerebral artery (P1/P2 junction) aneurysm. Aneurysm wall enhancement and surrounding vasogenic edema are in keeping with inflammatory change secondary to thrombosis.
Superior and laterally directed irregular wall aneurysm arising from P1 and P2 junction of left posterior cerebral artery measuring 7.8mm(height)x 8.3mm (body ) x 3.6mm (neck ) . The CT angiogram shows a large sac containing thrombus external to the patent portion of the aneurysm. No high-grade stenosis is shown. The left vertebral artery is dominant, the right very small caliber. Normal aortic arch configuration without significant atherosclerotic disease involving extracranial or intracranial vessels. Partially thrombosed aneurysm arising from the P1, P2 junction of left posterior cerebral artery. Site and morphology strongly suggest a dissecting etiology. Assessment with MRI and MRA would also be valuable as a baseline for followup.
Balloon assist coiling followed by LVIS 2.5*17 stent placement.
Coiled left P1/P2 junction aneurysm with probable recurrent neck. Signal at the dome is more likely evolving thrombus than flow, particularly given decreased overall size.
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