Presentation
The patient's speech became slurred, and within a short time, she collapsed. She was admitted to the emergency department with GCS 3 and anisocoria after resuscitation by ambulance.
Patient Data
A hyperdense fluid collection fills the left Sylvian sulcus and displaces the surrounding brain tissue. It represents a space-occupying subarachnoid hemorrhage, which extends to the brain sulci. There is also a sickle-shaped subdural hemorrhage in the region of the left frontal lobe and a small intraparenchymal hemorrhage in the left nucleus lentiform. All three bleeds connect in narrow lanes.
There is a significant midline shift to the right. The mass effect of the hemorrhage compresses the left lateral ventricle. There is a developing subfalcine herniation.
CT angiography was performed after the non-contrast CT examination to find the origin of the bleeding. There are two saccular aneurysms on the M2 segments of the middle cerebral artery. The maximum diameter of the bigger one is 10 mm, and the smaller one is 4 mm in the axial plane.
There is also a small aneurysm at the anterior communicating artery.
Case Discussion
In non-traumatic subarachnoid hemorrhage, the possibility of aneurysm rupture should always be considered. The appearance of the subarachnoid hemorrhage is atypical in this presented case. It is space-occupying and has parenchymal and subdural components.
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