Presentation
Alleged fall due to dizziness. Sustained left periorbital haematoma.
Patient Data
Acute subarachnoid haemorrhage around the midbrain and basal cisterns, namely bilateral ambient cisterns, left crural cistern, quadrigeminal cistern and left suprasellar cistern. There is extension into the left foramen of Luschka, forth ventricle and as well as hyperdense layerings in occipital horn of bilateral lateral ventricles.
The acute SAH is much thicker at the left ambient cistern, measuring up to 1.2cm in thickness.
Basal cisterns are partially effaced.
Left periorbital haematoma with extension to the left maxilla inferiorly. Both eye globes are normal in configuration.
Anterior circulation:
Visualised internal carotid arteries, both middle cerebral arteries and both anterior cerebral arteries are well opacified and normal in calibre.
Anterior communicating artery and left posterior communicating artery present. Right PCOM artery is not visualised.
Posterior circulation:
Dominant left vertebral artery.
Both visualised vertebral arteries, basilar artery, both superior cerebellar arteries and both posterior cerebral arteries are well opacified and normal in calibre.
No obvious stenosis, aneurysm , arteriovenous malformation or AV fistula.
Case Discussion
Patient has background medical illness of atrial fibrillation and was on long term anticoagulant. The usage of anticoagulant has increased this patient's bleeding risk with trivial trauma. The anticoagulant was withhold and the patient was treated conservatively.
95% of cases of perimesencephalic subarachnoid haemorrhage have a normal cerebral angiogram.
Unable to process the form. Check for errors and try again.