PICA aneurysm with pure primary intraventricular hemorrhage
Patient who had plasmacytoma, platelet count of 80 and INR 1.3, presented with coma, GCS 3.
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Almost pure primary intraventricular hemorrhage is seen on the initial non-contrast scan. There is only a small amount of blood in the cerebellopontine cistern. There is no blood elsewhere.
On CTA, the cause was identified - a small, 3.5 mm wide, left PICA aneurysm (or possibly pseudoaneurysm, the patient unfortunately expired prior to DSA) in its supratonsillar segment, which manifested itself as a pure intraventricular hemorrhage.