Right mesial temporal lobe jet hematoma from ruptured PCom artery aneurysm
Presentation
Thunderclap headache then ALOC.
Patient Data
Right mesial temporal lobe acute intraparenchymal hemorrhage with surrounding vasogenic edema. Thin right subdural hematoma in the floor of the middle cranial fossa, right aspect of the tentorum and over the right cerebral hemisphere. Subarachnoid hemorrhage in the suprasellar, interpenduncular and prepontine cisterns.
Midline shift of 6 mm with sulcal effacement of the right cerebral hemisphere. Almost complete effacement of the right lateral and third ventricles. Enlargement of the left temporal horn concerning for early hydrocephalus. Mild uncal herniation. No tonsillar herniation.
CT angiogram
There is a complex lobulated saccular aneurysm arising from the origin of the right posterior
communicating artery - 6 x 12 mm with a 2 mm neck. It protrudes laterally and abuts the mesial temporal lobe hematoma. No other cerebral arterial aneurysm is identified.
Case Discussion
The patient was transferred to a tertiary neurointerventional service where the aneurysm was successfully coiled.