Ruptured anterior communicating artery aneurysm

Case contributed by Dr Bruno Di Muzio

Presentation

Worst headache ever.

Patient Data

Age: 46
Gender: Male

 

There is dense subarachnoid blood, predominantly in the anterior interhemispheric fissure, also in both sylvian fissures, and in the suprasellar cistern extending to the left side of the interpeduncular cistern. No intraparenchymal or intraventricular extension.

Ventricles and cortical sulci within normal limits for a patient of this age. No evidence of hydrocephalus.

No evidence of acute vascular territory infarct.

Visualised paranasal sinuses and mastoid air cells are well-aerated. No concerning bone lesion.

CTA COW (aortic arch to vertex)

There is a 1.1 x 0.8.x 0.8 cm lobulated aneurysm arising from the anterior communicating artery. This has a wide - 5 mm - neck. It fills from supply via the left A1 segment.

The right A1 segment is hypoplastic.

Both the left and right A2 segments arise from the base of the aneurysm.

No other aneurysm is demonstrated.

 

Conclusion:

Lobulated wide neck anterior commuting artery aneurysm.

Acute subarachnoid haemorrhage with distribution of blood compatible with rupture of the ACom aneurysm.

DSA (angiography)

Anterior communicating artery aneurysm Endovascular Treatment

Diagnostic angiography 11 x 7 x 4 mm, daughter aneurysms, broad necked, arising from dominant left A1 segment. Right A1 segment is aplastic. Questionable area involving the right P1 of either dysplastic segment versus very small bleb aneurysm, worthy of follow up.

Case Discussion

Berry cerebral aneurysms occur in ~90% in the anterior circulation, and the ACA/ACoA complex accounts for ~30-40% of those. 

Treatment of large or symptomatic aneurysms should be considered, with either endovascular coiling or surgical clipping. This case illustrates a ruptured aneurysm treated by coiling. 

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Case information

rID: 37775
Case created: 22nd Jun 2015
Last edited: 21st Sep 2015
Tag: rmh
Inclusion in quiz mode: Included

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