Ruptured basilar tip aneurysm secondary to fibromuscular dysplasia

Case contributed by Christopher Burley
Diagnosis almost certain

Presentation

Sudden onset severe frontal headache, photophobia, nausea and vomiting. Patient distressed and disoriented. History of migraines however pain reported to be dissimilar. Previously well.

Patient Data

Age: 60
Gender: Female

CT Brain (Non-contrast)

Evidence of a large subarachnoid bleed with blood in the Sylvian fissures, frontoparietal regions and in the lateral, third and fourth ventricles. No evidence of cerebellar coning.

CT Angiogram

There is a 5 x 7 mm aneurysm arising from the terminal part of the basilar artery. No evidence of active bleeding. The terminal cervical ICA has a beaded appearance with a slight aneurysm on the right. Findings compatible with fibromuscular dysplasia.

Case Discussion

This case illustrates a large subarachnoid hemorrhage and basilar tip aneurysm in a patient with suspected fibromuscular dysplasia.

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