Presentation
Severe headaches followed by an altered state of consciousness.
Patient Data
there is a large amount of acute subarachnoid bleeding within all the basal cisterns as well as the Sylvian fissures and cerebral sulci bilaterally
large amount of blood is centered upon the left medial temporal lobe, with a possible intraparenchymal component
massive intraventricular hemorrhage with hydrocephalus
left fetal posterior cerebral artery with a 4 x 3.5 mm saccular aneurysm at it's P1 segment
This CT was performed to rule out ischemia two years ago.
Retrospectively, we can see that the saccular aneurysm in the left fetal PCA was smaller, but it was not reported back then.
Case Discussion
Underdiagnosed cerebral aneurysms can be dramatic for patients, surgeons, and radiologists and should always be reported.
This case demonstrates a massive subarachnoid hemorrhage following a rupture of an underdiagnosed saccular cerebral aneurysm.
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