Ruptured pericallosal aneurysm

Case contributed by Yaïr Glick

Presentation

His daughter heard a thud, ran into the kitchen, and found him lying on the floor.

Patient Data

Age: 80 years
Gender: Male

Large left frontal parafalcine intraparenchymal hemorrhage measuring 3.2 x 8.6 x 5.6 cm (ML x AP x CC). Extensive subarachnoid hemorrhage, more pronounced on the right - bifrontal, biparietal, bitemporal, right occipital; and in the interhemispheric fissure, suprasellar cistern, and Sylvian cisterns and fissures. The intraparenchymal hemorrhage exerts mass effect on the body of the corpus callosum and the lateral ventricles and bursts into the left ventricle through the corpus callosum. From the left ventricle, blood passes into all the other ventricles, reaching the median aperture and the foramina of Luschka. There is effacement or narrowing of all cerebral sulci and a rightward subfalcine herniation of 6 mm.

Findings suggestive of ruptured left pericallosal artery aneurysm.

Repeat CT, CTA and CTV done

ct

Repeat non-contrast CT, CTA, and CTV done less than 90 minutes later:

The intraparenchymal hemorrhage has widened and more blood has entered the left ventricle. The occipital and temporal horns of the lateral ventricles have dilated.

There is a tiny pedunculated left pericallosal artery aneurysm that appears to grow in the venous phase, proof that it is the source of the bleed.

Annotated image

The yellow arrows point to the pericallosal aneurysm.

Case Discussion

Presented to the ED with confusion, after having fallen in his home. A CT head was performed to rule out an intracranial bleed. The CT showed massive intraparenchymal, subarachnoid, and intraventricular hemorrhage. The location of the intraparenchymal hemorrhage was suggestive of a ruptured pericallosal artery aneurysm, which a CTA showed to be the case.
Sadly, the patient died before any intervention could be attempted.

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