Presentation
Sudden onset 10/10 severity (thunderclap) headache.
Patient Data
A large right hemispheric parenchymal hemorrhage with small volume subarachnoid hemorrhage, both centered adjacent to the right middle cerebellar artery. There is marked mass effect with midline shift to the left and uncal herniation, and marked adjacent edema.
On close inspection of the pre-contrast phase, a rounded high attenuation (but lower density than the hemorrhage) structure is present at the anteromedial margin of the hemorrhage, in the expected location of MCA and highly suggestive of an aneurysm.
CT angiogram confirms this MCA aneurysm.
Case Discussion
This case highlights the value of careful review of the non-contrast study, as the diagnosis is almost certain.
Further imaging with CT angiogram was performed to confirm the diagnosis and in order to aid decision making with a view to interventional radiology or neurosurgical treatment.
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