Presentation
Thunderclap headache
Patient Data
There is evidence of subarachnoid dense blood noted in the suprasellar, ambient, and interpeduncular cisterns and along the Sylvian and interhemispheric fissures, more on the right side.
After contrast administration, there is a bilobed saccular aneurysm arising from the junction of the clinoid C5 and supraclinoid C6 segments of the right ICA.
There is a fusiform aneurysmal dilatation of the lacerum C3 segment of the left internal carotid artery.
Case Discussion
The most common cause of nontraumatic subarachnoid hemorrhage is aneurysmal rupture, and the vast majority of aneurysmal formation occurs in the anterior circulation.
The typical presentation is the "worst headache of my life," which may also be accompanied by signs of meningism due to dural irritation or cranial nerve palsies, depending on the location.
Up to one-fifth of patients have more than one aneurysm, and management is invasive in cases accompanied by subarachnoid hemorrhage.
This patient was managed by endovascular coiling of the aneurysm.
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