Subarachnoid hemorrhage from ruptured right middle cerebral artery aneurysm

Case contributed by RMH Core Conditions


Severe headache, vomiting.

Patient Data

Age: 48
Gender: Female

Extensive subarachnoid hemorrhage in the basal cisterns, Sylvian fissures bilaterally, interhemispheric fissure anteriorly, and along the frontotemporal cerebral convexities bilaterally.

The hemorrhage predominates in the right Sylvian fissure where there is also adjacent right frontotemporal intra-parenchymal hematoma.

No intraventricular hemorrhage. Mild hydrocephalus indicated by temporal horn dilatation. No other intracranial abnormality.

Saccular right MCA aneurysm arising at the M1 bifurcation pointing laterally with a length of 6.3 mm. It measures 5.5 mm width with a relatively narrow neck of 3.3 mm width.

Saccular right pericallosal aneurysm pointing anteriorly with a length of 4.7 mm. It measures 3.8 mm width and has a relatively broad neck of 3 mm width.

No other intracranial aneurysms.

No significant intra- or extracranial arterial stenosis. Common origin of brachiocephalic trunk and left common carotid artery noted (bovine arch).

The proximal portion of the left vertebral artery is very tortuous.

Case Discussion

Patient proceeded to clipping of the right MCA aneurysm. There is increased risk of rupture with increasing aneurysm size. 

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Case information

rID: 33935
Published: 30th Jan 2015
Last edited: 7th Mar 2019
Inclusion in quiz mode: Included

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