Presentation
Collpase.
Patient Data
There is subarachnoid hemorrhage that predominantly obliterates the prepontine and pontocerebellar cisterns coating the brain stem on the left on the left. Associated intraventricular hemorrhage and hydrocephalus noted. The brain parenchyma has otherwise unremarkable appearances.
There is acute subarachnoid hemorrhage outlining the third and fourth ventricles, part of the lateral ventricles, and the left foramen magnum, prepontine cisterns. There is dilatation of the lateral and third ventricles consistent with obstructive hydrocephalus. There is no CT evidence of any significant transependymal CSF flow at this time.
EVD has been placed with tip in the left lateral ventricle, persistent and unchanged hydrocephalus. Subarachnoid hemorrhage is more prominent in size and distribution than on the presentation CT. No cerebral herniation. Coil material noted in the region of the left SCA.
Case Discussion
This patient was taken to theater for a ventricular catheter placement and subsequently to sent to neurointervention angiography, after agreement that coil embolization should be attempted.
Peripheral superior cerebellar artery aneurysms, like this one, can represent either a true saccular or a dissecting aneurysm. Coil treatment was offered to this patient after multidisciplinary discussion. A follow-up angiography (not shown) has not demonstrated residual filling or features to suggest dissection.
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