case_images: PMC10316180_01
case_images: Head computed tomography (CT) shows multiple skull base fractures underlying traumatic subarachnoid hemorrhage and left acute epidural hematoma (a and b). The skull fractures involve the right frontal bone, right pyramidal bone, clivus, left anterior clinoid process, and left mastoid process (c and d; orange arrow). Contrast-enhanced CT of the head shows no obvious aneurysm (e and f).
case_images: SNI-14-199-g001.jpg
case_images: PMC10316180_01_SNI-14-199-g001.jpg
case_images: F1
case_images: Head computed tomography (CT) revealed multiple skull base fractures underlying traumatic subarachnoid hemorrhage and left acute epidural hematoma [Figures 1a and b]. The skull fractures involved the right frontal bone, right pyramidal bone, clivus, left anterior clinoid process, and left mastoid process [Figures 1c and d]. Contrast-enhanced head CT was also performed, but no obvious aneurysm was found on the day of admission [Figures 1e and f].
case_images: Head magnetic resonance imaging on day 7 revealed bilateral internal carotid artery (ICA) stenosis, basilar artery (BA) stenosis, and pseudoaneurysm at the apical portion of the BA (a and b; yellow arrow).
case_images: SNI-14-199-g002.jpg
case_images: PMC10316180_01_SNI-14-199-g002.jpg
case_images: F2
case_images: Head magnetic resonance imaging (MRI) was performed 7 days after surgery and revealed bilateral ICA stenosis, BA stenosis, and a pseudoaneurysm at the apical portion of the BA [Figures 2a and b].
case_images: Digital subtraction angiography (DSA) revealed bilateral internal carotid artery stenosis (a and b; white arrow) and the aneurysm protruding irregularly anteriorly from the distal portion of basilar artery (BA) and proximal portion of the BA was dissected (c). The aneurysm gradually thrombosed, resulting in body filling and a volume embolization ratio of 15.7% (d). Second coil embolization was performed following DSA that revealed re-rupture of the aneurysm, resulting in body filling and a volume embolization ratio of 20.9% (e and f).
case_images: SNI-14-199-g003.jpg
case_images: PMC10316180_01_SNI-14-199-g003.jpg
case_images: F3
case_images: Digital subtraction angiography (DSA) revealed bilateral ICS stenosis [Figures 3a and b] and an aneurysm protruding irregularly anteriorly from the distal portion of the BA, and the proximal portion of the BA was dissected [Figure 3c]. The aneurysm was gradually thrombosed, resulting in body filling and a volume embolization ratio of 15.7% [Figure 3d]. A second coil embolization was performed following DSA, which revealed a rupture of the aneurysm, resulting in body filling and a volume embolization ratio of 20.9% [Figures 3e and f].
case_images: Head magnetic resonance imaging on day 42 showed no obvious blood flow in the aneurysm and the basilar artery stenosis and bilateral internal carotid artery stenosis had improved (a and b; orange arrow). Digital subtraction angiography also revealed improved bilateral internal carotid artery stenosis (c and d; white arrow).
case_images: SNI-14-199-g004.jpg
case_images: PMC10316180_01_SNI-14-199-g004.jpg
case_images: F4
case_images: Head MRI on day 42, 1 week after retreatment, showed no obvious blood flow in the aneurysm, and the BA and bilateral ICA stenoses had improved [Figures 4a and b]. DSA also showed improved bilateral ICA stenosis [Figures 4c and d].