case_images: PMC10795898_01
case_images: Brain CT without contrast shows a large interhemispheric hematoma, intraventricular hemorrhage, and subarachnoid hemorrhage (white arrows) in (A) Sagittal, (B) Axial, and (C) Coronal views.
case_images: rjad742f1.jpg
case_images: PMC10795898_01_rjad742f1.jpg
case_images: f1
case_images: IV) (Fig. 1). In addition, cerebral angiotomography and 3D reconstruction imaging suggested the presence of two abnormal vascular lesions: (i) a fusiform aneurysm of 12 x 7 mm in an accessory A2 portion of the ACA and (ii) an unruptured saccular aneurysm of 3.3 x 2.8 mm in the distal segment of the basilar artery adjacent to the anterolateral surface of the P1 segment and the left superior cerebellar artery (Figs 2 and 3).
case_images: Cerebral angiotomography. (A) Axial cut depicts a midline irregular vascular lesion (yellow circle). (B) Axial cut shows a small saccular aneurysm at the basilar artery (white arrow).
case_images: rjad742f2.jpg
case_images: PMC10795898_01_rjad742f2.jpg
case_images: f2
case_images: IV) (Fig. 1). In addition, cerebral angiotomography and 3D reconstruction imaging suggested the presence of two abnormal vascular lesions: (i) a fusiform aneurysm of 12 x 7 mm in an accessory A2 portion of the ACA and (ii) an unruptured saccular aneurysm of 3.3 x 2.8 mm in the distal segment of the basilar artery adjacent to the anterolateral surface of the P1 segment and the left superior cerebellar artery (Figs 2 and 3).
case_images: Three-dimensional reconstruction imaging. (A) Superior view of the Circle of Willis shows a variant of the ACA with an accessory A2 branch (white arrow) and a saccular aneurysm of 3.3 x 2.8 mm at the basilar artery (yellow arrow). (B) Inferior-superior view depicts the configuration of the ACA with a triplicated A2 segment and a fusiform aneurysm of 12 x 7 mm emerging in its distal portion, with branches arising from the aneurysm sac (white arrow). (C) Superior view of the anterior and posterior circulation exhibits the complex anatomy of the A1 and A2 segments (green arrows), the accessory A2 segment and distal fusiform aneurysm (white arrows), and the basilar aneurysm (yellow arrow). (D) Lateral view shows the course of the triplicated A2 segment with the fusiform aneurysm arising distally (white arrow) and the small basilar aneurysm (yellow arrow).
case_images: rjad742f3.jpg
case_images: PMC10795898_01_rjad742f3.jpg
case_images: f3
case_images: IV) (Fig. 1). In addition, cerebral angiotomography and 3D reconstruction imaging suggested the presence of two abnormal vascular lesions: (i) a fusiform aneurysm of 12 x 7 mm in an accessory A2 portion of the ACA and (ii) an unruptured saccular aneurysm of 3.3 x 2.8 mm in the distal segment of the basilar artery adjacent to the anterolateral surface of the P1 segment and the left superior cerebellar artery (Figs 2 and 3).
case_images: Postoperative head CT. (A, B) Sagittal and axial views show resolution of the hematoma and intraventricular hemorrhage with remaining postinfarction areas. (C-F) Postoperative head CT views depict the placement of clips in the accessory A2 artery (yellow arrow) and basilar aneurysm (green arrow).
case_images: rjad742f4.jpg
case_images: PMC10795898_01_rjad742f4.jpg
case_images: f4
case_images: Brain imaging demonstrated improvement of the hematoma and intraventricular hemorrhage with remnant postinfarction areas (Fig. 4).