case_images: PMC3114371_01
case_images: 3D reconstruction of the initial cerebral angiogram discloses a small anterior communicating artery aneurysm with two small lobules and a common neck
case_images: SNI-2-56-g001.jpg
case_images: PMC3114371_01_SNI-2-56-g001.jpg
case_images: F1
case_images: A 66-year-old man with an acute onset of headache and a brief period of loss of consciousness was diagnosed with acute subarachnoid hemorrhage and his cerebral angiogram revealed a small ACoA aneurysm [Figure 1].
case_images: A CT angiogram [axial (a) and sagittal images (b)] 3 days after surgery, as part of the work-up to assess for worsening confusion, revealed mild anterior circulation vasospasm without any evidence of residual or recurrent aneurysm
case_images: SNI-2-56-g002.jpg
case_images: PMC3114371_01_SNI-2-56-g002.jpg
case_images: F2
case_images: A CT angiogram done 3 days later, as part of the work-up to assess for worsening confusion, revealed mild anterior circulation vasospasm without any evidence of residual or recurrent aneurysm [Figure 2].
case_images: A repeat four-vessel cerebral angiogram [anteroposterior (a) and oblique (b) views] without 3D reconstructions 9 days after the initial surgery revealed mild right A1 and A2 vasospasm without any evidence of residual or recurrent aneurysm. A potential aneurysmal abnormality was retrospectively detected (arrow)
case_images: SNI-2-56-g003.jpg
case_images: PMC3114371_01_SNI-2-56-g003.jpg
case_images: F3
case_images: A repeat four-vessel cerebral angiogram without 3D reconstructions 9 days later revealed mild right A1 and A2 vasospasm without any evidence of residual or recurrent aneurysm [Figure 3]. In retrospective review, this pseudoaneurysm may have been present on the angiogram completed on day 9 [Figure 3].
case_images: A subsequent cerebral angiogram revealed a relatively large pseudoaneurysm originating from the anterior communicating artery adjacent to the neck of the previously clipped aneurysm and projecting superiorly
case_images: SNI-2-56-g004.jpg
case_images: PMC3114371_01_SNI-2-56-g004.jpg
case_images: F4
case_images: A subsequent cerebral angiogram revealed a relatively large pseudoaneurysm originating from the ACoA adjacent to the neck of the previously clipped aneurysm and projecting superiorly [Figure 4].
case_images: A follow-up angiogram disclosed no further growth of the pseudoaneurysm
case_images: SNI-2-56-g005.jpg
case_images: PMC3114371_01_SNI-2-56-g005.jpg
case_images: F5
case_images: Two weeks after the second surgery, a repeat cerebral angiogram revealed no significant residual aneurysm [Figure 5].