case_images: PMC11761364_01
case_images: Computed tomography (CT), three-dimensional computed tomography (3D CT), and computed tomography angiography (CTA) images on admission. (A) Head CT showing subarachnoid hemorrhage within the right Sylvian fissure and cerebral contusions located at the right temporal lobe (arrow). (B) CTA showing a 5-mm wide-necked aneurysm in the cavernous portion of the right internal carotid artery (ICA) (arrow). (C) 3D CT showing LeFort I + II type maxillary fractures and a mandibular fracture (C, arrowhead). (D-F) Coronal and axial face CT showing orbital and maxillary fractures (D, E, arrowhead) but no fractures in the bone structures around the right ICA.
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case_images: Contrast-enhanced CT revealed subarachnoid hemorrhage in the right Sylvian fissure (Figure 1A), a 5-mm wide-necked aneurysm in the cavernous portion of the right internal carotid artery (ICA) (Figure 1B), LeFort I + II maxillary fractures, and a mandibular fracture (Figure 1C,D). No fractures were observed around the right ICA (Figure 1E,F).
case_images: CTA images (A, F), 3D digital subtraction angiography (DSA) image (B), and DSA before and after flow diverter (FD) stenting on Day 17 (C-E). (A) CTA on Day 4 showing the enlarged aneurysm, with a 4-mm maximum diameter (arrow). (B) 3D DSA on Day 10 showing the enlarged aneurysm, with a 12-mm maximum diameter (arrow). (C, D) Lateral views of the right ICA DSA before FD stenting showing the wide-necked aneurysm with a 13.8-mm maximum diameter (C, arrow). Following the procedure, decreased and stagnant inflow into the aneurysm is observed (D, arrow). (E) Right ICA DSA showing the FD stent (PIPELINE , 3.75 x 18 mm) inserted in the aneurysm. (F) CTA on Day 97 showing complete occlusion of the aneurysm and confirming the patency of the stented segment of the right ICA (arrowhead).
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case_images: On Day 4, follow-up CT revealed the aneurysm had increased to 7 mm (Figure 2A). On Day 10, digital subtraction angiography revealed the aneurysm had enlarged to 12 mm (Figure 2B). Angiography revealed a widely patent stent, apposition against the vessel wall, complete aneurysm neck coverage, and a reduction and stagnation of contrast agent flow into the aneurysm (Figure 2C-E). Three months postinjury, CT angiography revealed complete aneurysm occlusion and confirmed the patency of the stented segment of the ICA (Figure 2F).
case_images: Patient's facial images on Day 73 (A) and Day 101 (B) postinjury. (A) An image showing severe ptosis in the right eyelid, exotropia, and dilated pupil in the right eye. (B) Partial clinical improvement of oculomotor nerve palsy is observed compared with (A).
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case_images: Her neurological symptoms partially improved, achieving Glasgow Outcome Scale score of 4 (Figure 3).