case_images: PMC10559379_01
case_images: Computed tomography (CT) and three-dimensional CT angiogram on admission after COVID-19 onset day 3 (a) diffuse subarachnoid hemorrhage with intraventricular hemorrhage and hydrocephalus. (b) Pearls and strings are seen in the left vertebral artery. (c) Chest CT shows multiple frosted shadows are seen in the bilateral lung fields.
case_images: SNI-14-324-g001.jpg
case_images: PMC10559379_01_SNI-14-324-g001.jpg
case_images: F1
case_images: Computed tomography (CT) scanning revealed SAH, intraventricular hemorrhage, and hydrocephalus [Figure 1a]. CT angiography (CTA) revealed a spindle-shaped dilatation of the left VA, and the posterior inferior cerebellar artery (PICA) was branched proximally [Figure 1b]. A simple chest CT revealed multiple frosted shadows in the peripheral areas of both lungs [Figure 1c].
case_images: Digital subtraction angiography of the right vertebral artery (VA) (a and b) and left VA (c) (a) right vertebral artery dissecting aneurysm (VAG), lateral view. The aneurysm was present just after the posterior inferior cerebellar artery (PICA) branch. (b) Right VAG, lateral view. Flow arrest was seen in the right VA while the PICA was preserved. (c) Left VAG, frontal view. After internal trapping, the left VA was perfused sufficiently, retrograde flow to the right VA, and a branch of the anterior spinal artery was observed.
case_images: SNI-14-324-g002.jpg
case_images: PMC10559379_01_SNI-14-324-g002.jpg
case_images: F2
case_images: DSA revealed that the aneurysm was PICA distal-type with a dome measuring 12.6 mm x 6 mm [Figure 2a]. Flow arrest was observed and the procedure was terminated [Figure 2b]. Blood flow from the contralateral left VA was sufficient and retrograde flow to the ipsilateral VA [Figure 2c].
case_images: Computed tomography (a) and magnetic resonance angiography (MRA) (b) on the 10 days after hospitalization. Digital subtraction angiography of the right vertebral artery (VA) on the 30 days after hospitalization (c-e). (a) Part of the left frontal lobe showed a low-intensity zone. (b) MRA showing mild stenosis of the left distal middle cerebral artery (white arrow). (c) Right vertebral angiography (VAG), lateral view. Recanalization is seen in the right VA. (d) Right VAG, lateral view. An aneurysm-like dilation (white arrowhead) is seen at the lower part of the coil mass. (e) Right VAG, lateral view. After re-embolized, flow arrest was seen in the right VA while the posterior inferior cerebellar artery (PICA) was preserved.
case_images: SNI-14-324-g003.jpg
case_images: PMC10559379_01_SNI-14-324-g003.jpg
case_images: F3
case_images: At that time, motor aphasia was observed, and CT revealed a focal cerebral infarction in the left frontal lobe [Figure 3a] that was thought to be caused by cerebral vasospasm at the distal middle cerebral artery (MCA) [Figure 3b]. On the 30th day, the aneurysm was recanalized [Figure 3c]. The recanalization segment showed an aneurysmal-like dilatation [Figure 3d], and coil embolization using nine coils was performed with a focus on the dilated area, achieving re-occlusion [Figure 3e].