case_images: PMC10783693_01
case_images: (a and b) Initial computed tomography (CT) scan showing left tentorial acute subdural hemorrhage (ASDH). (c and d) A CT scan during the second admission showed enlarged ASDH. (e and f) CT angiography showing left pseudoaneurysm in the P3 segment of the posterior cerebral artery (arrowhead) (arrow).
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case_images: PMC10783693_01_SNI-14-428-g001.jpg
case_images: F1
case_images: A head computed tomography (CT) scan showed a subcutaneous hematoma in the right parietal region and ASDH extending from a subarachnoid cyst in the left middle cranial fossa to the left tentorium and falx [Figures 1a and b]. Head CT imaging revealed ASDH extending from the left tentorium to the left convexity, with effacement of the sulci and a midline shift [Figures 1c and d]. Three-dimensional CT (3D-CT) showed a 7.0-mm mass lesion in the ASDH of the tentorium, which was contiguous with the left posterior inferior temporal artery (PITA) branching from the P3 segment of the PCA [Figures 1e and f].
case_images: (a) Left internal carotid artery angiography in the early (left panel) and late phase (right panel) showing a pseudoaneurysm (arrowhead). (b) Three-dimensional rotational angiography of the internal carotid artery showing the pseudoaneurysm (arrow).
case_images: SNI-14-428-g002.jpg
case_images: PMC10783693_01_SNI-14-428-g002.jpg
case_images: F2
case_images: Three-dimensional digital subtraction angiography and vertebral artery angiography demonstrated a pseudoaneurysm in the PITA from the P3 segment with irregular contours, delayed filling, and no obvious neck [Figures 2a and b].
case_images: (a) A microcatheter was introduced into the posterior inferior temporal artery. The arrowhead points at the pseudoaneurysm. (b) Injection of 33% n-butyl cyanoacrylate (NBCA). (c) Internal carotid artery angiography after injection of NBCA.
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case_images: PMC10783693_01_SNI-14-428-g003.jpg
case_images: F3
case_images: Aichi, Japan) was, then, advanced into the left internal carotid artery. A microcatheter (DeFrictor BULL; Medicos Hirata, Tokyo, Japan) was inserted proximal to the aneurysm in the left PITA using a microwire (TENROU 1014; Kaneka Medix, Osaka, Japan; [Figures 3a and b]). The artery was embolized with 0.13 mL of 33% NBCA. A left vertebral artery angiography revealed the disappearance of the pseudoaneurysm [Figure 3c].
case_images: (a) Magnetic resonance (MR) imaging showing a small infarction in the temporal lobe. (b) MR angiography revealed the absence of intra-aneurysmal flow (arrowhead). (c and d) Computed tomography angiography revealed the disappearance of the aneurysm (arrow).
case_images: SNI-14-428-g004.jpg
case_images: PMC10783693_01_SNI-14-428-g004.jpg
case_images: F4
case_images: However, the patient experienced no symptoms such as visual apraxia or loss [Figures 4a and b]. Follow-up magnetic resonance angiography and 3D-CT angiography demonstrated complete occlusion of the pseudoaneurysm with no recanalization [Figures 4c and d].