case_images: PMC6306131_01
case_images: (A) CT demonstrating SAH and enlargement of the ventricles. (B) 3D-CTA demonstrating two aneurysms at AComA and the left MCA. The left MCA aneurysm projects medially. (C) A raw image of CTA showing an artery running through the left hypoglossal canal (arrow). (D) Angiography (left: conventional, right: 3D) demonstrating PPHA (arrowheads) originating from the left ICA.
case_images: jocmr-11-01-072-g001.jpg
case_images: PMC6306131_01_jocmr-11-01-072-g001.jpg
case_images: F1
case_images: Computed tomography (CT) on admission demonstrated SAH (Fig. 1A), while three-dimensional CT angiography (3D-CTA) demonstrated aneurysms of the left MCA and AComA. The sizes of the aneurysms of MCA and AComA were 9 and 3 mm, respectively (Fig. 1B). An anomalous artery originated from the left internal carotid artery (ICA) ran through the hypoglossal canal and connected to the basilar artery (BA) (Fig. 1C). Angiography also demonstrated the left PPHA (Fig.1D).
case_images: (A) Post-operative 3D-CTA demonstrating a small residual neck of the MCA aneurysm (arrow). (B) CT on the sixth day showing additional hemorrhage in the basal cistern (arrow). (C) Angiography showing enlargement of the residual neck of the MCA aneurysm (arrow). (D) After the second operation, the aneurysm is not observed on 3D-CTA.
case_images: jocmr-11-01-072-g002.jpg
case_images: PMC6306131_01_jocmr-11-01-072-g002.jpg
case_images: F2
case_images: Post-operative 3D-CTA revealed a small residual neck of the MCA aneurysm (Fig. 2A). CT revealed additional SAH in the basal cistern (Fig. 2B). Angiography demonstrated enlargement of the residual neck of the left MCA aneurysm (Fig. 2C). Post-operative 3D-CTA demonstrated no residual aneurysm on the left MCA (Fig. 2D).