case_images: PMC11283649_01
case_images: (A, B) Noncontrast head computed tomography(CT) shows hematoma in the left frontal lobe, temporal lobe, and basal ganglia. (C-E) CTA axial source images and coronal and sagittal MPR images show spot sign (yellow arrow) in hematoma before surgery. (F) No intracranial vascular aneurysm were observed on the CTA.
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case_images: Noncontrast computed tomography (CT) showed a 50 mL hematoma in the left frontal lobe, temporal lobe, and basal ganglia without hyperdensity (except for calcium analogs) (Figure 1A and B), while CTA axial source images and coronal and sagittal multi-planar reconstruction images showed a spot suspended in the frontal lobe hematoma without vascular connection to the surrounding structures or with a density greater than 120 Hounsfield units (Figure 1C-E). No aneurysms affecting the left cerebral arteries or their branches were observed on CTA 3-dimensional reconstruction (Figure 1F).
case_images: (A, B) Intraoperative microscopic images revealed the presence of a 3 mm-sized saccular tissue (white arrow) resembling an aneurysm at the superior aspect of the hematoma cavity; its complete exposure led to the rupture and active hemorrhage (white asterisk). (C, D) The HE stain demonstrated that the wall of the aneurysm-like tissue was composed of organized thrombosis and fibrosis, as well as chronic inflammatory cell infiltration, but without intima, internal elastic laminae, or adventitia.
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case_images: After evacuation of the hematoma, under an intraoperative microscope, a piece of 3 mm saccular tissue resembling an aneurysm arose from a microvessel (Figure 2A). The process of exposing its complete form resulted in its rupture and bleeding (Figure 2B). Hematoxylin-eosin (HE) staining demonstrated that the wall of the aneurysm-like tissue was composed of organized thrombi and fibrosis, as well as chronic inflammatory cell infiltration, but lacked the intima, internal elastic laminae, and adventitia (Figure 2C and D).
case_images: (A, B) The NCCT and CTA axial source images revealed a successful and thorough evacuation of the hematoma, with no evidence of the CTA spot sign.
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case_images: At the 19-day follow-up examination, postoperative CTA confirmed that the hematoma had been thoroughly evacuated, and there was no sign of a CTA spot sign (Figure 3A and B).