case_images: PMC4857302_01
case_images: (a) Admission electrocardiogram showing sinus bradycardia (sinus rate   40 beats/min) with early repolarization in inferior limb leads II, III, aVF. (b) Pre-discharge electrocardiogram showing normalization of sinus bradycardia (sinus rate   66 beats/min).
case_images: 10.1177_2050313X15597355-fig1.jpg
case_images: PMC4857302_01_10.1177_2050313X15597355-fig1.jpg
case_images: fig1-2050313X15597355
case_images: He first sought medical attention at secondary care center where he was detected to have sinus bradycardia (Figure 1(a)). NCCT also diagnosed a well-defined round to oval focal hyperdense lesion in the left sylvian fissure with senile cerebral atrophy (Figure 2, image 1). A final NCCT (Brain) and electrocardiogram done 1 day prior to discharge showed resolution of IVH (Figure 2, image 3) and normalization of cardiac rate and rhythm (Figure 1(b)), respectively.
case_images: Image 1 (a-c) is index NCCT showing round to oval focal hyperdense lesion in the left sylvian fissure, perisylvian subarachnoid leak, and senile cerebral atrophy; image 2 (d-f) and image 3 (g-i) are post procedural NCCTs showing metal artifacts originating from the coils in left fronto-temporal region causing beam hardening artifacts.
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case_images: PMC4857302_01_10.1177_2050313X15597355-fig2.jpg
case_images: fig2-2050313X15597355
case_images: NCCT also diagnosed a well-defined round to oval focal hyperdense lesion in the left sylvian fissure with senile cerebral atrophy (Figure 2, image 1). Follow-up NCCT (Brain) performed 2 days after embolization revealed minimal intraventricular hemorrhage (IVH) with metal artifacts of the coils in the aneurysm (Figure 2, image 2). A final NCCT (Brain) and electrocardiogram done 1 day prior to discharge showed resolution of IVH (Figure 2, image 3) and normalization of cardiac rate and rhythm (Figure 1(b)), respectively.
case_images: CT cerebral angiography with 3D reconstruction revealed narrow necked bilobed aneurysm arising from the left MCA at the M2-M3 junction with the distal branches seen arising from fundus as well as the base of aneurysm.
case_images: 10.1177_2050313X15597355-fig3.jpg
case_images: PMC4857302_01_10.1177_2050313X15597355-fig3.jpg
case_images: fig3-2050313X15597355
case_images: A subsequent computed tomography (CT) cerebral angiography (Figure 3) for further evaluation of intracerebral aneurysm revealed narrow necked (2.8 mm) bilobed aneurysm (10.9 x 8.0 x 6.4 mm3) arising from the left middle cerebral artery (MCA) at the M2-M3 junction with the distal branches seen arising from fundus as well as the base of aneurysm. A final NCCT (Brain) and electrocardiogram done 1 day prior to discharge showed resolution of IVH (Figure 2, image 3) and normalization of cardiac rate and rhythm (Figure 1(b)), respectively.
case_images: (a) Digital subtraction angiogram (DSA) showing aneurysm of left MCA. (b) Advancement of a guide-wire and micro-catheter in roadmap. (c and d) Deployment of platinum coils in the aneurysm. (e-h) DSA images in multiple projections showing complete obliteration of aneurysm without any leak.
case_images: 10.1177_2050313X15597355-fig4.jpg
case_images: PMC4857302_01_10.1177_2050313X15597355-fig4.jpg
case_images: fig4-2050313X15597355
case_images: A postembolization angiogram revealed complete obliteration of the aneurysm (Figure 4(a)-(h)).