case_images: PMC9168302_01
case_images: A 36-year-old male admitted for aortic root abscess treatment and developed slurred speech. Noncontrast brain CT (a) demonstrated trace of subarachnoid hemorrhage over the right frontal convexity (red arrow), CTA (b) demonstrated tiny outpouching (black arrow) in a distal branch of the right middle cerebral artery in the region of the subarachnoid hemorrhage. Coronal FLAIR sequence MRI (c) confirmed the subarachnoid hemorrhage (blue arrow). Cerebral angiogram (DSA) right ICA injection lateral view (d) showed an irregular 2 mm aneurysm (red circle) in the distal branch of the superior division of the right middle cerebral artery. The small aneurysm was better seen on 3D image (e) (red arrow) and on the microcatheter injection (blue arrow) (f) Pre-embolization and postembolization (g) image with the onyx cast filling the aneurysm (black arrow) and the supplying arterial pedicle. Follow-up 6 months postembolization right ICA injection lateral view (h) demonstrated complete occlusion of the aneurysm (blue circle) with maintained patency of the MCA.
case_images: SNI-13-185-g002.jpg
case_images: PMC9168302_01_SNI-13-185-g002.jpg
case_images: F2
case_images: He was found to have focal subarachnoid hemorrhage (SAH) secondary to the right middle cerebral artery (MCA) IIA with a trace of the right frontal convexity SAH on computed tomography (CT) [Figure 2a]. MCA near the SAH. MRI showed the SAH as high signal on FLAIR imaging [Figure 2c]. DSA confirmed an 1.9 x 1.8 mm irregular aneurysm in a distal branch of the superior division of the right MCA [Figures 2d-2g]. Follow-up angiogram after 6 months revealed persistent complete occlusion of the aneurysm [Figure 2h].
case_images: PMC9168302_02
case_images: A 19-year-old female with the left cranial nerve VI palsy, CTA axial image (a) demonstrates saccular aneurysm from communicating segment of the left ICA (red arrow). Coronal plane (b) shows small lobulated extension anterolaterally (red arrow) and thrombosed left ICA with no contrast opacification (yellow arrow) compared to the contra lateral side which is normally opacified (not labeled). Cerebral angiogram right vertebral injection preembolization (c) demonstrates a 10 mm irregular lobulated aneurysm (red arrow) extending from the dysplastic communicating segment of left ICA. Post coil embolization (d), there is complete occlusion of the aneurysm (red arrow). One-month follow-up cerebral angiogram right vertebral injection anterior-posterior projection (e and f) shows the coil pack to be stable (red arrow) with complete occlusion and no evidence of recurrence. Persistent antegrade flow in the left middle cerebral artery (black arrow).
case_images: SNI-13-185-g003.jpg
case_images: PMC9168302_02_SNI-13-185-g003.jpg
case_images: F3
case_images: On presentation, she was found to have a sixth nerve palsy and CT/CTA [Figures 3a and b] demonstrated left ICA occlusion from the bifurcation to the communicating segment (3b, yellow arrow). The right vertebral injection [Figure 3c] demonstrated a 10 mm irregular lobulated aneurysm extending from the dysplastic communicating segment of the left ICA. PCOM while preserving patency of the left PCOM and terminal ICA segment which were supplying the left MCA. Post coil embolization [Figure 3d], there was complete occlusion of the aneurysm. On a 1-month follow-up, cerebral angiogram [Figures 3e and f] single-vessel right vertebral injection demonstrated coil pack stability with complete occlusion and recurrence (red arrow).
case_images: PMC9168302_03
case_images: A 33-year-old female with decreased level of consciousness; noncontrast CT (a) demonstrates diffuse SAH in the prepontine cistern and the right Sylvian fissure (red arrows), in addition to intraparenchymal hemorrhage in the right temporal lobe (green arrow). On CTA (b), a 9 mm round aneurysm extending from the sidewall of the right P2/3 junction (red circle) is seen. DSA AP view pre coil embolization (c) shows the aneurysm (yellow arrow) and postembolization (d) complete occlusion with no flow at the coil pack (blue arrow).
case_images: SNI-13-185-g004.jpg
case_images: PMC9168302_03_SNI-13-185-g004.jpg
case_images: F4
case_images: CT head scan [Figure 4] demonstrated diffuse SAH in the prepontine cistern and the right Sylvian fissure [Figure 4a] in addition to parenchymal hemorrhage in the right temporal lobe (green arrow). CTA [Figure 4b] showed a 9 mm aneurysm extending from the sidewall of the right P2/3 junction (red circle). DSA [Figure 4c] showed the aneurysm (yellow arrow) and post coil embolization DSA [Figure 4d] illustrated complete aneurysm occlusion (blue arrow).