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AJNR - American Journal of Neuroradiology

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Acute Vasogenic Edema Induced by Thrombosis of a Giant Intracranial Aneurysm: A Cause of Pseudostroke after Therapeutic Occlusion of the Parent Vessel

Dima Hammoud^a, Philippe Gailloud^a, Alessandro Olivi^b and Kieran J. Murphy^a

^a Department of Interventional Neuroradiology, the Johns Hopkins Medical Institutions, Baltimore, MD
^b Cerebrovascular Surgery, the Johns Hopkins Medical Institutions, Baltimore, MD

View larger version (115K): [in a new window]   FIG 1. Digital subtraction angiogram of the left common carotid artery shows a giant cavernous ICA aneurysm, pointing laterally and superiorly.

View larger version (55K): [in a new window]   FIG 2. Axial nonenhanced CT scan of the brain reveals a hyperattenuating thrombosed aneurysm cavity (open arrow) in the left cavernous sinus region. It extends into the middle cranial fossa, with surrounding ill-defined hypoattenuation in the white matter (solid arrows).

View larger version (108K): [in a new window]   FIG 3. Coronal fluid-attenuated inversion recovery (FLAIR) image shows white matter hyperintensity surrounding the thrombosed aneurysmal cavity in the cavernous sinus (arrows).

View larger version (108K): [in a new window]   FIG 4. Axial DW images obtained at the same time as Figure 3 show no restricted diffusion in the white matter surrounding the aneurysmal cavity (arrows). The hyperintensity seen on FLAIR images is compatible with vasogenic rather than cytotoxic edema.