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AJNR - American Journal of Neuroradiology

Published ahead of print on February 22, 2008
doi: 10.3174/ajnr.A1022

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Intrasellar Rupture of a Paraclinoid Aneurysm with Subarachnoid Hemorrhage: Usefulness of MR Imaging in Diagnosis

M. Ribeiro^a, P. Howard^b, R. Willinsky^b, K. ter Brugge^b, R. Agid^b, L. Thines^c and L. da Costa^b

^a Department of Neuroradiology, Hospital São Marcos, Braga, Portugal
^b Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
^c Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada

View larger version (112K): [in this window] [in a new window]   Fig 1. A, Axial unenhanced CT shows diffuse symmetric subarachnoid hemorrhage. B, Questionable hyperattenuation at the level of the sella turcica is difficult to interpret given adjacent streak artifact. C, Frontal view of right internal carotid angiogram shows MCA bifurcation and paraclinoid aneurysms. D, 3D right ICA angiogram in lateral view reveals the paraclinoid aneurysm arising distal to the ophthalmic artery but pointing inferiorly below the plane of the ophthalmic artery.

View larger version (72K): [in this window] [in a new window]   Fig 2. A, Axial CT angiography shows the sac of the paraclinoid aneurysm (arrow) adjacent to the sella, without intervening septum. B, At the level of the superior margin of the optic strut (arrowhead), the aneurysmal neck and body extend posteriorly from the ICA.

View larger version (179K): [in this window] [in a new window]   Fig 3. Coronal T1- and T2-weighted 3T MR imaging through anterior (A,C) and posterior (B,D) sella. C, Junction of aneurysmal neck and body (*), which projects partly superior to dural ring (interface with CSF) and partly inferior to the dural ring (interface with blood within sella). Note the large sella turcica filled with blood (arrows) showing homogeneous hypointensity on T2-weighted images and isointensity on T1-weighted images, consistent with intracellular deoxyhemoglobin. Note that the blood in the suprasellar cisterns has different signal intensity. D, The infundibulum can be traced to the compressed pituitary.