Case report
Actively bleeding intracranial aneurysm demonstrated by CT angiography

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Abstract

CT angiography (CTA) is increasingly being utilized in the initial diagnosis of subarachnoid hemorrhage. While active bleeding from an intracranial aneurysm has been demonstrated on conventional angiography, CT angiogram findings of active aneurysmal hemorrhage are not well described. We present a case of an actively bleeding anterior communicating artery aneurysm demonstrated by CT angiography. The initial CTA demonstrated the extravasation of contrast from the anterior communicating artery. A second CT scan less than 1 h later confirmed the ongoing hemorrhage, with extension of hemorrhage into the subarachnoid cisterns and the ventricular system. Recognition of active aneurismal hemorrhage by CTA may modify plan of treatment and follow-up imaging.

Introduction

CT angiography (CTA) is increasingly being utilized in the initial diagnosis of subarachnoid hemorrhage (SAH) [4], [5]. As such, subtle nuances and rare findings on CTA are being recognized and described. Active bleeding from an intracranial aneurysm at the time of imaging occurs rarely and has been demonstrated on conventional cerebral angiography. CT angiogram findings of active aneurysmal hemorrhage are not well described. Recognition of active aneurysmal hemorrhage by CTA may modify plan of treatment and following-up imaging. We present a case of an actively bleeding anterior communicating artery aneurysm demonstrated by CT angiography.

Section snippets

Case report

A 67-year-old man presented to the emergency room with severe headache and decreased mental status. Non-contrast CT scan of the head revealed diffuse cisternal subarachnoid hemorrhage (Fig. 1). CTA was then obtained (Fig. 2A). The CTA suggested active contrast extravasation from an anterior communicating artery aneurysm. Because the aneurysm had a wide neck, it was felt best suited for surgical repair rather than endovascular coiling. Plans for urgent craniotomy and clipping were made, but the

Discussion

CT angiography is an increasingly utilized modality in the diagnostic workup of intracranial aneurysms and subarachnoid hemorrhage. In comparison to cerebral angiography, CTA has the advantages of being non-invasive and readily available. Improvements in CT technology and widespread incorporation and availability of these technologies in clinical practice have contributed to the increasing use of CTA. Furthermore, CTA is commonly of sufficient quality and sensitivity to supplant the need for

Conclusion

This case demonstrates the appearance on CTA of active bleeding from a ruptured intracranial aneurysm. Recognition of this finding on CTA may modify treatment plans, timing and decision-making.

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  • Application of multislice computed tomographic angiography in diagnosis and treatment of intracranial aneurysms

    2010, Clinical Neurology and Neurosurgery
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    Therefore, prompt detection and evaluation of the aneurysm is critical for determining the appropriate endovascular or neurosurgical intervention. Computed tomographic angiography (CTA) is playing an increasing role in the screening of patients suspected of having intracranial aneurysms [8–14]. CTA is relatively inexpensive and can be performed rapidly immediately after routine unenhanced computed tomography (CT) of the brain in patients with suspected aneurysmal SAH, and CTA has shown potential in the minimally invasive detection of intracranial aneurysms [15,16].

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