Case reportActively bleeding intracranial aneurysm demonstrated by CT angiography
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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