PMC5287960_01
Preoperative MRA (A) shows unruptured intracranial aneurysm on left MCA bifurcation. Immediate postoperative head CT shows air density on the left frontotemporal area with a clip artifact (B). Follow-up head CT obtained 20 hours after clipping shows bilateral RCH with the characteristic zebra sign on superior folia and a massive mass effect on the fourth ventricle (C,D). CT = computed tomography, MCA = middle cerebral artery, RCH = remote cerebellar hemorrhage.
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F1
A-62-year-old male had an 4 mm unruptured left MCA bifurcation saccular aneurysm incidentally identified during work-up for a headache (Fig. 1A). A routine immediate postoperative head computed tomography (CT) showed no abnormal findings except air density on the left frontotemporal area due to perioperative CSF drainage and the patient's neurological status was unchanged from the preoperative level (Fig. 1B). Follow-up head CT scan performed 20 hours after surgery revealed bilateral RCH with a "zebra sign" (Fig. 1C and D).