PMC4857302_01
(a) Admission electrocardiogram showing sinus bradycardia (sinus rate   40 beats/min) with early repolarization in inferior limb leads II, III, aVF. (b) Pre-discharge electrocardiogram showing normalization of sinus bradycardia (sinus rate   66 beats/min).
10.1177_2050313X15597355-fig1.jpg
PMC4857302_01_10.1177_2050313X15597355-fig1.jpg
fig1-2050313X15597355
He first sought medical attention at secondary care center where he was detected to have sinus bradycardia (Figure 1(a)). NCCT also diagnosed a well-defined round to oval focal hyperdense lesion in the left sylvian fissure with senile cerebral atrophy (Figure 2, image 1). A final NCCT (Brain) and electrocardiogram done 1 day prior to discharge showed resolution of IVH (Figure 2, image 3) and normalization of cardiac rate and rhythm (Figure 1(b)), respectively.
Image 1 (a-c) is index NCCT showing round to oval focal hyperdense lesion in the left sylvian fissure, perisylvian subarachnoid leak, and senile cerebral atrophy; image 2 (d-f) and image 3 (g-i) are post procedural NCCTs showing metal artifacts originating from the coils in left fronto-temporal region causing beam hardening artifacts.
10.1177_2050313X15597355-fig2.jpg
PMC4857302_01_10.1177_2050313X15597355-fig2.jpg
fig2-2050313X15597355
NCCT also diagnosed a well-defined round to oval focal hyperdense lesion in the left sylvian fissure with senile cerebral atrophy (Figure 2, image 1). Follow-up NCCT (Brain) performed 2 days after embolization revealed minimal intraventricular hemorrhage (IVH) with metal artifacts of the coils in the aneurysm (Figure 2, image 2). A final NCCT (Brain) and electrocardiogram done 1 day prior to discharge showed resolution of IVH (Figure 2, image 3) and normalization of cardiac rate and rhythm (Figure 1(b)), respectively.
CT cerebral angiography with 3D reconstruction revealed narrow necked bilobed aneurysm arising from the left MCA at the M2-M3 junction with the distal branches seen arising from fundus as well as the base of aneurysm.
10.1177_2050313X15597355-fig3.jpg
PMC4857302_01_10.1177_2050313X15597355-fig3.jpg
fig3-2050313X15597355
A subsequent computed tomography (CT) cerebral angiography (Figure 3) for further evaluation of intracerebral aneurysm revealed narrow necked (2.8 mm) bilobed aneurysm (10.9 x 8.0 x 6.4 mm3) arising from the left middle cerebral artery (MCA) at the M2-M3 junction with the distal branches seen arising from fundus as well as the base of aneurysm. A final NCCT (Brain) and electrocardiogram done 1 day prior to discharge showed resolution of IVH (Figure 2, image 3) and normalization of cardiac rate and rhythm (Figure 1(b)), respectively.
(a) Digital subtraction angiogram (DSA) showing aneurysm of left MCA. (b) Advancement of a guide-wire and micro-catheter in roadmap. (c and d) Deployment of platinum coils in the aneurysm. (e-h) DSA images in multiple projections showing complete obliteration of aneurysm without any leak.
10.1177_2050313X15597355-fig4.jpg
PMC4857302_01_10.1177_2050313X15597355-fig4.jpg
fig4-2050313X15597355
A postembolization angiogram revealed complete obliteration of the aneurysm (Figure 4(a)-(h)).