PMC3896651_01
Nonenhanced CT performed at first admission, 5 hours after headache onset. Subtle signs of subarachnoid hemorrhage are evident (arrow), and there is also slight dilatation of the temporal horns of the lateral ventricles, suggesting hydrocephalus.
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F1
Nonenhanced computed tomography (CT) showed subtle signs of subarachnoid hemorrhage (SAH) with some frontobasal subarachnoid blood (Fig. 1).
Digital-subtraction angiography performed during the endovascular treatment procedure, 10 hours after the onset of subarachnoid hemorrhage. A: Injection of the left internal carotid artery showing a small aneurysm at the junction of segments 1 and 2 of the anterior cerebral artery. B: Simultaneous injection of both internal carotid arteries shows complete occlusion by coiling of the aneurysm.
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F2
During the procedure, both internal carotid arteries were catheterized to optimize depiction of the local vascular anatomy (Fig. 2).
MRI was performed at re-admission, 25 days after endovascular treatment of anterior cerebral artery aneurysm. A: T2-weighted MRI images showing subcortical areas with abnormal signal intensities and swelling in the left hemisphere. (B) Diffusion-weighted (B1000) and (C) apparent-diffusion-coefficient (ADC) maps show no diffusion restriction and elevated ADC values in the abnormal areas, suggesting vasogenic edema. D: T1-weighted MRI images after gadolinium administration show patchy enhancement of the abnormalities.
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F3
Magnetic resonance imaging (MRI) showed vasogenic edema mostly subcortically in the entire left hemisphere, with a preference for the watershed areas (Fig. 3). After gadolinium administration there was patchy enhancement in the lesions (Fig. 3).
MRI was performed 7 months after endovascular treatment of the anterior cerebral artery aneurysm. A: T2-weighted MRI images show considerably diminished reversible posterior leukoencephalopathy syndrome lesions, with only minimal residual enhanced-signal regions in the left hemisphere. B: T1-weighted MRI images after gadolinium administration show no enhancement of the abnormalities.
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F4
However, MRI performed 7 months after the first presentation showed further reduction of the lesions, with a single small area of signal enhancement remaining in the left frontal lobe (Fig. 4).