PMC6744794_01
Dose distribution of planning axial heavy T2-weighted magnetic resonance imaging for treatment planning to the left trigeminal nerve (arrow) from a copy of printed images from old medical records. Fourth ventricle (arrow head).
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F1
She received 45 Gy at 50% isodose at the proximal cisternal extent of the left trigeminal nerve [Figure 1].
Magnetic resonance imaging (a and b) at the first emergency department, and digital subtraction angiography before (c) and after (d) mechanical embolectomy. Diffusion-weighted image (a) shows a hyperintensity in the left insular cortex and a slight hyperintensity in the left middle cerebral artery territory. Magnetic resonance angiography (b) shows occlusion in the horizontal segment of the left middle cerebral artery. Digital subtraction angiography shows occlusion of the horizontal segment of the left middle cerebral artery (c). Complete recanalization is performed using the Solitaire FR/2 revascularization device (d). Onset to needle time: 1 h 30 min, onset to reperfusion time: 3 h 13 min, puncture to reperfusion time: 0 h 18 min.
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F2
MCA territory [Figure 2a]. Magnetic resonance angiography (MRA) revealed occlusion of the horizontal segment of the left MCA [Figure 2b]. MCA occlusion, even after t-PA injection [Figure 2c]. Mechanical thrombectomy was then performed using the Solitaire FR/2 revascularization device (Medtronic, Minneapolis, MN, USA; onset to reperfusion time: 3 h 13 min), and complete recanalization was achieved [Figure 2d].
Computed tomography just after thrombectomy shows subarachnoid hemorrhage and a hematoma in the left cerebellar hemisphere (a and b). Computed tomography angiography could not confirm the presence of aneurysms (c and d).
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F3
Brain CT performed immediately after mechanical thrombectomy revealed subarachnoid hemorrhage (SAH) with a hematoma in the left cerebellar hemisphere [Figure 3a and b]. As CT angiography (CTA) could not confirm the presence of an aneurysm [Figure 3c and d], DSA of the posterior cerebral circulation was performed, and it revealed a small irregular-shaped aneurysm at the branching site of the left circumflex branch of the anterior inferior cerebellar artery [Figure 4a].
Cerebral angiography of the posterior cerebral circulation performed after computed tomography shows aneurysm-like dilatation in the peripheral portion of the left circumflex branch at the distal position of the anterior inferior cerebellar artery. Coil embolization is performed for aneurysmal dilatation. (a) Cerebral angiography shows aneurysm-like dilatation (arrow). (b and c) Postembolization angiography shows complete obliteration of the aneurysm (arrow).
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F4
As CT angiography (CTA) could not confirm the presence of an aneurysm [Figure 3c and d], DSA of the posterior cerebral circulation was performed, and it revealed a small irregular-shaped aneurysm at the branching site of the left circumflex branch of the anterior inferior cerebellar artery [Figure 4a]. Thus, we treated it using coil embolization [Figure 4b and c] and performed surgical hematoma removal and decompressive craniectomy.