PMC7398370_01
a Non-contrast CT head demonstrating the patient's initial presenting scan with primarily right-sided subarachnoid hemorrhage. b CTA reconstructed images demonstrating normal bilateral vessel caliber
41016_2018_141_Fig1_HTML.jpg
PMC7398370_01_41016_2018_141_Fig1_HTML.jpg
Fig1
CT imaging demonstrated subarachnoid hemorrhage (Fig. 1a) from a right posterior communicating artery aneurysm. Importantly, no vasospasm was seen in the CTA from admission (Fig. 1b).
a Postoperative angiogram demonstrating clip occlusion. L ICA injection demonstrated no evidence of spasm. b R MCA and ACA concerning for mild non-flow-limiting spasm. c Repeat angiogram after neurologic deterioration demonstrates progressive narrowing of right MCA and ACA vasculature
41016_2018_141_Fig2_HTML.jpg
PMC7398370_01_41016_2018_141_Fig2_HTML.jpg
Fig2
Post-operative angiogram showed no evidence of flow-occluding spasm (Fig. 2a, b). An angiogram was performed (Fig. 2c), which showed vasospasm of the right ICA, MCA, and ACA, which was treated with IA verapamil.
a Axial FLAIR demonstrating significant amount of predominantly left-sided parieto-occipital vasogenic edema. b Axial FLAIR demonstrating significant amount of predominantly left-sided parieto-occipital vasogenic edema. c T2 axial MRI demonstrating significant amount of predominantly left-sided parieto-occipital vasogenic edema. d T2 axial MRI demonstrating significant amount of predominantly left-sided parieto-occipital vasogenic edema
41016_2018_141_Fig3_HTML.jpg
PMC7398370_01_41016_2018_141_Fig3_HTML.jpg
Fig3
When her aphasia failed to resolve, an MRI of her brain was performed which showed left parieto-occipital vasogenic edema suggestive of PRES (Fig. 3).
CTA reconstructions at 6 months post-hemorrhage demonstrating persistently occluded aneurysm and resolution of vasospasm
41016_2018_141_Fig4_HTML.jpg
PMC7398370_01_41016_2018_141_Fig4_HTML.jpg
Fig4
A year after discharge, she remained neurologically intact and a CTA demonstrated complete resolution of her PRES-associated cerebral edema as well as no recurrence of her aneurysm or vasospasm (Fig. 4).