PMC5909098_01
(a and b) NCCT of the head (axial and sagittal) suggestive of interhemispheric bleed and corpus callosal hematoma. (c) MR angiography brain suggestive of mirror image of bilateral DACA aneurysm. (d) MR angiography brain suggestive of mirror image of bilateral DACA aneurysm (TOF)
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F1
Patient came with noncontrast computed tomography (NCCT) of the head [Figure 1a and b]. Magnetic resonance angiography (MRA) of the brain from outside was suggestive of aneurysm on both distal anterior cerebral artery (ACA) at the junction of pericallosal and callosomarginal arteries [Figure 1c and d].
(a and b) DSA of the head showing right DACA aneurysm at the junction of right pericallosal and callosomarginal artery directing anterosuperiorly. (c and d) DSA of the head showing left ICA with left DACA aneurysm. (e) Intraoperative photograph showing clipped DACA aneurysms of both sides. (f) NCCT of the head on the 4th postoperative day showing right posterior frontal infarct. (g) NCCT head after 1 month showing resolving right posterior frontal infarct
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F2
Focal segmental areas of spasm were noted in both pericallosal arteries [Figure 2a-d]. Right-sided DACA aneurysm was identified and clipped in a similar manner [Figure 2e]. CT of the head was done, which was suggestive of right posterior frontal venous infarct and bleed [Figure 2f]. NCCT head performed after 1 month was suggestive of resolving hematoma without any evidence of infarct [Figure 2g].