PMC6499460_01
Case #1 Presenting axial non-contrast CT scan showing large amount of IVH
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F1
Computed tomography (CT) [Figure 1] revealed a right parietal intraparenchymal hemorrhage with IVH.
Case #1 Catheter angiography showed a Cognard type IV dAVF [(a) Lateral and (b) A/P Views]
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F2
Catheter angiography showed a Cognard type IV dural arteriovenous fistula (dAVF) [Figure 2], which was embolized the next day and cured [Figure 3].
Case #1 Catheter angiography showing cured dAVF [(a) A/P and (b) Lateral Views]
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F3
Catheter angiography showed a Cognard type IV dural arteriovenous fistula (dAVF) [Figure 2], which was embolized the next day and cured [Figure 3].
Case #1 Catheter angiography of initial left ICA injection [(a) A/P view and (b) Lateral View]
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On PBD 29, he became aphasic and angiogram now showed severe left internal carotid artery vasospasm [Figures 4 and 5], which was in a different vascular distribution than his prior vasospasm episode.
(a) Catheter angiography from PBD 29 showing severe supraclinoid left ICA vasospasm. (b) Balloon inflation angioplasty of vasospasm segment. (c) Improvement of vasospasm s/p balloon angioplasty of left ICA
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F5
On PBD 29, he became aphasic and angiogram now showed severe left internal carotid artery vasospasm [Figures 4 and 5], which was in a different vascular distribution than his prior vasospasm episode.
PMC6499460_02
Case #2. Presenting axial non-contrast CT scan showing primary 3rd ventricular IVH
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F6
He was presented to the ER with severe headaches and was found to again have an intraventricular hemorrhage on CT scan [Figure 6].
Case #2 MRI showing typical appearance of cavernoma in the 3rd ventricle. [(a) Sagittal T2, (b) Axial T2, (c) Sagittal T1 with contrast]
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F7
Angiogram [Figure 7] was again negative and an MRI [Figure 8] showed what appeared to be a cavernous malformation with of the third ventricle with surrounding hemorrhage and layering in the atria of the occipital horns bilaterally.
Case #1 (a) Initial Catheter angiography AP projection of left ICA. (b) Initial Catheter angiography lateral projection of left ICA
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F8
Angiogram [Figure 7] was again negative and an MRI [Figure 8] showed what appeared to be a cavernous malformation with of the third ventricle with surrounding hemorrhage and layering in the atria of the occipital horns bilaterally.
Case #2 (a) Catheter angiography from PBD 22 showing a dominant left A1 segment with vasospasm. (b) Improvement of vasospasm s/p balloon angioplasty of left A1 segment
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F9
His hospital course was complicated by cerebral vasospasm on PBD 22, which failed medical management and required interventional treatment by angioplasty of the left vertebral artery, bilateral A1, right M1, and a verapamil injection to the right ICA [Figure 9].