PMC4014823_01
Initial presentation with diffuse subarachnoid hemorrhage around basal cisterns (a) and CTA demonstrating a basilar apex aneurysm (arrow head) as probable source and three additional anterior circulating aneurysms (arrows)
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F1
Computed tomography angiography (CTA) demonstrated diffuse SAH and intraventricular haemorrhage [Figure 1a]. Four aneurysms were identified including an 8 mm basilar apex aneurysm, a 7 mm anterior communicating artery (AComm) aneurysm, and smaller bilateral middle cerebral artery aneurysms [Figure 1b].
Postbleed day 1 (PBD#1) catheter angiogram demonstrating irregular basilar apex without evidence of aneurysm filling indicating spontaneous thrombosis (a: AP and b: lateral views; c and d 3D reconstructions in AP and lateral views). PBD#8 catheter angiogram again did not show aneurysm filling (e and f). Note significant vasospasm of basilar trunk in (e). Lateral view is magnified to show persistent thrombosis of basilar apex aneurysm (f)
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F2
Catheter angiography on postbleed day (PBD) #1 showed irregularity at the basilar apex with no filling of the dome of the basilar aneurysm, consistent with spontaneous thrombosis [Figure 2a-d]. Catheter angiography on PBD #8 showed moderate vasospasm of the basilar artery, fullness of the basilar apex with less irregularity of the apex, but no filling of the dome or neck of the aneurysm [Figure 2e-f].
Rapid decline of patient on PBD#26 demonstrated new SAH on CT scan (a) and redemonstration of previously thrombosed basilar apex aneurysm on catheter angiography (b: 3D reconstruction; c: AP and d: lateral views), which was subsequently coil embolized (e: AP, f: lateral views). Arrowheads demonstrate coil mass in e and f.
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F3
CT showed new acute SAH in the fourth ventricle and in the prepontine cistern, extending inferiorly along the medulla [Figure 3a]. Catheter angiography on PBD #27 showed recanalization of the basilar apex aneurysm [Figure 3b-d]. The basilar artery aneurysm was treated with coil embolization [Figure 3e and f].