PMC5779736_01
(A) Initial photograph disclosing the bilateral sixth nerves palsy. (B) Emergent CT scan demonstrating thick cisternal hemorrhage, in particular prepotine cistern without ventriculomegaly. (C) Emergent CT angiography demonstrating the aneurysm on the left VA (white arrow). (D) Left vertebral angiography showing a dissecting aneurysm of the VA (white arrow). (E) Resolution of hemorrhage is noted in the prepontine cistern. (F) Postdeployment and coil embolization, DSA revealing complete occlusion of the left vertebral aneurysm. CT = computed tomography, VA = vertebral artery.
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F1
He was alert and followed some commands with slight nuchal rigidity and bilateral abducens nerve palsy (Fig. 1A). He also had marked urinary retention but without lower abdominal pain. Emergent computed tomography (CT) confirmed a subarachnoid hemorrhage filling the anterior supratentorial, prepontine, and perimesencephalic cisterns (Fig. 1B). Emergency CT angiography demonstrated a dissecting aneurysm on the left VA (Fig. 1C). The patient received a digital subtraction angiography the next day and the aneurysm was embolized with a coil (Fig. 1D). Four weeks later, another angiography found that compared with previous images and CT scans, the vertebrobasilar artery showed hemorrhage resolution in the prepontine cistern (Fig. 1E). Meanwhile, follow-up angiography found complete occlusion of the vertebral aneurysm (Fig. 1F).