PMC4508710_01
Computed tomography scans on admission show subarachnoid hemorrhage in the basal cistern (A) and a small hemorrhage in the Sylvian fissure (B). Intraventricular hemorrhage with hydrocephalus was also found (B).
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F1
C-reactive protein, 11.6 mg/dl; aspartate aminotransferase: 222 U/l; alanine aminotransferase: 144 U/l; gamma-glutamyl transpeptidase: 108 U/l; beta-D-glucan: 29.5 pg/ml; and candida antigen: positive. Computed tomography (CT) demonstrated diffuse SAH predominantly located in the basal cistern and enlargement of the ventricle (Fig. 1), which led to a diagnosis of SAH corresponding to Hunt & Kosnik grade 4, World Federation of Neurosurgical Societies grade V, and Fisher group 4.
Left vertebral artery angiograms show a basilar artery aneurysm originating from the right basilar-superior cerebellar artery junction (arrow). A: towne view, B: translucent 3-D image.
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F2
Cerebral angiogram revealed a wide-necked saccular aneurysm, 7.7 x 8.3 x 7.0 mm in size, originating from the right basilar-superior cerebellar artery (SCA) junction (Fig. 2).
A: Left vertebral artery angiograms reveal a sparse density of coil cast showing incomplete obliteration of the aneurysm sac (arrow). B: Subtracted image shows disappearance of the aneurysmal body indicating diversion of the aneurysm space from the blood stream (arrow).
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F3
We finished the coil embolization, as the preventive effect of aneurysmal re-rupture had been achieved in this case (Fig. 3).
Magnetic resonance angiography one year after intravascular treatment does not show recurrence of basilar artery aneurysm (arrow). A: towne view, B: lateral view.
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F4
Magnetic resonance angiography performed 1 year after intravascular surgery did not show recurrence of aneurysm (Fig. 4).