PMC4192925_01
Skull CT revealing SAH in basal cisterns, hydrocephalus and hemoventricle in posterior fossa; brain MR disclosing laminar hemorrhage in T1 sagittal and axial images, just ahead of cervicomedullary junction; cerebral angiogram: In A, anteroposterior view of posterior circulation with no abnormalities. In B, lateral view. In C, a small aneurysm in ASA is noted, which is better exposed in D
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F1
She underwent a computed tomography (CT) scan of the head, which revealed SAH, intraventricular hemorrhage, and hydrocephalus [Figure 1]. Magnetic resonance imaging (MRI) of the neck revealed a laminar bleed at the right anterior cervicomedullary junction [Figure 1]. At that time, a 2-mm saccular aneurysm was found in the ASA, presumably the cause of SAH [Figure 1].
An angiotomography of intracranial vessels, which could not identify the ASA aneurysm
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F2
CT angiography performed at the same time could not display the aneurysm clearly [Figure 2].
Amplified image of ASA aneurysm at diagnosis, with 2 mm of diameter. At right, control angiogram 3 months after bleeding, revealing normal posterior circulation
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F3
Monthly routine angiograms revealed resolution of the aneurysm 90 days after bleeding (angiograms at 1- and 2-month follow-up were quite similar), which was highly suggestive of vascular dissection [Figure 3].