PMC3130466_01
CT and angiographic evaluation. Nonenhanced head CT demonstrates acute hemorrhage within the frontal horns of the lateral ventricles (a) and in the fourth ventricle (b). Catheter cerebral angiography with a right internal carotid injection in the oblique view shows aneurysmal dilatation along the distal aspect (arrow) of a lenticulostriate artery (arrowheads) arising from the A1 segment of the right anterior cerebral artery (ACA). Three-dimensional vessel reconstruction (d) clearly demonstrates the origin of the parent medial lenticulostriate vessel from the horizontal segment of the ACA with aneurysmal dilatation distally (arrow)
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F1
Noncontrast head computed tomography (CT) revealed symmetric IVH with moderate blood in the lateral, third, and fourth ventricles [Figure 1a and 1b]. Catheter cerebral angiography was performed revealing the hemorrhage source to be a 4 x 2.6 mm aneurysm of a distal medial lenticulostriate artery arising from the proximal A1 segment of the right anterior cerebral artery (ACA) [Figure 1c and d].
Angiographic fibromuscular dysplasia. A characteristic "string of beads" appearance is seen in the right (a) and left (b) cervical internal carotid arteries in the lateral view after an internal carotid artery contrast injection. Similarly, vessel contour irregularity is also demonstrated in the cervical vertebral artery in AP view after a left vertebral contrast injection
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F2
Additional angiographic findings included two saccular right-sided MCA aneurysms (4 mm and 2 mm), one fusiform aneurysm of the right-sided MCA posterior temporal branch (1-1.5 mm), and fibromuscular dysplasia (FMD) of the extracranial carotid and vertebral arteries [Figure 2].
Follow-up imaging. Catheter angiography performed 5 days after initial presentation demonstrates the interval resolution of the aneurysmal dilatation of the distal tip of the right medial lenticulostriate artery (arrowheads; a). Repeat noncontrast head CT performed 2.5 months after discharge shows the resolution of the prior intraventricular hemorrhage (b and c)
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F3
Repeat catheter angiography 5 days after initial presentation showed no evidence of the previously noted distal medial lenticulostriate aneurysm [Figure 3a]. A follow-up noncontrast head CT performed 2.5 months after discharge showed no stigmata of the IVH [Figure 3b and c].