PMC4533423_01
Neuroimagings at the onset of subarachnoid hemorrhage. A: Axial computed tomography scan demonstrating diffuse subarachnoid hemorrhage in the basal cistern and bilateral sylvian fissure. B, C: Preoperative right carotid angiogram of (B) right oblique view showing a 6.5-mm saccular aneurysm attached to the posterior communicating segment of the right internal carotid artery, and (C) left oblique view showing major arteries without significant vasospasm.
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F1
A noncontrast head computed tomography (CT) demonstrated SAH mainly in the right sylvian fissure (Fig. 1A), and subsequent intraarterial digital subtraction angiography (DSA) confirmed the presence of a 6.5-mm-diameter, saccular aneurysm at the posterior communicating segment of the right internal carotid artery (Fig. 1B).
A: Postoperative right carotid arteriogram obtained at day 9 showing severe vasospasm in the right middle cerebral artery and anterior cerebral artery (arrow heads). B: Axial computed tomography scan obtained at day 15 showing cerebral infarction in the right corona radiata. C-F: Axial magnetic resonance images of (C, D) T1-weighted image and (E, F) T2-weighted image 8 months after onset from subarachnoid hemorrhage indicating resultant cerebral infarction in the right prefrontal cortex (middle frontal gyrus) and corona radiata with surrounding edema.
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F2
DSA revealed severe diffuse vasospasm in the right middle cerebral artery and right anterior cerebral artery (Fig. 2A). Despite several treatments, cerebral infarction in the right and prefrontal cortex and corona radiata resulted (Fig. 2B), and she was afflicted by persistent disturbance of consciousness.