Presentation
Sudden status epilepticus and fainted.
Patient Data
Extensive acute subarachnoid hemorrhage at all basal cisterns, bilateral Sylvian fissures, bilateral frontal cerebral sulci and interhemispheric fissure. Thickened and larger hematoma noted at the right anterior parasagittal location with a few hypodensities/low attenuating area within the posterior aspect of this hematoma, which is presumed location of right anterior cerebral artery (ACA) or anterior communicating artery (ACOM).
A few punctate hemorrhage at right lentiform nucleus.
Basal cisterns are effaced with generalized cerebral edema.
Hydrocephalus with acute intraventricular hemorrhagic extension.
A narrow-necked saccular aneurysm at the anterior communicating artery, near to the junction between A1 and A2 segments of right ACA. Hypoplastic A1 segment of left ACA.
Dominant left vertebral artery. Small right vertebral artery.
Annotated image of CT angiogram of circle of Willis at axial view showed the labeled anatomy of anterior communicating artery, A1 segment of right anterior cerebral artery and anterior communicating artery saccular aneurysm.
Case Discussion
Case of anterior communicating artery saccular aneurysm rupture with extensive acute subarachnoid hemorrhage. CT angiogram of brain would be the next imaging modality for patients presented with extensive acute subarachnoid hemorrhage as the majority of SAH cases are attributed to the rupture aneurysm.
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