Ruptured ACom aneurysm

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Severe headache

Patient Data

Age: 60 years
Gender: Male
ct

A bilobed aneurysm is seen originating from the junction between the right anterior cerebral and anterior communicating arteries, measuring 6.5 x 3.5 x 5 mm in AP, SS and CC dimensions. Its neck measures 2.1 mm. It is directed mainly superiorly.

Moderate subarachnoid hemorrhage is seen; mainly at the supra-seller region and bilateral high frontal and parietal region.

Intra-ventricular hemorrhage is seen at the body of the lateral ventricles bilaterally.

Mild diffuse brain edema is seen.

Cortical and subcortical hypodense area is seen at the medial aspect of the left frontal lobe, suggestive of recent ischemic infarct.

Case Discussion

The commonest site of intracranial berry aneurysm is at ACom. Most patients present with spontaneous rupture with resultant subarachnoid hemorrhage.

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