Presentation
Reduced GCS
Patient Data
Large right frontotemporal intraparenchymal hematoma. A rounded ~2 cm area of intermediate attenutation (isodense to grey matter) at the anterior margin of the hematoma at the Sylvian fissure, suspicious for an aneurysm.
Associated mass effect with midline shift to the left, local sulcal effacement and complete effacement of the right lateral ventricle. Small-volume intraventricular extension with contrast pooling in the occipital horns of the right and left lateral ventricles. No subarachnoid blood product identified.
A large right MCA bifurcation aneurysm with a narrow neck, pointing laterally, associated with a large right frontotemporal intraparenchymal hematoma. Associated mass effect with 12 mm of midline shift to the left, local sulcal effacement and complete effacement of the right lateral ventricle, stable. Small volume intraventricular extension with contrast pooling in the occipital horns of the right and left lateral ventricles. No subarachnoid blood product identified.
Conclusion: Large right frontotemporal aneurysmal parenchymal hemorrhage with intraventricular extension, secondary to giant right MCA bifurcation aneurysm.
Case Discussion
Saccular cerebral aneurysms, also known as berry aneurysms, account for the vast majority of intracranial aneurysms and are the most common cause of non-traumatic subarachnoid hemorrhage. Some aneurysms however, particularly MCA and ACom aneurysms, may cause predominantly intraparenchymal hemorrhage.
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