42yoM with sudden onset "worst headache of his life" speakin | Figure 1

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42yoM with sudden onset "worst headache of his life" speaking in the ER then rapid deterioration to unresponsiveness, intubation and coma. CT shows massive subarachnoid hemorrhage and hydrocephalus (dilated ventricles including lateral, frontal and temporal horns, 4th ventricle). CT angio showed ruptured Posterior inferior cerebellar artery aneurysm. In this case the aneurysm ruptured into the 4th ventricle causing "upstream" hydrocephalus with blood moving from the 4th ventricle upwards. A ventricular catheter was placed immediately to relieve ICP, followed by interventional securing of the aneurysm. Pt survived with grave neurological deficits.

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Continuation of the HSA Case

After the patient had placed the external ventricular shunt, the patient was referred to the endovascular treatment center where a cerebral vessel arteriography was performed with the use of a 3D reconstruction to reduce the time of examination and contrast in the patient where A baby aneurysm was diagnosed in the bifurcation of the carotid artery and another ruptured bilocular aneurysm of the large neck in the right middle cerebral artery, which caused HSA. Thus, we started the endovascular treatment with the use of a balloon microcatater to stabilize and help to place the micromoles within the large neck aneurysm with greater precision and without the risk of them entering the light of the middle cerebral artery and obstructing the same causing further damage Greater in the patient and close the aneurysm as soon as possible, thus reducing cerebral bleeding. After placing the micromoles in the ruptured aneurysm we removed the microballoon and performed a final arteriography to visualize the aneurysm closure and if we did not have any evident damage in the vessels of the middle cerebral where everything was within normality and the aneurysm was successfully treated. Diagnostic conclusion: right hemisphere HSA caused by acute middle cerebral artery aneurysm bleeding treated.


\arrow points to an AComm #Aneurysm. That ruptured and caused a #Subarachnoid-hemorrhage


\Patient in a state of brain death. The CT scan shows intra-cerebral haemorrhage, the cause is a ruptured aneurysm of the right middle cerebral artery.


\EVD placement (by yours truly :D); #Subarachnoid-hemorrhage after an AComm #Aneurysm rupture


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