CT ANGIOGRAM HEAD AND NECK WITH AND WITHOUT CONTRAST:
CLINICAL HISTORY: 50-year-old female with subarachnoid hemorrhage.
Parenchyma, ventricles, and extra-axial spaces: Diffuse subarachnoid hemorrhage is again seen within the suprasellar and prepontine cisterns with extension to bilateral sylvian fissures. Mild interval increase in ventriculomegaly, which is best seen within the temporal horns. No evidence for infarction.
Visualized paranasal sinuses: Clear.
Mastoid air cells: Clear.
Bones: No focal abnormality.
Enhancement: No abnormal enhancement.
INTRACRANIAL ANGIOGRAM: Study limited due to venous technique.
Posterior circulation: No flow-limiting stenosis or aneurysm.
Dural venous sinuses: Patent.
Proximal great vessels: No flow-limiting stenosis or dissection.
Cervical vessels: No flow-limiting stenosis or dissection.
Soft tissues: Normal.
Lung apices: Clear.
1. Diffuse subarachnoid hemorrhage secondary to rupture of a saccular aneurysm extending posteriorly from the left posterior communicating artery, measuring 7.7 mm (AP) x 5.9 mm (transverse), with neck measuring approximately 1.7 mm. This aneurysm is amenable to coiling.
2. Mild interval increase in size of ventricles, concerning for evolving hydrocephalus.
3. No additional aneurysms are detected, although sensitivity is limited due to venous technique.
(Ruptured left ICA/M1 aneurysm and moya moya vasculopathy)