Status post ruptured aneurysm coiling, with altered mental status change
female patient was admitted to the emergency room with a suspected
subarachnoidal hemorrhage (SAH). Initial non-enhanced cranial CT
(NECT) noted a small subarachnoidal bleeding in the sylvian fissure
on the right side. On intracranial
T-angiography (CTA) a giant-aneurysm (17 x 11 mm) of the right
middle cerebral artery (MCA) was detected.
The patient was
transferred to the neurosurgery department for aneurysm clipping
therapy. Due to massive calcifications at the neck of the aneurysm,
no appropriate position of the aneurysm clip could be achieved. Two
days later the patient underwent endovascular coil embolization of
the MCA aneurysm.
On the sixth day
after SAH, duplex sonography revealed high flow rates of the
intracranial arteries and the patient was referred to the radiology
department for comprehensive stroke imaging, including NECT and
Volume-Perfusion-CT (VPCT) of the brain to rule out vasospasm.
Perfusion imaging shows:
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