Right mesial temporal lobe jet hematoma from ruptured PCom artery aneurysm

Case contributed by Dr Craig Hacking

Presentation

Thunderclap headache then ALOC.

Patient Data

Age: 50 years
Gender: Female

Right mesial temporal lobe acute intraparenchymal hemorrhage with surrounding vasogenic edema. Thin right subdural hematoma in the floor of the middle cranial fossa, right aspect of the tentorum and over the right cerebral hemisphere. Subarachnoid hemorrhage in the suprasellar, interpenduncular and prepontine cisterns.

Midline shift of 6 mm with sulcal effacement of the right cerebral hemisphere. Almost complete effacement of the right lateral and third ventricles. Enlargement of the left temporal horn concerning for early hydrocephalus. Mild uncal herniation. No tonsillar herniation.

There is a complex lobulated saccular aneurysm arising from the origin of the right posterior
communicating artery - 6 x 12 mm with a 2 mm neck. It protrudes laterally and abuts the mesial temporal lobe hematoma. No other cerebral arterial aneurysm is identified.

Case Discussion

The patient was transferred to a tertiary neurointerventional service where the aneurysm was successfully coiled.

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Case information

rID: 66569
Published: 26th Feb 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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