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Multiple Intracranial Aneurysms - Case 1

A 33 year-old man developed the abrupt onset of a severe headache followed by nausea and vomiting. CT imaging demonstrated diffuse subarachnoid hemorrhage.

   Note the Multiple Intracranial Aneurysms

Top of the Carotid     MCA Bifurcation     Top of the Basilar     ACA - Pericallosal

Subarachnoid Hemorrhage - Multiple Intracranial Artery Aneurysms. Cerebral angiogram; (Left) Left internal carotid artery injection, Oblique view; (Right) Left vertebral artery injection, AP view. Note the aneurysms arising from multiple areas, including the top of the carotid, the MCA bifurcation, the top of the basilar and the ACA-pericallosal bifurcation. ICA = internal carotid artery, ACA = anterior cerebral artery, MCA = middle cerebral artery, PCA = posterior cerebral artery.

This case emphasizes the importance of performing a four vessel angiogram (both carotid arteries, both vertebral arteries) in patients with subarachnoid hemorrhage (SAH), and not stopping the procedure once an aneurysm is discovered. Indeed, the incidence of multiple aneurysms in patients with SAH is approximately 15-20%.

Revised 11/29/06.
Copyrighted 2006. David C Preston