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Multiple Intracranial Aneurysms - Case 2

A 45 year-old man developed a severe headache followed by a brief loss of consciousness. CT imaging demonstrated diffuse subarachnoid hemorrhage.

   Note the Multiple Intracranial Aneurysms

               Anterior Communicating Artery   Top of the Carotid     Posterior Communicating Artery

Subarachnoid Hemorrhage - Multiple Intracranial Artery Aneurysms. Cerebral angiogram; (Left) Left internal carotid artery injection, AP view; (Right) Left internal carotid artery injection, Lateral view. Note the aneurysms arising from multiple areas, including the top of the carotid, the anterior communicating and the posterior communicating arteries. The first two are large and multi-lobulated. ICA = internal carotid artery, ACA = anterior cerebral artery, MCA = middle 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