Detection of a ruptured aneurysmal sac by MRI in a case of negative angiogram. Successful clipping of an anterior communicating artery aneurysm

Abstract

A case of a ruptured aneurysm is presented in which the angiograms did not disclose the sac. Rupture of an aneurysm of the anterior communicating artery was suspected from the distribution of subarachnoid blood on computerized tomography (CT), and the presence of a sac was highly suggestive on magnetic resonance imaging (MRI), which led us to open surgery. A non-thrombosed aneurysm was discovered at the suspected site, and successfully clipped. The necessity is discussed of MRI investigation in patients with subarachnoid haemorrhage (SAH) of unknown aetiology.

Intracranial Aneurysms

“…Although uncommon, there have been several instances of thrombosed intracranial aneurysms that were not visualized on angiography but were clearly demonstrated with MRI. 83,84 Recently, helical CT angiography has been used to detect intracranial aneurysms, and preliminary reports indicate that the detection rate with this technique is similar to that with MRI angiography. 85,86 An advantage of helical CT angiography in surgical planning is its ability to demonstrate the relation of the aneurysm to the bony structures of the skull base.…”

Radiological Evaluation of Cerebral Aneurysms in Selected Clinical Presentations

“…7 Thus, in the group of patients with aneurysmal pattern of hemorrhage on CT scan and a negative first angiogram ( Fig 4A, B), repeat A C B D angiography is necessary within 7 to 10 days ( Fig 4C, D). An aneurysm is found in up to 17% of the patients following a second angiogram, [9][10][11] and even if a second angiogram does not demonstrate an aneurysm, a third angiogram may be considered. 12 The reasons an intracranial aneurysm may be concealed on initial angiography include technical reasons, lack of sufficient oblique projections, presence of vasospasm, partial thrombosis of the aneurysm, or obliteration of the aneurysm by mass effect of an adjacent blood clot.…”

Rendimientos cognitivos en pacientes con aneurisma cerebral

“…Se utiliza sobre todo para el cribado de aneurismas en los familiares de pacientes que han tenido una HSA aneurismática (Huston, et al, 1994;Keller, et al, 1989;Masaryk, et al, 1989;Okahara, et al, 2002;Ronkainen, et al, 1995) y para identificar trombos en los aneurismas (Curnes, et al, 1993;Pertuiset, et al, 1989;Schievink, 1997b).…”

“…Sin embargo, la RM y angio-RM craneal son el mejor método para demostrar la presencia de un trombo dentro del saco del aneurisma (Curnes, et al, 1993;Pertuiset, et al, 1989).…”