PDF(Pubmed)
Abstract：
A patient presented with acute onset headache and subsequent unconsciousness. The neurologic exam showed left-sided myoclonic jerking and right flaccid hemiparalysis. Noncontrast computed tomography revealed diffuse subarachnoid hemorrhage (SAH) with acute hydrocephalus. Initial digital subtraction angiography (DSA) showed no culprit source for SAH. Repeat DSA on day 7 after initial presentation raised suspicion for left internal carotid artery ophthalmic segment and left lateral lenticulostriate artery (LSA) aneurysms. A magnetic resonance vessel wall imaging (VWI) exam was performed given the presence of multiple potential culprit aneurysms. Vessel wall enhancement around the dome of the left LSA aneurysm suggested rupture, which then facilitated treatment with surgical clipping. LSA aneurysms are exceedingly rare and challenging to treat. Given the associated high degree of morbidity, expedient diagnosis is critical to direct management. VWI could be a valuable tool for detecting ruptured aneurysms in the setting of angiogram-negative SAH.
摘要：
患者出现急性发作性头痛和随后的无意识。神经系统检查显示左侧肌阵挛性抽搐和右侧弛缓性偏瘫。非对比计算机断层扫描显示弥漫性蛛网膜下腔出血（SAH）伴急性脑积水。初始数字减影血管造影（DSA）未显示SAH的罪魁祸首。初次就诊后第7天重复DSA，怀疑左颈内动脉眼段和左外侧豆状纹状动脉（LSA）动脉瘤。考虑到存在多个潜在的罪魁祸首动脉瘤，进行了磁共振血管壁成像（VWI）检查。左LSA动脉瘤穹顶周围的血管壁增强提示破裂，然后通过手术夹钳促进治疗。LSA动脉瘤非常罕见且治疗具有挑战性。鉴于相关的高发病率，权宜的诊断是关键的直接管理。在血管造影阴性SAH的情况下，VWI可能是检测破裂动脉瘤的有价值的工具。
