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Table of Contents    
LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 2  |  Page : 234-235

Actively leaking ruptured acom aneurysm: Fountain sign


Department of Neurointervention, Bombay Hospital, Institute of Medical Science and Research, Mumbai, Maharashtra, India

Date of Submission10-Jan-2014
Date of Decision10-Jan-2014
Date of Acceptance06-Apr-2014
Date of Web Publication14-May-2014

Correspondence Address:
Shaileshkumar S. Garge
Department of Neurointervention, Bombay Hospital, Institute of Medical Science and Research, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.132454

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How to cite this article:
Garge SS, Visana DR, Vyas PD, Modi PD, Poyam SN, Ghatge S. Actively leaking ruptured acom aneurysm: Fountain sign. Neurol India 2014;62:234-5

How to cite this URL:
Garge SS, Visana DR, Vyas PD, Modi PD, Poyam SN, Ghatge S. Actively leaking ruptured acom aneurysm: Fountain sign. Neurol India [serial online] 2014 [cited 2021 May 5];62:234-5. Available from: https://www.neurologyindia.com/text.asp?2014/62/2/234/132454


Sir,

We describe an interesting imaging finding in a patient with ruptured anterior communicating artery (Acom) aneurysm. The ruptured Acom aneurysm was actively leaking as observed in digital subtraction angiography (DSA), giving the appearance of a fountain, i.e. "the fountain sign" [Figure 1]. Axial computed tomography (CT) angiography image showed contrast-filled outpouching in the Acom region suggestive of Acom aneurysm [Figure 2]. DSA Towns view left internal carotid artery (ICA) injection showed Acom aneurysm with anterior cerebral artery (ACA) and terminal ICA vasospasm. There was contrast seen actively leaking out of the ruptured Acom aneurysm, giving the appearance of a fountain. In Video 1, the DSA running images Towne's view left ICA injection give better depiction of the active leakage occurring from the ruptured Acom aneurysm, giving the appearance of a fountain.
Figure 1: Axial CT angiography image showing contrast-filled outpouching in the Acom region suggestive of acom aneurysm

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Figure 2: DSA angiography Towns view left ICA injection showing acom aneurysm with ACA and terminal ICA vasospasm. There is contrast seen actively leaking out of the ruptured Acom aneurysm, giving the appearance of a fountain

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Case: A 42-year-old male patient presented with acute severe headache and disorientation. A plain CT scan revealed subarachnoid hemorrhage (SAH). Patient was in Grade 4 Hunt and Hess classification. CT angiography revealed abnormal contrast-filled vascular outpouching arising from the Acom artery [Figure 1]. DSA angiography confirmed the Acom aneurysm which was actively leaking in the subarachnoid space [Figure 2]. Coil embolization of the aneurysm was done. Patient expired after 1 day with hydrocephalus and raised intracranial pressure.

Aneurysmal SAH is still a serious disease with high rates of case fatality (40-50%) and morbidity. Outcome is still determined by the severity of initial bleeding or early rebleeding. [1] In our case, the aneurysm was actively bleeding as seen in DSA and whose appearance resembled a fountain. This appearance can be seen in any actively leaking ruptured aneurysm. Risk factors of rupture occurring in an unruptured intracranial aneurysm are diameter of aneurysm, patient's age, gender, aneurysm group, active smoking, and hypertension. [2]


  Acknowledgment Top


Department of Radiology, Bombay Hospital, Mumbai is acknowledged.

 
  References Top

1.Juvela S. Treatment options of unruptured intracranial aneurysms. Stroke 2004;35:372-4.  Back to cited text no. 1
[PUBMED]    
2.Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: Probability of and risk factors for aneurysm rupture. J Neurosurg 2000;93:379-87.  Back to cited text no. 2
    


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