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NEUROIMAGE
Year : 2014  |  Volume : 62  |  Issue : 4  |  Page : 477-478

CT angiography demonstration of ongoing intraventricular hemorrhage from actively bleeding posterior communicating artery aneurysm


Department of Neurosurgery, Nabari City Hospital, Nabari, Mie, Japan

Date of Web Publication19-Sep-2014

Correspondence Address:
Hiroshi Yokota
Department of Neurosurgery, Nabari City Hospital, 1-178 Yurigaoka Nishi, Nabari, Mie 518-0481
Japan
Hiroshi Yokota
Department of Neurosurgery, Nabari City Hospital, 1-178 Yurigaoka Nishi, Nabari, Mie 518-0481
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.141308

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How to cite this article:
Yokota H, Ida Y, Yokota H, Ida Y. CT angiography demonstration of ongoing intraventricular hemorrhage from actively bleeding posterior communicating artery aneurysm. Neurol India 2014;62:477-8

How to cite this URL:
Yokota H, Ida Y, Yokota H, Ida Y. CT angiography demonstration of ongoing intraventricular hemorrhage from actively bleeding posterior communicating artery aneurysm. Neurol India [serial online] 2014 [cited 2020 Oct 23];62:477-8. Available from: https://www.neurologyindia.com/text.asp?2014/62/4/477/141308


Demonstration of CT angiography of ongoing intraventricular hemorrhage from actively bleeding posterior communicating artery aneurysm.

A 61-year-old man presented with consciousness disturbance. Non-contrast computed tomography (CT) demonstrated subarachnoid hemorrhage (SAH) along with intraventricular hemorrhage (IVH) [Figure 1]. Subsequent three-dimensional CT angiography and maximum intensity projection images showed a posterior communicating artery (PCoA) aneurysm originating from the left internal carotid artery with 2 corkscrew-like contrast extravasations, one of which continued to the lateral ventricle, whereas the other extended to the cisternal subarachnoid space [Figure 1]. Intraventricular perforation of contrast extravasation through the left temporal horn and subsequent extension into the lateral ventricle was noted against the background of IVH [Figure 1]. The patient died shortly after we performed ventricular drainage.
Figure 1: Non-contrast CT revealed IVH as well as SAH (a). Threedimensional CT angiography (b). Maximum intensity projection images (c and d). Extravasation from a left PCoA aneurysm (An) is seen as a corkscrew-like structure extending toward the lateral ventricle (arrows) and cisternal subarachnoid space (arrowheads). Ongoing IVH at the level between the temporal horn and lateral ventricle (d). Lt; left, ICA; internal carotid artery, ACA; anterior cerebral artery, MCA; middle cerebral artery, PCoA; posterior communicating artery, PCA; posterior cerebral artery

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The CT angiography findings of active bleeding have been reported as various configurations of contrast extravasation, such as cone-, vascular- and ribbon-like structures, [1],[2] though only a single case report with an anterior communicating artery aneurysm has documented ongoing IVH development. [2] Those findings of active bleeding suggest a potentially fatal clinical course. [1],[2] According to an autopsy study, bleeding from a ruptured PCoA aneurysm causes IVH via penetration into the temporal horn and subsequent expansion of the ventricular system. [3] CT-angiography images obtained in the present case clearly depicted the bleeding pathway during development of the IVH.

 
  References Top

1.Hashiguchi A, Mimata C, Ichimura H, Morioka M, Kuratsu J. Rebleeding of ruptured cerebral aneurysms during three-dimensional computed tomographic angiography: Report of two cases and literature review. Neurosurg Rev 2007;30:151-4.  Back to cited text no. 1
    
2.Im SH, Oh CW, Hong SK, Kwon OK, Kim SH. CT angiography demonstration of the development of intraventricular hemorrhage during aneurysm rupture. Clin Neurol Neurosurg 2007;109:299-301.  Back to cited text no. 2
    
3.Shimura T, Hirano A, Llena JF. Pathology of intracerebral hemorrhage in ruptured aneurysms of the posterior communicating artery at its origin from the internal carotid artery. No Shinkei Geka 1985;13:1169-73.  Back to cited text no. 3
    


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