Neurol India Home 

Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 1109--1110

Large Ophthalmic Artery Aneurysm Presented as Isolated Basifrontal Hematoma without Subarachnoid Hemorrhage: A Rare Imaging Finding

Anshu Mahajan, Gaurav Goel, Biplab Das, Karanjit S Narang 
 Neurointervention Surgery, Department of Neurosciences, Medanta, The Medicity, Gurgaon, Haryana, India

Correspondence Address:
Gaurav Goel
Neurointervention Surgery, Department of Neurosciences, Medanta, The Medicity, Gurgaon, Haryana

How to cite this article:
Mahajan A, Goel G, Das B, Narang KS. Large Ophthalmic Artery Aneurysm Presented as Isolated Basifrontal Hematoma without Subarachnoid Hemorrhage: A Rare Imaging Finding.Neurol India 2021;69:1109-1110

How to cite this URL:
Mahajan A, Goel G, Das B, Narang KS. Large Ophthalmic Artery Aneurysm Presented as Isolated Basifrontal Hematoma without Subarachnoid Hemorrhage: A Rare Imaging Finding. Neurol India [serial online] 2021 [cited 2021 Nov 29 ];69:1109-1110
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Full Text

A 38-year-old female, known hypertensive and hypothyroid, presented with a 1-day history of sudden severe headache followed by vomiting. She had a history of gradual diminution of vision on the left side for six months. Non-contrast computed tomography (NCCT) head was done which showed an isodense lesion in left basifrontal region with surrounding hematoma and associated edema [Figure 1]a and [Figure 1]b. There was no evidence of subarachnoid hemorrhage (SAH) on NCCT head. Cerebral angiography was performed which revealed a large left ophthalmic artery aneurysm measuring 19 × 9 mm with neck measuring 4.6 mm. It was projecting superiorly on the frontal and lateral projection of angiogram [Figure 1]c and [Figure 1]d. Ophthalmic artery was arising from the neck of the aneurysm. We performed successful balloon-assisted coiling with preservation of origin of the ophthalmic artery [Figure 1]e. The patient was discharged after seven days without any neurological deficit. Patient came for follow-up angiography after 6 months which showed significant recanalization of the aneurysm with compaction of coil mass [Figure 1]f. The recanalization of the aneurysm was anticipated in our case owing to the large size of the aneurysm. We planned endovascular flow diverter treatment for the recanalized aneurysm. Surpass flow diverter (Stryker Neurovascular, Fremont, CA, USA) 4 × 30 mm was successfully deployed across the neck of the aneurysm from the ophthalmic segment to cavernous segment proximally [Figure 1]g and [Figure 1]h. The patient was advised clinical and angiographic follow-up after three months.{Figure 1}

There are few reported cases of ruptured aneurysm presented with isolated intracerebral hemorrhage (ICH) in the literature which mainly includes the aneurysm located in distal cerebral arteries.[1] Ruptured aneurysm at the main trunk of the circle of Willis presented with isolated ICH were also reported by other authors.[2],[3],[4] Our literature review yielded 23 cases of isolated intracerebral hematoma due to aneurysm rupture.[1],[2],[3],[4],[5],[6],[7],[8] Multifactorial causes of isolated intracerebral hematoma due to ruptured aneurysm have been documented in the literature.[2],[5] The sensitivity of the NCCT decreases with the delay in the interval time between the symptom onset and imaging which can lead to false-negative imaging result of SAH. There was no significant delay (approximately 9 h) in NCCT head acquisition and time of ictus in our case. Sometimes, the density of brain parenchyma increases due to mass effect of ICH and the blood component in subarachnoid space might be diluted due to squeezing out of ICH. Furthermore, this leads to the superposition effect of aneurysmal ICH causing difficulty in diagnosing underlying minimal SAH. The dome of aneurysm buried into the cerebral parenchyma has also been proposed as another cause. In our case, there was also a large ophthalmic artery aneurysm projecting superiorly and that might be buried into the subpial basifrontal lobe. In addition, the linear relationship between the hematocrit and hemoglobin and the appearance of hyperdensity which is a reflection of electron density on noncontrast head has been described in the literature[6] however, in our case hemoglobin and hematocrit values were normal.[5] To our knowledge, this is the first case report of ruptured large ophthalmic artery aneurysm with isolated intracerebral hemorrhage without any evidence of SAH on NCCT head.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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