scholarly journals Contrast extravasation from basilar artery without aneurysm formation on digital subtraction angiography in computed tomography angiogram-negative subarachnoid hemorrhage: A case report

2021 ◽  
Vol 12 ◽  
pp. 498
Author(s):  
Hideki Nakajima ◽  
Takuro Tsuchiya ◽  
Shigetoshi Shimizu ◽  
Hidenori Suzuki
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Digital Subtraction Angiography ◽  
Basilar Artery ◽  
Neurological Status ◽  
Computed Tomographic Angiography ◽  
World Federation ◽  
Digital Subtraction ◽  
Contrast Extravasation ◽  
Computed Tomographic ◽  
Tomographic Angiography

Background: The causes of angiogram-negative subarachnoid hemorrhage (SAH) on initial angiography, which accounts for 10–30% of spontaneous SAH, are heterogeneous and still unclear. We report a case of nonaneurysmal SAH, in which initial computed tomographic angiography (CTA) showed no source of bleeding, but the subsequent digital subtraction angiography (DSA) revealed contrast extravasation from the basilar artery without aneurysms. Case Description: A 67-year-old woman with a medical history of hypertension presented as SAH of World Federation of Neurological Surgeons Grade II. CTA on admission did not show any cause of bleeding and DSA was subsequently performed to show contrast extravasation from a perforator of the middle third of the basilar artery without aneurysms during the subsequent DSA, resulting in profound deterioration SAH and neurological status. The patient was conservatively treated. Follow-up DSAs on days 2 and 16 showed no source of bleeding as well. Conclusion: Although the precise cause of bleeding in this case is uncertain, SAH might be caused by local dissection of the basilar artery perforator, and the bleeding site might heal spontaneously without forming of a pseudoaneurysm.

Contrast Extravasation on Computed Tomographic Angiography Mimicking a Basilar Artery Aneurysm in Angiogram-Negative Subarachnoid Hemorrhage

Neurosurgery ◽  
2012 ◽  
Vol 71 (5) ◽  
pp. E1047-E1052 ◽  
Author(s):  
Nate D. Stetson ◽  
John Pile-Spellman ◽  
Jonathan L. Brisman
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Digital Subtraction Angiography ◽  
Basilar Artery ◽  
Artery Aneurysm ◽  
Computed Tomographic Angiography ◽  
Vascular Lesion ◽  
Digital Subtraction ◽  
Contrast Extravasation ◽  
Computed Tomographic ◽  
Tomographic Angiography

Abstract BACKGROUND AND IMPORTANCE: Contrast extravasation on computed tomography angiography (CTA) is becoming more common, with increasing use of CTA for myriad intracranial vascular pathologies. This article describes the first 2 documented cases of contrast extravasation from a nonaneurysmal basilar artery source seen on CTA and discusses possible pathophysiologic mechanisms. CLINICAL PRESENTATION: We present 2 cases of diffuse atraumatic subarachnoid hemorrhage in which the CTA showed an abnormality in association with the basilar artery highly suggestive of a ruptured aneurysm. Follow-up digital subtraction angiography, however, was completely negative. Subsequent repeat digital subtraction angiography failed to reveal a vascular lesion. Both patients were treated for complications associated with SAH, but given the negative digital subtraction angiography, no intervention was performed. CONCLUSION: Because of the frequent use of CTA, contrast extravasation is an increasingly common observation. Physicians should be aware that basilar artery extravasation can mimic the appearance of an aneurysm.

BLISTER-LIKE ANEURYSMS OF THE ANTERIOR COMMUNICATING ARTERY

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 807-811 ◽  
Author(s):  
Norberto Andaluz ◽  
Mario Zuccarello
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Digital Subtraction Angiography ◽  
Internal Carotid ◽  
Computed Tomographic Angiography ◽  
Anterior Communicating Artery ◽  
Digital Subtraction ◽  
Computed Tomographic ◽  
Tomographic Angiography

Abstract OBJECTIVE Blood blister-like aneurysms are small hemispherical bulges from the dorsomedial wall of the internal carotid artery that resemble berry aneurysms but differ in their clinical and surgical features. On the basis of our literature review, blister-like aneurysms have been reported to occur only at nonbranching sites of the dorsomedial internal carotid artery. In this report on our series of five patients, we describe blister-like aneurysms of the anterior communicating artery (AComA) and discuss important diagnostic and therapeutic aspects unique to them. METHODS In our retrospective review of 719 patients with nontraumatic subarachnoid hemorrhage admitted to our service from 1998 to 2003, 181 (25.17%) patients harbored AComA aneurysms. Five (2.76%) patients (four women, one man) had blister-like aneurysms that were recognized at the time of surgery. RESULTS Initial digital subtraction angiography was diagnostic in only one patient. A second digital subtraction angiogram was diagnostic in one patient but failed to reveal an aneurysm in the remaining three patients; these were eventually diagnosed by computed tomographic angiography. All aneurysms were clipped. At the time of surgery, the aneurysms arose from the horizontal portion of the AComA without any involvement of the branches of the anterior cerebral artery. All presented as blister-like aneurysms that were thin-walled and lacking a surgical neck. On dissection, two of the lesions ruptured. All lesions were treated with straight fenestrated clips through the A1–AComA junction, thus remodeling the AComA. No delayed rupture was noted at the time of the last follow-up evaluation. At the time of discharge, outcomes were good in two patients, fair in two, and poor in the remaining patient. CONCLUSION Blister-like aneurysms constitute technically challenging lesions that may occur at the AComA. Computed tomographic angiography is valuable in diagnosis. Blister-like aneurysms should be suspected when digital subtraction angiography findings are negative for subarachnoid hemorrhage.

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