J Korean Neurosurg Soc.  2014 Jun;55(6):357-361. 10.3340/jkns.2014.55.6.357.

Rupturing Anterior Communicating Artery Aneurysm during Computed Tomography Angiography: Three-Dimensional Visualization of Bleeding into the Septum Pellucidum and the Lateral Ventricle

• Kim E

• KMID: 2191117
• DOI: http://doi.org/10.3340/jkns.2014.55.6.357

Abstract

Computed tomography angiography (CTA) is commonly used in setting of subarachnoid hemorrhage, but imaging features of aneurysm rupturing taking place at the time of scanning has rarely been described. The author reports a case of actively rebleeding aneurysm of the anterior communicating artery with intraventricular extravasation on the hyperacute CTA imaging. The rebleeding route, not into the third ventricle but into the lateral ventricles, can be visualized by real-time three-dimensional CT pictures. The hemorrhage broke the septum pellucidum and the lamina rostralis rather than the lamina terminalis.

Keyword

Anterior communicating artery aneurysm; Computed tomography; Computed tomography angiography; Lamina rostralis; Subarachnoid hemorrhage

MeSH Terms

Aneurysm
Angiography*
Arteries
Hemorrhage*
Hypothalamus
Intracranial Aneurysm*
Lateral Ventricles*
Septum Pellucidum*
Subarachnoid Hemorrhage
Third Ventricle

Figure

• 

  Fig. 1 A : Initial plain CT scan shows thin SAH and subdural hematoma. B : There is no cavum septum pellucidum on the vertex cut. C : Source image of CTA reveals saccular aneurysms at the anterior communicating artery (arrow) and the left middle cerebral artery. D and E : Delayed images immediately after CTA show extensive SAH associated with intracerebral and intraventricular hemorrhages as well as blood within the septum pellucidum. CTA : computed tomography angiography, SAH : subarachnoid hemorrhage.

• 

  Fig. 2 A : Three-dimensional reconstruction of CTA depicts the spatial relationship between the aneurysm (arrow) and extravasated contrast medium (arrowhead). B : CTA with maximum intensity projection outlines the entire region of extravasated fresh blood (arrowheads) spouting from the ruptured ACoA aneurysm (arrow). ACoA : anterior communicating artery, CTA : computed tomography angiography.

• 

  Fig. 3 A-D : Axial images of CTA demonstrate the caudorostral pathway of the extravasated contrast medium (arrowheads) into the preexisting hematoma of lower density from the interhemispheric cistern into the septum pellucidum and into the frontal horn and body of the lateral ventricle. E and F : Sagittal CTA views illustrate the diffusion of the contrast medium (arrowheads) from the rebleeding ACoA aneurysm (arrow) through the lamina rostralis (asterisk) into the septum pellucidum without penetrating into the lamina terminalis. G and H : Coronal reformatted CT scan clearly shows the ejected blood (arrowheads) which pass through the septum pellucidum up to the frontal horn of the left lateral ventricle. ACoA : anterior communicating artery, CTA : computed tomography angiography.

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  Fig. 4 Coronal T2-weighted magnetic resonance image shows the thin strip of white matter of the lamina rostralis (arrowhead). This separates the anterior interhemispheric cistern (lower arrow) from the space between the leaves of the septum pellucidum (upper arrow) as well as the floor of the frontal horns in the mature brain.

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