53 year-old with subarachnoid and intraventricular hemorrhage
CT noncontrast
Right internal carotid artery injection arterial phase frontal and lateral views
Right internal carotid artery injection venous phase lateral view
Findings:
Markedly slow
cerebral contrast transit with faster external carotid reflux flow than
internal flow (arterial phase) and delayed arterial clearing (venous
phase). Right ICA aneurysm (cause of SAH)
DDX:
inadvertent external carotid (instead of internal carotid) injection, vasospasm, cerebral hypoperfusion,
Diagnosis:
ICA aneurysm rupture with severe SAH and cerebral swelling and hypoperfusion.
Discussion:
This degree of
cerebral hypoperfusion while not equivalent to "brain death",
nevertheless indicates a very poor prognosis. It was elected to
withdraw support and not treat the aneurysm. SPECT demonstrated
brain death.
Submitted by Dean Shibata, MD, UW Neuroradiology
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