2017 Volume 39 Issue 1 Pages 24-28
A 38 year-old woman with a sudden headache was transferred to the ER. Head CT and CT angiography (CTA) revealed subarachnoid hemorrhage without any aneurysm. Multimodality examinations were performed repeatedly during the acute period. On her 14th hospital day, digital subtraction angiography showed a slight protruded change of the right internal carotid artery (C3 portion), which was suspected as a blood blister-like aneurysm. As a result of comparing the MRI and CTA images, the false lumen was speculated to spread around the posterior wall of the ophthalmic artery bifurcation. Balloon occlusion test showed tolerance, however, no intraorbital blood flow was observed through any angiographies during ICA occlusion. We changed the strategy to the stent assisted coil embolization with preserved ophthalmic artery flow because trapping of dissecting lesion carried a very high risk of visual impairment. After this embolization, there was good course with no neurological deterioration, no blurred vision, and no recurrence of this aneurysm. As for the present patient, diagnostic multimodality imaging with MRI and angiography seemed to not only change the determination of therapeutic strategy but also avoid complication risk.
