2020 Volume 42 Issue 6 Pages 543-547
It is difficult to diagnose and treat the disease of elderly patient who suffer with coexist dementia. We experienced a case with subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm requiring differentiation from traumatic SAH that developed elderly patient with dementia. And at that time, enhanced MR-vessel wall imaging (enhanced MR-VWI) was useful for differential diagnosis. A 74-year-old woman was admitted to our hospital from the practitioner diagnosed with traumatic SAH after fall. Though she was independent, she has suffered from Alzheimer’s disease with severe recent memory disturbance. Her Glasgow Coma Scale was E4V4M6, and had no other neurological deficit. She had contusion on her forehead and no other wound. Head computed tomography (CT) showed SAH on interhemispheric fissure, anterior part of basal cistern, left frontal brain surface. And added 3D-CT angiography revealed anterior communicating artery aneurysm (AcomA). We needed to differentiate the cause of SAH from intrinsic and traumatic mechanism, but she could not elaborate on the cause. We tried to perform enhanced MR-VWI as motion-sensitized driven equilibrium (MSDE) to differentiate the ruptured AcomA. Significant enhancement was observed at the wall of AcomA aneurysm on MSDE images. So we determined the AcomA as the rupture site and performed endovascular coil embolization. Her postoperative course was uneventful and rebleeding was not observed. Identification of the ruptured aneurysm is the most important problem in the treatment of SAH. Differential diagnosis can often be difficult in the elderly patient, especially with severe dementia. Enhancement of the aneurysmal wall on MSDE method can provide a useful finding in the decision of treatment strategies for SAH.
