Abstract
A 54-year-old female was admitted for a sudden headache, vomiting, and disturbance of consciousness. Computerized tomography at admission revealed a subarachnoid hemorrhage. When the left carotid angiography was carried out 2 hours after the onset, she was almost alert and had no neurological deficits. Anterior-posterior view of the angiography showed a large ophthalmic aneurysm, 20×20 mm in diameter, but no arteriosclerotic changes. Deterioration of consciousness and a right hemiparesis were noted immediately after the performance of a lateral view of the angiography, which revealed an aneurysm with niveau formation in its lumen and occlusion of the left internal carotid artery just distal to the aneurysm. The left carotid angiographies performed 20 days and 4 months after the onset showed recanalization of the internal carotid artery and reduction of the aneurysmal size. Gradual improvement of her neurological deficits was noted. Clipping of the aneurysmal neck with 2 large clips was performed under temporary occlusion of the left cervical internal carotid artery 5 months after the onset.
It was thought that the hemodynamic alteration could have occurred during the angiography, which pushed out a part of the intra-aneurysmal thrombus into the periphery of the parent artery.
