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53 year-old with subarachnoid and intraventricular hemorrhage
CT noncontrast
Right internal carotid artery injection arterial phase frontal view
Right internal carotid artery injection arterial phase lateral view
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