Ruptured, right-sided giant middle cerebral artery (MCA) bifurcation aneurysm with right, intraparenchymal temporal lobe hematoma. Ruptured, right-sided.

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Presentation transcript:

Ruptured, right-sided giant middle cerebral artery (MCA) bifurcation aneurysm with right, intraparenchymal temporal lobe hematoma. Ruptured, right-sided giant middle cerebral artery (MCA) bifurcation aneurysm with right, intraparenchymal temporal lobe hematoma. On noncontrast CT, the aneurysm was seen as a round structure that was hypoattenuated compared with the temporal lobe hematoma (A). Postcontrast high-resolution CT angiography (HCRTA) showed an unbalanced contact constraint with the frontal and temporal lobes (B) and with the greater sphenoid wing (C–E). The aneurysm had a regular shape with no blebs. This case showed how the trajectory and growth of the aneurysm could have been influenced by the contact constraints it developed with the perianeurysmal environment. As it grew, this aneurysm was probably canalized laterally and outward by the adjacent frontal and temporal lobes that delimitate the sylvian fissure, and then, when it developed a contact constraint with the sphenoid greater wing, it grew caudally toward the middle cranial fossa.A, Axial, noncontrast enhanced, HRCT. A, aneurysm; H, hemorrhage.B and C, Axial, postcontrast HRCTA. H, hemorrhage.D, 3D reconstruction of HRCTA, superior view.E, 3D reconstruction of HRCTA, posteroanterior view. D. San Millán Ruíz et al. AJNR Am J Neuroradiol 2006;27:504-512 ©2006 by American Society of Neuroradiology