Middle cerebral artery aneurysm diagnosis [Neurosurgery Wiki]

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====== Middle cerebral artery aneurysm diagnosis ======

===== Angiography =====

{{::middle_cerebral_artery_aneurysm_angiography.png?300|}}

At the origin of the superior division of the left [[middle cerebral artery]], a [[saccular aneurysm]] is seen. The [[aneurysm sac]] presents a regular morphology with a bottom of 5.5 mm and a neck of 3 mm. Another more proximal [[wide necked aneurysm]] is also observed.
===== CT =====
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{{::middle_cerebral_artery_aneurysm_ct.png?500|}}

Axial CT scan in a [[patient]] with [[SAH]] (and [[intraparenchymal hematoma]]) from a ruptured right [[middle cerebral artery aneurysm]].

A: CT slice through the [[suprasellar cistern]] (ssc) showing a classic SAH pattern, with blood in the ssc, [[interhemispheric fissure]] (ihf) & [[Sylvian fissure]]s (sf).

B: CT slice slightly above the ssc showing SAH in the [[interpeduncular cistern]] (ipc), the [[ambient cistern]]s (ac) as well as intraparenchymal hematoma (iph) from the [[aneurysm]]al rupture.
Note the dilated [[temporal horn]]s (th) and blood in the [[fourth ventricle]] (V4).
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Sylvian fissure subpial hematoma: a rare imaging presentation of a [[ruptured middle cerebral artery aneurysm]]
((Schroeder JA, Reith TP, Benson MD, Maley JE, Freitas LF. Sylvian fissure subpial hematoma: a rare imaging presentation of a ruptured middle cerebral artery aneurysm. Arq Neuropsiquiatr. 2024 Sep;82(9):1-2. English. doi: 10.1055/s-0044-1788268. Epub 2024 Aug 31. PMID: 39216491.)).