Middle cerebral artery aneurysm diagnosis

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.

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 fissures (sf).

B: CT slice slightly above the ssc showing SAH in the interpeduncular cistern (ipc), the ambient cisterns (ac) as well as intraparenchymal hematoma (iph) from the aneurysmal rupture. Note the dilated temporal horns (th) and blood in the fourth ventricle (V4).

Sylvian fissure subpial hematoma: a rare imaging presentation of a ruptured middle cerebral artery aneurysm ¹⁾.