Case #42

CT

• Peripherally-calcified mass along the medial right temporal lobe with adjacent small volume subarachnoid and subdural hemorrhage tracking along the floor of the right middle cranial fossa

MRI

• Giant aneurysm involving the right internal carotid artery terminus and M1 segment of the right MCA with saccular component measuring 2.7 x 1.2 x 1.7 cm
• Radiating pulsation artifact
• A more posterior fusiform component measuring up to 0.6 cm in thickness appears to supply right M2 branches, which remain patent
• Tiny (~0.2 cm) outpouching directed medially from the supraclinoid right internal carotid artery, possibly representing a tiny aneurysm or infundibulum associated with the superior hypophyseal artery
• Hypoplastic right A1 ACA segment
• Increased scattered subarachnoid hemorrhage, most abundant in the right sylvian fissure and sylvian cistern
• Small volume intraventricular hemorrhage layering in the occipital horns of the lateral ventricles
• Enlarged right cerebral convexity subdural hematoma measuring up to 5 mm in thickness
• No midline shift or evidence of herniation or hydrocephalus