31 Aneurysms and Vascular Malformations

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig SK 31-1 Anterior communicating artery aneurysm. (A) Axial CT scan shows clot (h) in the left gyrus rectus. There is blood in the anterior interhemispheric fissure and sylvian fissures. Note the hydrocephalus. (B) Oblique view from a catheter angiogram shows an aneurysm in the anterior communicating artery (A).6

• Fig SK 31-2 Posterior communicating artery aneurysm. (A) Axial CT and (B) MR images show subarachnoid hemorrhage (h) in the basilar cisterns.6

• Fig SK 31-3 Middle cerebral artery bifurcation aneurysm. (A) Axial CT scan shows subarachnoid hemorrhage confined mostly to the right sylvian fissure (arrows). (B) Frontal view from a catheter angiogram shows an aneurysm (A) at the bifurcation of the right middle cerebral artery.6

• Fig SK 31-4 Basilar artery tip aneurysm. (A) Contrast-enhanced CT scan shows a large aneurysm (L) at the level of the basilar artery tip. (B) Frontal projection from a catheter angiogram shows a giant aneurysm (A) arising from the tip of the basilar artery.6

• Fig SK 31-5 Posterior inferior cerebellar artery aneurysm. (A) Axial CT scan shows hemorrhage (arrow) in the fourth ventricle. (B) Lateral projection of a posterior fossa catheter angiogram shows an aneurysm (A) arising in the supratonsillar segment of a posterior inferior cerebellar artery.6

• Fig SK 31-6 Post-traumatic aneurysm. (A) CT scan obtained 2 weeks after head injury shows a hematoma (h) as well as a central enhancing abnormality (a), which was shown at angiography (B) to represent a post-traumatic aneurysm (arrow) in the pericallosal artery.6

• Fig SK 31-7 Giant aneurysm. (A) Coronal T1-weighted MR image shows a large intrasellar aneurysm (arrow). (B) Axial postcontrast CT scan in another patient shows opacification of the lumen (L) of a giant aneurysm arising in the bifurcation of the right middle cerebral artery. Note the concentric and hyperdense layers of clot along the walls of this aneurysm.6

• Fig SK 31-8 Developmental venous anomaly. Postcontrast axial T1-weighted MR image shows a venous angioma in the right temporal lobe. Slow flow results in enhancement of the lesion.6

• Fig SK 31-9 Capillary telangiectasia. Postcontrast T1-weighted MR image shows enhancement in this pontine lesion (arrow). The non-contrast images showed no abnormality.6

• Fig SK 31-10 Vein of Galen aneurysm. (A) Coronal sonogram shows a hypoechoic and dilated vein of Galen. (B) T2-weighted MR image confirms the aneurysmal dilatation of the vein of Galen (A).6