Article Figures & Data
Figures
- FIG 1.
A 78-year-old woman with an example of a physiologically occult aneurysm on the initial DSA on the postbleed day 1. A frontal projection (A) with 3D reconstruction shows no source lesion (B). A second DSA on postbleed day 6 had normal findings. The patient was discharged and re-presented with worsening headache on postbleed day 12. A third DSA on postbleed day 12 (C) demonstrated a submillimeter basilar artery perforator blister aneurysm (curved white arrow) that was clipped.
- FIG 2.
A 36-year-old woman admitted with an internal carotid artery blister aneurysm, misdiagnosed due to 2 forms of operator-dependent error. The initial DSA (A) shows a perceptual-type interpretive error in that a laterally projecting blister (white arrow) was not recognized. The blister was more evident on the second DSA (B) and perceived but misinterpreted as vasospasm due to developing vasospasm elsewhere (dashed arrows). Finally, the lesion (yellow arrow) was recognized on the third DSA (C) as vasospasm abated. Intraoperative photographs (D) confirm the rupture site (yellow arrow) secured with clipping.
Tables
Summary of data in patients with vascular source identified
Patient Positive DSA Findings (No.) Timing of Diagnosis (PBD) Rebleed SAH Pattern Source 1 2 5 No NPM A1 blister aneurysm 2 2 3 Day 2 NPM PICA dissecting aneurysm 3 2 5 No NPM A1 blister aneurysm 4 2 7 No NPM Cervicomedullary AVF 5 2 8 No NPM Distal MCA mycotic aneurysm 6 2 39 Day 37 NPM AcomA saccular aneurysm 7 3 5 No NPM A1 dissecting aneurysm 8 3 12 No NPM Basilar blister aneurysm 9 3 8 No NPM AcomA saccular aneurysm 10 3 7 No PM Cervicomedullary AVF 11a NA 17 Day 17 NPM AcomA saccular aneurysm 12a NA 2 No NPM AcomA blister aneurysm 13a NA 16 Day 16 NPM Thrombosed R MCA aneurysm Note:—AcomA indicates anterior communicating artery; PBD, postbleed day; NA, not applicable; R, right.
↵a Aneurysm identified at craniotomy.
