Ruptured Middle Cerebral Artery Bifurcation Aneurysm Presented with Intracerebral Hematoma without Subarachnoid Hemorrhage in Normotensive Patient: Case Report

Ruptured intracranial aneurysm usually manifests as subarachnoid hemorrhage (SAH) and aneurysms that only present with intracerebral hematoma are mostly confined to the terminal branches. Intracerebral hematoma (ICH) mainly caused by bleeding within the brain tissue itself, ICH is most commonly caused by hypertension, arteriovenous malformations, or head trauma. It is very rare that ruptured middle cerebral artery bifurcation aneurysms presenting with ICH. One such case was reported in this paper. A 35-year-old male presented with sudden right-sided weakness of the face, arm, and leg, severe headache with nausea and vomiting, with sudden aphasia. Computed tomography (CT) and magnetic resonance imaging (MRI) showed intracerebral hematoma seen in the left front parietal lobe with no evidence of subarachnoid hemorrhage. Left internal carotid artery digital subtraction angiography (DSA) showed giant left middle cerebral artery bifurcation aneurysm with large false part revealed to be the cause of the intracerebral hematoma (ICH). Unique bleeding pattern was due to the projection of the false part of the aneurysm which showed on brain CT as faint hyperintensity seen in the left cerebral hemisphere that connecting with mentioned above intracerebral hematoma by linear density. This mean that this aneurysm is at high risk of rebleeding, so endovascular coiling was done immediately.

Publication History

Article published online:
14 December 2021