Middle aged female presented with sudden onset right sided weakness and headache. Examination found power of 3/5 on right side and Hunt and Hess grade of 4. CT angiogram showed an enlarged basilar top aneurysm. The plan was for endovascular coiling or clipping. Repeated measurements were taken to determine appropriate stent size. The aneurysm was successfully coiled and stented, discussed with references provided.

1. Dr. Shahnawaz Alam
Neuroradiological Case
Discussion

2. Brief History & examination:
 Middle age female, Right handedness, H/o supplemented by her son
 C/o: Not able to speak with right side weakness x 24 days,
sudden in onset, progressive
 H/o: sudden severe HA asst. with nausea and vomiting, Neck
tightness with pain, LOC +
 O/E: Vitals: PR-86, BP-132/84,RR-18,Spo2 98% on RA,GCS- E3V2M5,
 Bilateral pupils ERL,2mm
 Power: Rt. UL & LL-3/5, Lt.-5/5, DTR 2+, Tone & Bulk- Normal
 Hunt and Hess grade-4, WFNS 4, Modified Fisher 4
 Plan: CT-Angio brain with 3D-reconstruction- clipping vs coiling.

5. Enlarged 3D view of basilar top aneurysm
showing aneurysm and both PCA
Measurements

6. Repeated vascular measurements
to assess for stent size

11. Endovascular Coil & Stent
DISCUSSION

12. Endovascular Coils

18. Stents

26. ThankYou!
References:
• Osborn Brain Imaging ; 2nd edition
• Seven Aneurysms Tenets and Techniques by Michael T. Lawton,
Professor of Neurological Surgery
Chief of Vascular and Skull Base Neurosurgery
Department of Neurological Surgery
University of California, San Francisco