Using gadolinium-enhanced magnetic resonance imaging to identify the rupture site in subarachnoid hemorrhage with multiple intracranial aneurysm: A case report

Abstract

A 35-year-old man presented with subarachnoid hemorrhage (SAH). Magnetic resonance angiography revealed three intracranial aneurysms: a middle cerebral artery (MCA) aneurysm, an internal carotid artery-anterior choroidal artery (IC-AC) aneurysm, and an internal carotid artery-posterior communicating artery (IC-Pcom) aneurysm. Three-dimensional fast spin echo T1 imaging with variable flip angles using gadolinium-enhancement (vessel wall magnetic resonance imaging: vessel wall MRI) showed wall enhancement only on the IC-AC aneurysm. We performed neck clipping for all three aneurysms by right transsylvian approach, and confirmed the sign of rupture on the IC-AC aneurysm. Post-operative course was uneventful and he recovered well. Vessel wall MRI is useful to identify the rupture site in the case of SAH with multiple intracranial aneurysms.