A collage of aneurysms…
In our experience, small basilar perforator aneurysms are present in the vast majority of patients with perimesencephalic-type hemorrhage. There are grading systems re how little or large the hemorrhage is etc. The more blood the more the chance of finding a more classic source. The problem with that theory is that it presumes that “true” perimesencephalic bleeds are “nonaneurysmal”. This is an example of circular reasoning type of logical fallacy. They are only nonaneurysmal insofar as an aneurysm is not identified — not because its really true. In fact, it is false — the aneurysms are there — you just need better imaging to see them.
Below are several examples
HR-CBCT (DYNA)
MIPs — see anything?
Finding was not appreciated. Repeat angio in 1 week — see below. Both under general anesthesia
Thats what they look like. Very real and that’s the cause
Another case — this is a more obvious one…
Nothing below…
Or here
Now for the DYNA — nothing from the basic one
How about a secondary, more detailed reconstruction
Now we can see on delayed imaging DSA — and only because its a big one
Case 3 below:
Day 11
Day 15 — here is the cause
Anaglyph stereo
Treated this one
Convinced yet?
The overall prognosis is of course excellent. But that does not mean we should not try to find out what the cause is, and why they happen.
