Ruptured Basilar Perforator Dissecting Aneurysm

Another case of “nonaneurysmal subarachnoid hemorrhage” — until there is an aneurysm

First angio negative

Follow up

DYNA CT follow up negative

Third angio — who would do one? And under general anesthesia.  Oblique view showing a small aneurysm (arrow) arising from upper basilar perforator

DYNA.  Notice small caliber of vessel at ostium, followed by pseudoaneurysm.  This is a classic dissecting aneurysm appearance

Anaglyph stereo

Cross-eye stereos

Pipeline treatment




And another

Learning point — as technology improves, and as we decide that looking for a cause is worthwhile, we might discover a few more of these in the “nonaneurysmal SAH” wastebasket.

Companion case here