Detection of blood blister–like aneurysm and intramural hematoma with high-resolution magnetic resonance imaging

Case report

Nobutaka Horie M.D., Ph.D. 1 , Minoru Morikawa M.D., Ph.D. 2 , Shuji Fukuda M.D. 1 , Kentaro Hayashi M.D., Ph.D. 1 , Kazuhiko Suyama M.D., Ph.D. 1 and Izumi Nagata M.D., Ph.D. 1
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  • 1 Departments of Neurosurgery and
  • 2 Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
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Blood blister–like aneurysms (BBAs) tend to have a more precipitous clinical course, enlarging rapidly and rebleeding frequently. Nevertheless, they often present a diagnostic challenge because of the characteristic morphological features of a wide neck and shallow outpouching of the medial wall. The authors present the case of a 34-year-old woman who suffered a subarachnoid hemorrhage whose cause could not be determined on the initial imaging with digital subtraction (DS) angiography and CT angiography. Interestingly, MR imaging studies obtained on the 7th day revealed an intramural hematoma on the dorsal wall of the left internal carotid artery, which helped in the diagnosis of BBA on the third DS angiography study obtained on the 8th day, and in the surgical intervention on the 10th day. This case supports the hypothesis that focal dissection contributes to the formation of BBAs. Use of MR imaging in the subacute stage, in addition to DS and CT angiography, might be helpful in the diagnosis of BBAs.

Abbreviations used in this paper: BBA = blood blister–like aneurysm; DS = digital subtraction; ICA = internal carotid artery; OphA = ophthalmic artery; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage.

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Contributor Notes

Address correspondence to: Nobutaka Horie, M.D., Ph.D., Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, Japan, 852-8501. email: nobstanford@gmail.com.

Please include this information when citing this paper: published online September 16, 2011; DOI: 10.3171/2011.8.JNS11909.

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