Hunt Hess Grade 1 Subarachnoid Hemorrhage (SAH)

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Figure 1: A) NCT Brain with faint hyperdense SAH in suprasellar cisterns B) DSA angiography of Acom Aneurysm with anterior “beak” C) 3-D DSA Recon demonstrates complex morphology and wide-neck

Figure 2: Post Microsurgical Clipping A) DSA lateral B) 3-D DSA Recon

KEY LEARNING POINTS:

  1. Persistent constant headaches lasting beyond 24-48 hours should prompt immediate medical attention and Brain scanning to evaluate for potential high-risk pathologies, especially SAH and sentinel leaks from ruptured brain aneurysms.
  2. Multi-disciplinary evaluation by a team of cerebrovascular surgeons and interventionalists should be performed to determine the optimal treatment and management strategies for often complex aneurysm geometries.
  3. Microsurgical clipping represents a very effective option for definitive treatment and complete functional recovery in many patients.

REFERENCES:

  1. Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures. Proust F, Debono B, Hannequin D, et al.  J Neurosurg. 2003;99(1):3‐14. doi:10.3171/jns.2003.99.1.0003
  2. Microneurosurgical management of anterior communicating artery aneurysms. Hernesniemi J, Dashti R, Lehecka M, et al. Surg Neurol. 2008;70(1):8‐29. doi:10.1016/j.surneu.2008.01.056

CATEGORY: ENDOVASCULAR // HUNT HESS GRADE 1 SUBARACHNOID HEMORRAHAGE (SAH)

Hunt Hess Grade 1 Subarachnoid Hemorrhage (SAH)

A 43-year-old man presents with a 4-day history of a constant headache. Initial CT Head demonstrates very small Hunt Hess Grade 1 supra-sellar Subarachnoid Hemorrhage (SAH), prompting cerebral angiography, which confirmed complex wide-neck anterior communicating artery aneurysm (Figure 1. A. NCT B. Lateral DSA C. 3-D DSA Recon). He underwent open microsurgical clipping of the aneurysm with preservation of the parent vessels and complete obliteration of the aneurysm (Figure 3. A. Lateral DSA B. 3-D DSA Recon). After monitoring and critical care management for SAH, he made a complete functional recovery, returning to all activities of daily living.

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