title: Detection of blood blister-like aneurysm and intramural hematoma with high-resolution magnetic resonance imaging.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Nagasaki University School of Medicine, Sakamoto, Nagasaki, Japan. nobstanford@gmail.com
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Horie
authors.forename: Minoru
authors.initials: M
authors.lastname: Morikawa
authors.forename: Shuji
authors.initials: S
authors.lastname: Fukuda
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Suyama
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagata
mesh_terms: D000328:Adult; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000601:surgery; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging* / Q000601:surgery; D002533:Cerebral Angiography; D003399:Craniotomy; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed