A 29-year-old woman presented with a sudden onset of a headache and 3 generalized tonic-clonic seizures. She was 30 weeks' pregnant, used cocaine, and had poor dental hygiene. Computed tomographic scans of her head showed diffuse subarachnoid hemorrhage and a hematoma in the left distal temporal region (Figure, A and B). Magnetic resonance imaging scans of her brain showed subarachnoid hemorrhage and a focus of signal void in the left distal temporal region (Figure, C and D). Magnetic resonance angiographic scans of her brain failed to detect an aneurysm (Figure, E and F). Computed tomographic scans (Figure, G-J) and catheter digital subtraction angiographic scans showed an aneurysm (size, 1.6 × 1.7 cm) in a distal branch of the left middle cerebral artery (Figure, K and L). The coil was unable to be placed owing to the distal location of the aneurysm. A cerebrospinal fluid sample and a blood culture showed no microbial growth, and a transthoracic echocardiogram showed no evidence of endocarditis. Serial computed tomography angiographic scans and serial digital subtraction angiographic scans showed complete thrombosis of the aneurysm in about 1 month. At 32 weeks and 3 days' gestation, she delivered by cesarean section. The patient was treated with levetiracetam, vancomycin hydrochloride, aztreonam, clindamycin hydrochloride, and nimodipine. Both the mother and neonate did well.
Sun L, Slivka AP. Sensitivity of Computed Tomography Angiography vs Catheter Angiography in the Detection of a Ruptured Intracranial Infectious Aneurysm in a Pregnant Woman. Arch Neurol. 2012;69(2):270. doi:10.1001/archneurol.2011.870