Ruptured ACOM aneurysm

Case contribution: Dr Radhiana Hassan


  • A 52 years old man with underlying DM and hypertension
  • Presented with severe headache for few days
  • Initially admitted to a hospital, CT brain reported normal
  • Patient took AOR despite unresolved headache
  • Later he was admitted to another hospital
  • Another CT scan brain done and reported normal again
  • During hospitalisation, patient had one episode of seizures followed by drowsiness
  • Currently GCS=E4VtM5, pupils 3+/3+, Power bilateral lower limbs are 3/5
Initial urgent non-contrast CT brain


A repeat non-contrast CT brain after patient had seizures

CT scan findings:

  • Initial CT scan shows subtle hyperdensity in the interhemispheric region which is worse on subsequent scan
  • Extension of bleed into right  sylvian fissure, and in the suprasellar cistern extending to the interpeduncular cistern.
  • There is also intraparenchymal hemorrhage with surrounding oedema of right frontal lobe on subsequent scan
CT angiogram

CT angiogram findings:

  • A lobulated aneurysm with wide neck seen arising from the ACOM
  • It is pointing anteriorly, no active contrast extravasation

Diagnosis: Ruptured ACOM aneurysm


  • Subarachnoid hemorrhage secondary to ruptured cerebral aneurysm results in significant morbidity and mortality.
  • Clinical outcomes after aneurysm rupture and treatment are influenced by cumulative cerebral infarction burden.
  • Anterior communicating artery aneurysms (AcomAs) are among the most commonly identified ruptured aneurysms
  • AcomA rupture and treatment are more strongly associated with cognitive and behavioral deficits relative to other aneurysm locations
  • The cause of these neuropsychiatric deficits remains uncertain, but prior studies have suggested ischemic injury to the frontal cortex, ventromedial prefrontal (orbitofrontal) cortex, or striatum as a possible etiology.
Author: radhianahassan