, Volume 60, Issue 7, pp 665–667 | Cite as

Cerebral aneurysm rebleed with ventricular breakthrough captured by four-dimensional CT angiography

  • Wulphert VenderinkEmail author
  • Frank van Megen
  • Joost de Vries
  • Frederick J. A. Meijer
Letter to the Editor

Case report

A 44-year-old female presented at our hospital after collapse with headache and decrease of consciousness. The patient was directly transferred for head CT, which demonstrated a large subarachnoid hemorrhage located in the insular cistern on the right side (Fig.  1). At this moment, there was no intraventricular hemorrhage (IVH). During acquisition of a subsequent dynamic CT angiography, also referred to as 4D-CTA, the patient suffered an aneurysmal rebleed with leakage of contrast out of a middle cerebral artery (MCA) aneurysm on the right side with spread in the insular cistern. Furthermore, intraventricular breakthrough was seen with spread of contrast agent into the right lateral ventricle, the third and fourth ventricles with outflow into the subarachnoid space at the level of the greater foramen (Figs.  2 and 3, videos 1, 2, and 3). The patient underwent surgical clipping of the aneurysm with evacuation of the insular cistern hematoma. A week after admission, the...



We thank Rashindra Manniesing and Midas Meijs from the Diagnostic Image Analysis Group (DIAG) for providing the 4D-CTA color-mapping image.

Compliance with ethical standards


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

All study data was anonymized and is not traceable to the patient.

Supplementary material

234_2018_2039_MOESM1_ESM.avi (15.5 mb)
ESM 1 (AVI 15900 kb)
234_2018_2039_MOESM2_ESM.avi (7.6 mb)
ESM 2 (AVI 7761 kb)
234_2018_2039_MOESM3_ESM.avi (14.9 mb)
ESM 3 (AVI 15280 kb)


  1. 1.
    Suzuki K, Morita S, Masukawa A, Machida H, Ueno E (2011) Ruptured aneurysm with extravasation observed in four-dimensional computed tomography angiography. Jpn J Radiol 29(5):348–352CrossRefPubMedGoogle Scholar
  2. 2.
    Kortman HG, Boogaarts HD, Prokop M et al (2016) Four-dimensional computed tomography angiography demonstrating a ruptured basilar artery aneurysm causing anterior cerebral circulation arrest. J Stroke Cerebrovasc Dis 25(9):e146–e147CrossRefPubMedGoogle Scholar
  3. 3.
    Mohr G, Ferguson G, Khan M, Malloy D, Watts R, Benoit B, Weir B (1983) Intraventricular hemorrhage from ruptured aneurysm. Retrospective analysis of 91 cases. J Neurosurg 58(4):482–487CrossRefPubMedGoogle Scholar
  4. 4.
    Scholtes F, Signorelli F, Bojanowski MW (2011) Rupture of anterior communicating artery aneurysms during computed tomography angiography: description of the pathway for intraseptal and intraventricular hemorrhage. J Neurosurg 115(3):617–620CrossRefPubMedGoogle Scholar
  5. 5.
    Hayashi M, Handa Y, Kobayashi H, Kawano H, Nozaki J, Noguchi Y (1989) Prognosis of intraventricular hemorrhage due to rupture of intracranial aneurysm. Zentralbl Neurochir 50(3–4):132–137PubMedGoogle Scholar
  6. 6.
    Mayfrank L, Hutter BO, Kohorst Y et al (2001) Influence of intraventricular hemorrhage on outcome after rupture of intracranial aneurysm. Neurosurg Rev 24(4):185–191CrossRefPubMedGoogle Scholar
  7. 7.
    Rosen DS, Macdonald RL, Huo D, Goldenberg FD, Novakovic RL, Frank JI, Rosengart AJ (2007) Intraventricular hemorrhage from ruptured aneurysm: clinical characteristics, complications, and outcomes in a large, prospective, multicenter study population. J Neurosurg 107(2):261–265CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiology and Nuclear MedicineRadboud University NijmegenNijmegenThe Netherlands
  2. 2.Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
  3. 3.Department of NeurosurgeryRadboud University NijmegenNijmegenThe Netherlands

Personalised recommendations