In July, 2010, a 58-year-old woman was found comatose at home. She was intubated and transferred to our hospital. CT showed a subarachnoid haemorrhage from a large left carotid artery aneurysm with generalised brain swelling and hydrocephalus (figure A). Under general anaesthesia, angiography was done for definitive diagnosis and treatment planning. Contrast injection in the left internal carotid artery showed a slowly filling giant carotid-ophthalmic aneurysm (figure B). To elucidate the anatomy of the aneurysm, a rotational run was performed for reconstruction into three-dimensional images. During this rotational run, the aneurysm ruptured again from the previous rupture point at the top with immediate contrast extravasation into the subarachnoid space and the ventricles (figure C, see also webvideo). The internal carotid artery was subsequently endovascularly occluded with coils and a detachable balloon. The next day, brain death was confirmed and medical support was withdrawn.
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