A 20-year-male presented with sudden onset headache and loss of left eye vision. Fundus examination showed preretinal bleed with red glow [Figure la]. Plain computed tomography (CT) of the head showed left thin acute subdural hematoma (SDH) without any subarachnoid hemorrhage (SAH) [Figure 1b]. Digital subtraction angiography (DSA) [Figure lc and d] showed saccularinternal carotid artery (ICA) aneurysm measuring 7.2 × 4.3 mm with neck of 2 mm, just proximal to the origin of anterior choroidal artery. Patient underwent left pterional craniotomy, evacuation of acute SDH, and clipping of the aneurysm. Intraoperatively, there was no evidence of SAH and the aneurysm was seen to be arising from choroidal segment of ICA, directed posterolaterally. Postoperatively, vision in left eye gradually improved and was normal at 3-months follow-up.
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