Active Bleeding in Acute Subarachnoid Hemorrhage Observed by Multiphase Dynamic-Enhanced CT

A 56-year-old woman with Claassen grade 3 and WFNS grade 4. There was a large aneurysm in the MCA. We selected scans obtained at 5, 24.6, 33, and 52.6 seconds, and this case showed typical findings of nebulous enhancement around an aneurysm that was associated with extravasation (A, blank arrow). Hematomas larger than those seen on plain CT were observed during the surgical clipping procedure, and premature rupture occurred intraoperatively. A follow-up plain CT obtained the following day showed increased hematoma (B).

A 68-year-old woman with Claassen grade 4 and WFNS grade 5. A 9-mm aneurysm was identified in the right internal carotid posterior communicating portion by CTA. Contrast extravasation at the third ventricle was suspected on the basis of a CTP source image (A). Active bleeding from an aneurysm penetrating the third ventricle was confirmed with sagittal 20-mm-thickness-slab maximum-intensity-projection images (B), and a volume-rendered image was also useful for assessing the shape of the aneurysm (C, white arrow) and the extent of bleeding (C, arrowheads). Contrast medium in the aneurysm was washed out in the delayed phase, but extravasation was not.