Acute subdural hematoma from ruptured posterior communicating
20) Selective pupil sparing can, however, pose a diagnostic dilemma, because it can occur with subarachnoid compressions, particularly due to posterior communicating
artery aneurysm, affecting the inferior part of the 3rd nerve, a site that does not initially impact the pupillo-motor fibres located at its superior or medial margin.
In our clinical case, DSA showed occlusion of most of the basilar artery, with only minimal opacification of the vertebrobasilar confluence and basilar tip (the latter via posterior communicating
arteries on carotid injection).
Just under half of the aneurysms treated were posterior communicating artery aneurysms, not because we selected them to coil but because they seem to have a high incidence in our population.
Three other patients in our series haemorrhaged: one was transferred to us with a basilar tip aneurysm and bled the night she arrived in the intensive care unit; another had a dissection of the internal carotid artery while her posterior communicating artery aneurysm was being treated with Onyx, which we no longer use for aneurysms; and the third patient was referred to us with what had been considered an unclippable posterior communicating artery aneurysm, which we were able to coil with a satisfactory result of between 95% and 99% occlusion.
1) To treat our patients as expediently as possible, procedures in WFNS grade 1 or good grade 2 patients with posterior communicating artery aneurysms are done under local anaesthetic; we have done this in at least 12 cases, with good results.
1-6) Ruptured aneurysm of anterior and posterior communicating arteries in patients with agenesis of the ICA has been reported.
Bilateral hypoplasia of the internal carotid arteries associated with aneurysm of the right posterior communicating artery.
Both decreasing vision and blurred vision with unilateral headaches represent warning signs of an underlying aneurysm of the ophthalmic or posterior communicating
10] The posterior communicating
arteries allow for the connection of the anterior cerebral and posterior cerebral circulation.