Does Gyrus Rectus Bleed Always Means ACA Territory Aneurysm? Importance of Viewing CT Angiogram in Console
Vishal M Pishe1, Veda C Sawalgi2, Anu Kapoor2, Alugolu Rajesh1, M Vijaya Saradhi1
1 Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
2 Department of Radiology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
Correspondence Address:
Alugolu Rajesh
Additional Professor, Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad - 500 082, Telangana
India
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/0028-3886.383868
Sir,
Hematomas in the gyrus rectus are sine-qua-none of anterior cerebral artery (ACA) territory aneurysm/vascular malformation. We here report a case of a 40-year-old female patient with non-contrast computed tomography (NCCT) brain s/o right gyrus rectus bleed with an aneurysm arising from the contralateral paraclinoid internal carotid artery (ICA) aneurysm.
Gyrus rectus-The portion of the inferior frontal lobe immediately adjacent to the longitudinal fissure (and medial to the medial orbital gyrus and olfactory tract) is named the gyrus rectus or straight gyrus and is continuous with the superior frontal gyrus on the medial surface. A specific function for the straight gyrus has not yet been brought to light.
Common causes of hematoma in gyrus rectus documented in literature:
Ruptured aneurysm in ACA territory.Ruptured anterior ethmoidal artery aneurysm,[1]Ruptured superior hypophyseal artery aneurysm.Paraclinoid ICA aneurysms are defined as aneurysms originating from the clinoidal and ophthalmic segments of the ICA, and constitute between 5% and 14% of all intracranial aneurysms.[2]
Rupture aneurysm in the ICA territory generally causes subarachnoid hemorrhage (SAH) in a basal cistern, and in the ACA territory causes SAH in interhemispheric fissure or may present with gyrus rectus bleed. Ruptured aneurysms with a presentation of intracerebral hemorrhage (ICH) and/or intraventricular hemorrhage (IVH) are rarely reported.[3]
In this case, the patient had a left paraclinoid aneurysm, which grew medially causing compression over the optic track leading to vision loss and rupture causing contralateral (rt side) gyrus rectus bleeding [Figure 1].
The usual thought process is to evacuate the hematoma and create space for easy clipping. However, this would have created havoc as the aneurismal neck was beneath the clinoid of the contralateral side. Many times the neurosurgeons look at the films provided rather than analyzing the angiogram on the console while processing.
ConclusionThis case brings to light an unusual presentation of a ruptured paraclinoid ICA aneurysm and the need for careful evaluation of CT angiograms preferably in the console by the treating neurosurgeons.
Acknowledgment
The authors are pleased to acknowledge their invaluable support for the conduction of this study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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