What Would You Do?

Case contributed by Felipe Albuquerque, MD

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A 56-year-old man presented with severe headache and sudden loss of consciousness. He was intubated in the emergency room where he was noted to flexion withdraw his upper extremities and extend his lower extremities. He demonstrated a dense upgaze palsy. Otherwise, the patient's medical history was unremarkable. Because of hydrocephalus detected on his computed tomography scan at admission (Figure 1), an external ventricular drain was inserted. He remained unchanged neurologically except for a reduction in his upgaze palsy. Cerebral angiography in a posteroanterior (Figure 2) and lateral projection (Figure 3) demonstrate a wide-necked basilar apex aneurysm measuring approximately 2 cm. Consultation with both the cerebrovascular and endovascular services was obtained.

Fig. 1	Fig. 2	Fig. 3
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What would you do?

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