Tiny R PICA Aneurysm

nDifferential diagnosis

nSaccular aneurysm, Vessel loop/tortuosity (multiple projections), infundibulum (conical w vessel from apex), pseudoaneurysm (more distal), other T1 hyperintensity (pit lesion, lipoma)

nClinical

nWHOL- SAH 60-85%, CN palsy, sz, TIA

nF>M esp w multiple

nRupture risk increased:

nIrregular/multilobulated/pointed, length:neck >1.6, >10 mm, systemic factors (HTN, F, smoking)

nImaging

n90-95% from COW- 90% PCOM, ACOM, MCA trif, 10% PICA or BA

nWith SAH may see aneurysm as hypodense to SAH

nCTA very sensitive and specific for detection of SAH source in ruptured aneurysm

nPitfall: thrombosed aneurysm

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