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This was a 62-year-old gentleman who presented with

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a left hemiparesis, and a study was

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done to evaluate for a stroke.

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So this included the CTA as well as a non-contrast

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CT scan. Let me show you the CTA.

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So here we are looking at the aorta,

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the superior vessels, and for this case,

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since it's a left hemiparesis,

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we'll concentrate on the right side.

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So here's our right common carotid artery leading to the right

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internal carotid artery. It's a little bit tortuous.

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We're just following the right common carotid

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artery. The carotid sheath looks good.

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Here's the jugular vein, which is not opacified.

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So good technique showing just the arterial system.

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And as we follow the right internal carotid artery,

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we come into this contrast-enhancing mass which is

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medial to the right internal carotid artery.

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However,

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you can see that it becomes part and parcel of the

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right internal carotid artery as we

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come to the angle of the mandible.

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So this is indeed a pseudoaneurysm of the right

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internal carotid artery. Extremely large.

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Notice that it's in the prestyloid region of the

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carotid space and it extends to the skull base.

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So this accounted for the patient's source of an

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embolus which led intracranially. Let's continue.

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I'm going to change the window

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here to look at the brain.

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So now we're looking at the brain

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parenchyma at the cerebellum.

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And as you can see, as we come up further superiorly,

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there's a difference in the density of the right

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hemisphere compared to the left hemisphere with

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absence of good middle cerebral

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artery branching pattern.

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Here's the Sylvian fissure, normal vessels in the

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left Sylvian fissure, absence of vessels

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in the right Sylvian fissure.

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This is all infarcted brain tissue within the

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right middle cerebral artery distribution.

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The anterior cerebral arteries you

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actually see not bad over here,

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but you can see that there is diminished caliber to

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the right supraclinoid and cavernous carotid artery

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and then a clot within the middle cerebral artery.

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So this is an example of a patient who had

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a stroke associated with a right internal carotid

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artery pseudoaneurysm extending into the middle

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cerebral artery and leading to the frontal,

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temporal, and parietal lobes.