43 years old male patient had a ruptured Acomm artery aneurysm and came for coiling after 1.5 months.

the first coil was successfully placed, however there was stretching of the second coil hence it was removed along with the microcatheter.

Subsequently a fresh catheter was intriduced over a microwire. During the manipulation, contrast leakage was noted from the supraclinoid ICA

LICA injection AP and Lat views showing  contrast extravasation from terminal ICA. Note that the micocatheter has been pulled down now

Fortunately, the extravasation stopped spontaneously and rather quickly.

LICA injection after 3 minute of perforation, AP and Lat views, showing normal arteries with no e/o leakage anymore

Further coiling was abandoned. Intracranial blood circulation was normal and patient was hemodynamically stable.

DynaCT at end of procedure showing diffuse SAH. Dense contrast is seen in ambient cistern

NCCT head done next morning, patient still intubated, showing diffuse SAH, IVH, e/o residual contrast and significant hydrocephalus

NCCT head, post EVD, which was done immediately after seeing the preceding scan; patient was hemodynamically stable throughout

On day 3, patient was extubated and had bilateral lower limb paresis (2/5) as well as left upper limb paresis (4/5). He was irritable with intermittent comprehension and response. Gradually, over a period of 6-7 days, his neurology improved, however he still had significant left lower limb weakness nad the irritability persisted.

NCCT on day 7 showing near complete resolution of hemorrhage, hydrocephalus still persists

MRI on day 7, done as no focal lesion was seen on the preceding CT, shows hydrocephalus, left temporal region hematoma and underlying parenchymal signal change, but no other focal lesions.

EVD drainage was done for two days, during which time , he improved significantly.

After a total of 2 weeks, he was discharged in a stable condition, with only mild residual weakness in left ankle and slight behavioral change but otherwise with good mental score.