This is an aneurysm of the right anterior cerebral artery (MCA). In October 1998 the aneurysm was successfully coiledb y percutaneous transluminal embolization with GDC coils (platinum spiral) after a subarachnoid hemorrhage Hunt & Hess I°.
In 03/2004 (5 1/2 years after embolization), the aneurysm became symptomatic, the patient developed epilepsy. Because of an increase in size and re-established blood circluation (prone to rupture and bleeding) the aneurysm was clipped and surgically removed. The lesions in the right temporal lobe shows a distinct homogeneous contrast enhancement and significant perifocal edema. Based solely on the pictures, without knowledge of the patient's history, one would also have to consider an intracranial abscess or meningeoma of the right sphenoid wing as possible cause. The contrast enhancement at the tumor border is atypical for a meningeoma, though. This is more typical of a cystic lesion. For an abscess, the homogeneity is atypical, also the patients lacks serological paramters of inflammation. Thus even without knowing the patient's history the most likely diagnosis is an aneurysm.
