{"id":2292,"date":"2025-02-08T15:18:25","date_gmt":"2025-02-08T20:18:25","guid":{"rendered":"https:\/\/wordpress.forensicpath.us\/?p=2292"},"modified":"2025-02-08T15:18:25","modified_gmt":"2025-02-08T20:18:25","slug":"pathology-cases-embolization-of-a-posterior-inferior-cerebellar-artery-pica-saccular-aneurysm","status":"publish","type":"post","link":"https:\/\/wordpress.forensicpath.us\/index.php\/2025\/02\/08\/pathology-cases-embolization-of-a-posterior-inferior-cerebellar-artery-pica-saccular-aneurysm\/","title":{"rendered":"Pathology cases — Embolization of a posterior inferior cerebellar artery (PICA) saccular aneurysm"},"content":{"rendered":"

A 35-year-old woman in a home for those with mental disabilities complained of a severe headache.\u00a0 She became unresponsive about 20 minutes later.\u00a0 She was taken to the hospital. CT showed basilar subarachnoid hemorrhage and further evaluation revealed a right PICA berry aneurysm.\u00a0 She underwent emergent embolization, but declined.\u00a0 An autopsy was ordered in the public interest because of an unexpected death in an institutionalized subject.<\/p>\n

At autopsy, she was noted to have the classic basilar SAH of the perforated berry aneurysm:<\/p>\n

\"\"<\/a><\/p>\n

There was also a fair amount of SAH over the left lobe of the cerebellum, and pretty obvious cerebral edema.\u00a0 The left lobe of the cerebellum was soft an necrotic:<\/p>\n

\"\"<\/a><\/p>\n

There was hemorrhage into the lateral ventricles, as well as the 3rd and 4th ventricles (yes this is cut fresh — deal with it):<\/p>\n

\"\"<\/a><\/p>\n

The Circle of Willis looked OK.\u00a0 The left PICA was dark red, extraordinarly firm, and distended.\u00a0 It had a football-shaped aneurysm:<\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a><\/p>\n

On histologic examination, it was full of black gritty material on H&E. I presume this is the embolization material.\u00a0 There was obvious layered fibrin and red cells surrounding the lumen:<\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a> \"\"<\/a> \"\"<\/a><\/p>\n

There was a bit of a dissection:<\/p>\n

\"\"<\/a><\/p>\n

Better seen on elastic stain:<\/p>\n

\"\"<\/a><\/p>\n

Usually the internal elastic lamina is ratty, but in this case, it just stopped:<\/p>\n

\"\"<\/a><\/p>\n

Here’s a couple of trichromes because they are pretty (and show the fibrin deposition nicely):<\/p>\n

\"\"<\/a> \"\"<\/a><\/p>\n

 <\/p>\n

As always, free for use with or without attribution, but attribution is appreciated.\u00a0 \u00a0If high resolution images are needed, contact me.<\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

A 35-year-old woman in a home for those with mental disabilities complained of a severe headache.\u00a0 She became unresponsive about…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[99,108,60],"tags":[59,67,56,28],"class_list":["post-2292","post","type-post","status-publish","format-standard","hentry","category-forensic-pathology","category-gross-pathology","category-photomicrographs","tag-autopsy","tag-brain","tag-histology","tag-pathology"],"_links":{"self":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2292","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/comments?post=2292"}],"version-history":[{"count":1,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2292\/revisions"}],"predecessor-version":[{"id":2308,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2292\/revisions\/2308"}],"wp:attachment":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/media?parent=2292"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/categories?post=2292"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/tags?post=2292"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}