A case of brain aneurysm diagnosed by transcranial color‐coded duplex sonography in the intensive care unit

Abstract

A 53-year-old male with no relevant clinical history presented coma with a Glasgow coma scale of 3/15 requiring orotracheal intubation and mechanical ventilation support at the emergency room. During transfer to the intensive care unit (ICU), a brain computed tomography (CT) and CT angiography was carried out. Because in our ICU we routinely use the point-of-care ultrasound as an extension of the physical exam, TCCS was performed at the admission before looking at the brain CT to assess the cause of neurological impairment. It showed the presence of a rounded hypoechoic lesion in the proximal portion of the left middle cerebral artery (LMCA) with a positive color Doppler signal within that measured 18mm 12mm (Figure 1). Brain CT and CT angiography (CTA) showed left intra-parenchymal bleeding involving the basal ganglia, as well as bilateral subarachnoid bleeding, with involvement of peritroncal cisterns, and a fusiform-type