Figure 1.

Mass effect exacerbation and delayed rupture.

Middle-aged patient with previously ruptured and partially coiled giant Left P-comm aneurysm. The prior hospitalization was complicated by symptomatic vasospasm resulting in ischemic stroke. The patient was lost to follow-up for many years and eventually presented to our clinic with worsened R hemiparesis and partial 3^rd cranial nerve palsy due to mass effect on the midbrain (a) from the recanalized giant aneurysm ((b) Pre-PED angiogram). PED embolization resulted in significant intra-aneurysmal contrast stagnation ((c) Post-PED angiogram). However, the patient presented to ED 5 months later with worse R hemiparesis and obtundation due to interval aneurysm growth and rupture (d).