Subarachnoid hemorrhage with cerebral vein thrombosis and aneurysmal disease: a treatment conundrum. A case report.

Coexisting cerebral vein thrombosis and aneurysmal disease in the setting of acute subarachnoid hemorrhage is rare. We present the case of a 62 year-old woman presenting to our institution with an episode of collapse with a transient loss of consciousness with a 24 hour history of occipital headache. Imaging demonstrated extensive basal cisternal, intraventricular and cortical subarachnoid hemorrhage. Digital subtraction angiography and magnetic resonance imaging confirmed the presence of an aneurysm in the proximity of the right posterior communicating artery as well as thrombosis of the right anastomotic vein of Labbe. The patient underwent endovascular coil embolization to exclude the aneurysm and post-treatment anticoagulation. Despite a SAH rebleed with reversal of the anticoagulation, the patient subsequently made an unremarkable recovery with no neurological deficit.