Utilizing Digital Subtraction Angiography in the Diagnosis of Intracranial Aneurysms: A Case Report on Posterior Communicating Aneurysm

Introduction: Posterior communicating artery aneurysm (PComA) is one of the most common intracranial aneurysms. Most patients with this condition present to the ophthalmologist as their first point of call because of diplopia and blurring of vision associated with this condition. Intra-arterial digital subtraction angiography (DSA) is the gold standard imaging method for intracranial aneurysms. However, this imaging modality is invasive and associated with a lot of complications. In recent times, most clinicians prefer other minimally invasive imaging modalities which may sometimes produce reports that are incongruent to the clinical picture. Case Presentation: This case report presents a 38-year-old man who presented with symptoms and signs suggestive of pupil involving third nerve palsy most likely due to a posterior communicating aneurysm. Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) done were normal. However, diagnosis was confirmed with a DSA. The patient underwent a timely cerebral aneurysm coiling and his condition has improved since then. Conclusion: Although other imaging modalities such as Computed Tomography Angiography (CTA) and MRA may be able to confirm the diagnosis of intracranial aneurysms, DSA is still indispensable in the prompt diagnosis and management of patients. DSA should be considered whenever the clinical picture and the MRA or CTA reports are inconsistent.