Sylvian fissure subpial hematoma: a rare imaging presentation of a ruptured middle cerebral artery aneurysm

A 68-year-old female patient with a previously unruptured aneurysm in the left middle cerebral artery ([Figure 1]) presented with aphasia and severe headache. A computed tomography angiography (CTA) showed growth and new lobulation ([Figure 1]) associated with hemorrhages, including a large sylvian hematoma, probably in the subpial compartment ([Figure 2]). The findings suggested aneurysm rupture.